高压氧联合药物治疗突发性聋的疗效及影响因素分析

Analysis of the efficacy and influencing factors of hyperbaric oxygen therapy combined with drug therapy in sudden sensorineural hearing loss

摘要:

目的探讨高压氧联合药物治疗突发性聋的临床疗效及影响因素。方法采用前瞻性队列研究设计，使用REDCap软件建立突发性聋临床资料数据库，纳入2019年7月—2024年7月在北京市海淀医院治疗的突发性聋患者，分成单纯药物治疗组和高压氧联合药物治疗组，应用Logistic建立倾向评分模型，使用近邻匹配法进行匹配以保持两组患者治疗前基线一致。匹配后纳入统计的突发性聋患者共184例，单纯药物治疗组92例，高压氧联合药物治疗组92例。以疗效分级(痊愈、显效、有效、无效)为主要评估指标，并计算总有效率(痊愈、显效、有效率之和)，比较两组不同治疗方案的临床疗效，并进一步分析突发性聋不同听力曲线分型对疗效的影响。结果 ①单纯药物治疗组和高压氧联合药物治疗组治疗3周后随访总有效率分别为58.7%与60.9%，两组间疗效分级差异具有统计学意义(P＜0.05)，高压氧联合药物治疗组优于单纯药物治疗组。②不同听力曲线对疗效的影响：平坦型突发性聋患者57例，单纯药物治疗组和高压氧联合药物治疗组的总有效率分别为46.7%与81.5%，高压氧联合药物治疗组的疗效明显优于单纯药物治疗组(P＜0.05)；全聋型突发性聋患者95例，单纯药物治疗组和高压氧联合药物治疗组的总有效率分别为63.0%与51.0%，两组间疗效分级差异具有统计学意义(P＜0.05)，单纯药物治疗组临床疗效优于高压氧联合药物治疗组；低频下降型突发性聋患者13例，单纯药物治疗组和高压氧联合药物治疗组的总有效率分别为83.3%与57.1%，两组间疗效分级差异无统计学意义(P＞0.05)。高频下降型突发性聋患者19例，单纯药物治疗组和高压氧联合药物治疗组的总有效率分别为60.0%与55.6%，两组间疗效分级差异无统计学意义(P＞0.05)。结论与单纯药物治疗相比，高压氧联合药物治疗可提高突发性聋患者的临床疗效，尤其对平坦型突发性聋患者。对于全聋型、低频下降型、高频下降型突发性聋患者，高压氧联合药物治疗并不能提高其临床疗效。提示听力曲线分型可能是影响高压氧联合药物治疗效果的重要影响因素。

Abstract:

Objective To investigate the clinical efficacy and influencing factors of HBOT(hyperbaric oxygen therapy, HBOT) combined with medication in the treatment of SSNHL (sudden sensorineural hearing loss, SSNHL). Methods A prospective cohort study was conducted using REDCap software to establish a clinical database for SSNHL. Patients treated at Beijing Haidian hospital from July 2019 to July 2024 were enrolled and divided into two groups: a medication-only group and a combined HBOT-medication group. A logistic regression model was applied to establish propensity scores, and nearest neighbor matching was used to ensure baseline consistency before treatment in the two groups of patients. After matching, a total of 184 SSNHL patients were included in the analysis: 92 cases in the medication-only group and 92 cases in the combined HBOT-medication group. The efficacy grading cure, marked improvement, effective and ineffective was the primary outcome measure and calculate the total effective rate (sum of cure,marked imporovement,effective rate) to compare the clinical efficacy of different treatment regimens between the two groups. And further analysis was performed to assess the impact of different audiogram curve types on treatment outcomes. Results ①The total effective rates for the medication-only group and the combined HBOT-medication group were 58.7% and 60.9% respectively. The efficacy grading of the combined HBOT-medication group was significantly higher than that of the medication-only group (P<0.05). ②Impact of audiogram curve types on efficacy: Flat-type SSNHL (57 cases), the total effective rates for the medication-only and combined HBOT-medication were 46.7% and 81.5% respectively. The efficacy grading of the combined HBOT-medication group was significantly better than that of the medication-only group (P<0.05).Total deafness-type SSNHL (95 cases): The total effective rates for the medication-only and combined HBOT-medication groups were 63.0% and 51.0% respectively. The efficacy grading of the combined HBOT-medication group was significantly lower than that of the medication-only group (P<0.05).Low-frequency descending SSNHL (13 cases): The total effective rates for the medication-only group and the combined HBOT-medication group were 83.3% and 57.1% respectively. There was no statistically significant difference between the two groups (P>0.05).High-frequency descending SSNHL (19 cases): The total effective rates for the medication-only group and combined HBOT-medication group were 60.0% and 55.6% respectively. There was no statistically significant difference between the two groups (P>0.05). Conclusions Compared to the medication-only group, the combined HBOT-medication group can significantly improve the clinical efficacy of patients with SSNHL patients, particularly for those with flat-type hearing loss. However, the combined HBOT-medication does not enhance efficacy in total deafness-type, low-frequency descending, or high-frequency descending SSNHL. These findings suggest that audiogram curve type may be a critical factor influencing the effectiveness of the combined HBOT-medication.