鼓室内注射地塞米松或甲泼尼龙治疗突发性聋的疗效观察

目的:观察鼓室内注射地塞米松或甲泼尼龙治疗突发性聋的疗效.方法:鼓膜穿刺注入地塞米松(5 g/L)或甲泼尼龙(40 g/L),每日注射1次,7 d为1个疗程.比较地塞米松和甲泼尼龙鼓室内注射前后4个频率(500、1000、2000、4000 Hz)气导纯音听阈均值(PTA),下降10 dB以上为有效.结果:47例突发性聋患者中,鼓室内注射地塞米松组(24例)前后PTA分别为(71.59±27.66)dB HL、(53.44±30.10)dB HL,经配对t检验差异有统计学意义(P<0.01),总有效率为67%.鼓室内注射甲泼尼龙组(23例)前后的PTA分别为(68.64±25.21)dB HL、(55.76±26.42)dB HL,经检验差异有统计学意义(P<0.01),总有效率为43%.经Fisher Exact检验,鼓室内注射地塞米松组和甲泼尼龙组的有效率差异无统计学意义(P>0.05).11例患者经过其他治疗(静脉类固醇药物、扩血管药物或高压氧治疗)后再应用鼓室内注射地塞米松治疗,仍然取得了较好的疗效(P<0.05);13例患者单纯应用鼓室内注射地塞米松治疗,PTA下降较明显,差异有统计学意义(P<0.05).17例患者经过其他治疗再应用鼓室内注射甲泼尼龙治疗,仍然取得了较好的疗效(P<0.01),6例患者单纯应用鼓室内注射甲泼尼龙治疗,PTA虽有下降,但差异无统计学意义(P>0.05).患者未出现鼓室内感染、鼓膜穿孔和听力下降.结论:鼓室内注射地塞米松或甲泼尼龙治疗突发性聋有效,两者之间的疗效比较无明显差异.推荐地塞米松作为鼓室内注射药物治疗突发性聋,并作为突发性聋的初始治疗.     

鼓室内与静脉注射糖皮质激素治疗伴糖耐量异常突发性聋疗效比较

目的比较糖皮质激素鼓室内注射与静脉给药对伴糖耐量异常的突发性聋患者的疗效。方法采用随机数字法,将50例伴糖耐量异常的初治单侧突发性聋患者随机平均分为鼓室注射组(地塞米松鼓室内注射)和静脉给药组(地塞米松静脉滴注),两组患者均同期接受相同的改善微循环及营养神经药物治疗。治疗期间每隔3天对患者进行纯音听阈测试,比较两组患者疗效。结果所有患者在治疗过程中平均听阈均逐渐下降,治疗后15天时静脉注射组患者平均听阈由治疗前的85.4±5.6dB HL下降至48.2±4.9dB HL,鼓室给药组由84.8±5.6dB HL下降至31.7±4.6dB HL,鼓室注射组患者总有效率为84.00%(21/95),较静脉给药组(68.00%,17/25)高(P<0.05)。结论采用糖皮质激素鼓室内注射对伴糖耐量异常的突发性聋患者的疗效较静脉给药的疗效更好。     

伴和不伴眩晕突聋患者疗效比较

目的观察伴和不伴眩晕突聋患者的疗效差异。方法选取2008～2010年收治并随诊1年后的突聋病例为研究对象,其中不伴眩晕突聋患者43例,伴眩晕突聋患者53例,两组患者均给予能量合剂及银杏叶提取物静脉滴注,1次/天;甲钴胺注射液0.5mg、地塞米松15mg加入5%葡萄糖250ml静脉滴注,1次/天,连用3天,若有效再用2天后停用激素;巴曲酶5BU加入0.9%氯化钠注射液静脉滴注,隔日一次,用3次,比较两组疗效。结果治疗前伴眩晕突聋组平均纯音听阈(58.43±19.31dB HL)与不伴眩晕组(58.64±20.81dB HL)差异无统计学意义(P>0.05),治疗后不伴眩晕突聋组的平均听阈(36.03±20.85dB HL)明显低于伴眩晕突聋组(40.12±22.21dB HL)(P<0.05)。伴眩晕突聋组总有效率为66.04%(35/53),不伴眩晕突聋组总有效率为55.81%(24/43),两组总有效率差异无统计学意义。随访一年,不伴眩晕突聋组和伴眩晕突聋组都有所好转,两组总好转率差异无统计学意义(P>0.05)。结论本组患者中,伴和不伴眩晕突聋者总效率差异无统计学意义,但治疗后伴眩晕突聋组听阈下降不如不伴眩晕组。     

鼓室内注射甲基强的松龙治疗难治性突聋的短期效果观察

目的 研究鼓室内注射甲基强的松龙治疗难治性突发性聋的临床疗效及其并发症.方法 选取2006年1月至2007年1月在中山大学附属第二医院耳鼻咽喉科住院治疗的突发性聋患者30例,所有患者均为常规全身用药治疗两周无效,再接受鼓室注射治疗.采用耳内镜辅助下行鼓室内注射甲基强的松龙,每周一次,共三次.治疗结束后一个月复查纯音测听及鼓膜情况,分别比较治疗前后250、500、1 000、2 000、4 000 Hz的听阈,疗效评价采用平均听阈下降10 dB为有效.结果 30名患者中,9名有效,有效率30%.治疗后500、1 000、2 000 Hz的平均听阈下降明显,有统计学意义(P＜0.01).无鼓膜穿孔及眩晕、听力下降的病例.结论 鼓室内注射激素可作为突发性聋的挽救性治疗方法 .     

鼓室内与静脉注射地塞米松治疗突发性聋疗效比较北大核心CSCD

目的探讨鼓室内与静脉注射激素治疗突发性聋的疗效。方法 121例单耳突发性聋患者进行前瞻性随机对照研究,分为治疗组(60例,地塞米松3~5mg鼓室内注射,1次/天,连续7d)和对照组(61例,地塞米松10mg/d静脉滴注,持续3~5d),并于治疗前及治疗后第1、4及8w行纯音听阈测试,比较两组治疗后的有效率;并分别比较两组低频下降型、高频下降型及全频下降型患者之间治疗后气导听力提高值及3型之间总体听力提高值。结果 (1)治疗后1周治疗组痊愈11例,显效15例,有效20例,总有效率76.7%(46/60);对照组痊愈9例,显效16例,有效18例,总有效率71.67%(43/60),两组间总有效率比较差异无统计学意义(P>0.05)。治疗后4w及8w,两组间总有效率比较差异均无统计学意义(P>0.05)。(2)治疗后8w治疗组低频下降型及高频下降型突聋患者听力提高值分别为26.35±4.77及17.04±9.60dB,对照组分别为20.60±3.60及14.08±7.43dB,治疗组疗效较对照组更优(P<0.05)。(3)两组合计治疗后低频下降型突发性聋患者听力提高值(23.48±4.52dB)明显优于高频下降型(15.39±8.97dB)及全频下降型(10.73±7.11dB)(P<0.01)。结论连续1周每日鼓室内注射地塞米松治疗突发性聋是一种安全有效的方法,对于低频及高频下降型突发性聋患者,其较静脉给药疗效更优,值得临床推广。     

鼓室注射糖皮质激素治疗高压氧不耐受的难治性突发性聋北大核心CSCD

目的探讨常规药物治疗效果不佳的难治性突发性聋患者在高压氧不耐受情况下鼓室注射糖皮质激素的临床疗效。方法经常规药物治疗十天以上效果不佳的突发性聋患者,按高压氧耐受与否,分为鼓室注射组28例(28耳)与高压氧组34例(34耳);鼓室注射组年龄31~81岁,平均52.54±10.90岁,鼓室内注射甲泼尼龙20mg,隔日一次,连续五次;高压氧组年龄41~68岁,平均54.09±8.24岁,每日行高压氧治疗一次,共10天;观察两组治疗前后的听阈变化及有效率。结果鼓室注射组治疗前0.25~8kHz平均听阈为65.54±18.17dB HL,治疗后平均听阈下降18.54±13.87dB,痊愈2例,显效5例,有效4例,无效17例,总有效11例(11耳),总有效率为39.29%(11/28);对照组治疗前平均听阈为67.21±18.36dB HL,治疗后平均听阈下降17.26±12.77dB,痊愈4例,显效5例,有效4例,无效21例,总有效13例(13耳),总有效率为38.24%(13/34),两组总有效率比较差异无统计学意义(P>0.05)。结论鼓室注射激素和高压氧治疗均可改善难治性突聋患者的听力,鼓室注射尤其适合不耐受高压氧治疗的患者。     

糖皮质激素鼓室内注射治疗突发性聋伴高血压病的临床观察

目的 通过与静脉注射糖皮质激素比较,评估鼓室注射糖皮质激素对突发性聋伴高血压病的治疗效果.方法 选取突发性聋伴高血压病患者60例,分为2组:①鼓室注射组(治疗组):29例患者,鼓室内注射地塞米松,隔日一次l0mg,连续5次;②静脉注射组(对照组):31例患者,静脉注射地塞米松,每日一次20mg,连续3天,然后每3天减半至第9天停药.在治疗后10天和60天分别进行听力学评估,观察纯音听阈均值(PTA)的变化.结果 ①疗程结束时,治疗组和对照组PTA分别提高(21.93±12.91) dB和(17.84±11.75) dB;差异无统计学意义(P=0.20);②疗程结束后7周,治疗组和对照组PTA分别提高(27.48±13.96) dB和(18.45±11.60) dB,差异有统计学意义(P=0.008).③疗程结束后7周,治疗组和对照组PTA提高15 dB的分别有22例(75.8％)和15例(48.3％),差异有统计学意义(P=0.029);④治疗过程中,对照组有6例血压升高,而治疗组无一例出现血压升高.结论 糖皮质激素鼓室内注射治疗伴发高血压病的突发性聋具有良好的疗效和安全性.     

早期行鼓室内甲强龙注射或高压氧对全聋型突发性聋患者的疗效观察

目的探讨早期行鼓室内甲强龙注射或高压氧对全聋型突发性聋患者的疗效。方法将2017年8月~2019年4月期间确诊的全聋型突发性聋患者102例(102耳)随机分为三组,各组34例,根据治疗方案不同分为三组基础治疗组(金纳多+巴曲酶+泼尼松片)、高压氧组(基础治疗加高压氧治疗)、鼓室内激素注射组(基础治疗加鼓室内甲强龙注射)。三组均治疗一个月,比较三组的治疗效果。结果102例中,94例(94耳)完成所需的治疗和随访。鼓室内激素注射组(62.5%,20/32)和高压氧组(65.5%,19/29)有效率均明显高于基础治疗组(33.3%,11/33),差异有统计学意义(均为P<0.05);高压氧组与鼓室内激素注射组有效率差异无统计学意义(P>0.05)。治疗后高压氧组(64±23.1 dB HL)、鼓室内激素注射组(66±26.5 dB HL)纯音平均听阈低于基础治疗组(79±20.6 dB HL),差异有统计学意义(均为P<0.05),高压氧组与鼓室内激素注射组治疗后纯音平均听阈比较,差异无统计学意义(P>0.05)。结论全聋型突发性聋患者早期行鼓室内甲强龙注射或高压氧治疗,能提高疗效。     

鼓室注射地塞米松治疗突发性聋

目的：报告鼓室注射地塞米松治疗突发性感音神经性聋（突聋）的疗效。方法：对1例双耳突聋患者行鼓室注射地塞米松治疗。结果：双耳纯音气导听阈下降40dB以上。结论：鼓室注射地塞米松是治疗突聋的有效方法。     

鼓室联合静脉地塞米松+传统方法治疗突发性耳聋的近期疗效

目的 观察鼓室地塞米松灌注(ITD)联合静脉地塞米松+传统方法治疗突发性耳聋(SSNHL)的近期疗效,比较此方法与“单纯静脉地塞米松+传统治疗”方法的差别.方法 将住院患者按入院时间分为治疗A组(11例,11耳)、治疗B组(11例,13耳)、对照A组(11例,11耳)、对照B组(11例,13耳).签署同意书后,对照A组、B组给予静脉输地塞米松磷酸钠注射液、高氧液(A组)/高压氧(B组)、活血化瘀类中药、维生素类等药物;治疗A组、B组在此基础上给予ITD.于ITD结束和一个疗程(10 d)结束当天或第2天复查纯音测听,记录检查结果并计算500 Hz、1 kHz、2kHz、4 kHz的纯音气导平均听阈(PTA),比较4个组治疗前后PTA及250 Hz、8 kHz纯音听阈的差异.以提高15dB HL为有效,比较各组有效率的差异,并观察ITD的并发症.结果 治疗A组治疗后PTA提高(25.73±6.07) dB HL(P ＜0.01);治疗B组治疗后PTA提高(24.15±4.86)dB HL(P ＜0.01);对照A组治疗后PTA提高(16.36±3.36) dB HL(P ＜0.01);对照B组治疗后PTA提高(19.46±6.01)dB HL(P＜0.01).4个组治疗前后PTA差异均有统计学意义.除治疗A组外,各组治疗前后250 Hz改善的差异均有统计学意义.除治疗B组外,各组治疗前后8 kHz改善差异均无统计学意义.对于250Hz和8kHz,治疗A组与对照A组、治疗B组与对照B组之间听力改善差异均无统计学意义(P＞0.05).治疗A组有效9耳(81.8％),对照A组有效4耳(36.4％),两组有效率差异具有统计学意义(P＜0.05);治疗B组有效8耳(61.5％),对照B组有效5耳(38.5％),两组有效率差异无统计学意义(P＞0.05).治疗A组、B组22例患者穿刺耳均未见鼓室内感染,无效但听力未见继续下降1例.注射过程中出现一过性眩晕5例、轻微水肿2例,余20例均未出现全身不良反应.结论 ITD联合静脉地塞米松及传统的活血化瘀类、维生素类、高氧液或高压氧等治疗突发性耳聋方法有效,疗效可能比单纯运用全身地塞米松及传统的活血化瘀类、维生素类、高氧液或高压氧等更为明显,但并不是对每个患者都有效;安全易行,患者依从性高;低频听力提高较高频听力显著.两种治疗方法对低频听力的改善无明显区别.     

Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy

OBJECTIVE: Intratympanic steroids are increasingly used in the treatment of inner ear disorders, especially in patients with sudden sensorineural hearing loss (SNHL) who have failed systemic therapy. We reviewed our experience with intratympanic steroids in the treatment of patients with sudden SNHL to determine overall success, morbidity, and prognostic factors. HYPOTHESIS: Intratympanic steroids have minimal morbidity and the potential to have a positive effect on hearing recovery in patients with sudden SNHL who have failed systemic therapy. STUDY DESIGN: The authors conducted a retrospective review. METHODS: Patients presenting with sudden SNHL defined as a rapid decline in hearing over 3 days or less affecting 3 or more frequencies by 30 dB or greater who underwent intratympanic steroids therapy (24 mg/mL dexamethasone) were reviewed. Excluded were patients with Meniere disease, retrocochlear disease, autoimmune HL, trauma, fluctuating HL, radiation-induced HL, noise-induced HL, or any other identifiable etiology for sudden HL. Patients who showed signs of fluctuation of hearing after injection were excluded. Pretreatment and posttreatment audiometric evaluations including pure-tone average (PTA) and speech reception threshold (SRT) were analyzed. Patient variables as they related to recovery were studied and included patient age, time to onset of therapy, status of the contralateral ear, presence of diabetes, severity of HL, and presence of associated symptoms (tinnitus, vertigo). A 20-dB gain in PTA or a 20% improvement in SDS was considered significant. RESULTS:: Forty patients fit the criteria for inclusion in the study. The mean age of the patients was 54.8 years with a range from 17 to 84 years of age. Overall, 40% (n = 16) showed any improvement in PTA or SDS. Fourteen (35%) men and 26 (65%) women were included. Using the criteria of 20-dB improvement in PTA or 20% improvement in SDS for success, 27.5% (n = 11) showed improvement. The mean number of days from onset of symptoms to intratympanic therapy was 40 days with a range of 7 days to 310 days. A statistically significant difference was noted in those patients who received earlier injection (P = .0008, rank sum test). No patient receiving intratympanic dexamethasone after 36 days recovered hearing using 20-dB PTA decrease or a 20% increase in discrimination as criteria for recovery. Twelve percent (n = 5) of patients in the study had diabetes with 20% recovering after intratympanic dexamethasone (not significantly different from nondiabetics at 28.6%, Fisher exact test, P = 1.0). Comparison to other studies that used differing steroid type, concentration, dosing schedule, inclusion criteria, and criteria for success revealed, in many instances, a similar overall recovery rate. CONCLUSIONS: Difficulty in proving efficacy of a single modality is present in all studies on SNHL secondary to multiple treatment protocols, variable rates of recovery, and a high rate of spontaneous recovery. Forty percent of patients showed some improvement in SDS or PTA after treatment failure. When criteria of 20-dB PTA or 20% is considered to define improvement, the recovery rate was 27.5%. Modest improvement is seen with the current protocol of a single intratympanic steroid injection of 24 mg/mL dexamethasone in patients who failed systemic therapy. Dramatic hearing recovery in treatment failures was rarely encountered. No patient showed significant benefit from intratympanic steroids after 36 days when using this protocol for idiopathic sudden SNHL. If patients injected after 6 weeks are excluded from the study, the improvement rate increases from 26.9% to 39.3%. Earlier intratympanic injection had a significant impact on hearing recovery, although with any therapeutic intervention for sudden SNHL, early success may be attributed to natural history. If we further exclude seven patients treated with intratympanic steroids within 2 weeks of the onset of symptoms (i.e., study only those patients treated with intratympanic dexamethasone between 2 and 6 weeks after onset of symptoms), still, 26% improved by 20 dB or 20% SDS. The recovery rates after initial systemic failure are higher than would be expected in this treatment failure group given our control group (9.1%) and literature review. These findings indicate a positive effect from steroid perfusion in this patient population.     

Intratympanic dexamethasone and hyaluronic acid in patients with low-frequency and Ménière's-associated sudden sensorineural hearing loss.

BACKGROUND: Steroids are widely used for the treatment of cochleovestibular disorders. Direct steroid application in the middle ear cavity, when combined with a round window membrane permeability-modulating substance, increases the level of the steroid reaching the target cells. We measured hearing in patients with idiopathic isolated low-frequency sensorineural hearing loss and in patients with sudden sensorineural hearing loss and a history of Ménière's disease. Contradictory reports about effectiveness of intratympanic steroid therapy on vertigo control and hearing improvement in patients with Ménière's disease exist in the literature. METHODS: Eighteen patients with isolated low-frequency idiopathic sudden sensorineural hearing loss and 21 patients with sudden sensorineural hearing loss and a history of Ménière's disease were prospectively evaluated. The acute effect of the intratympanic application of dexamethasone with hyaluronic acid on hearing outcome after failure of an initial standard treatment with intravenous steroid and vasoactive substances was assessed. Evaluation was based on standard pure-tone audiometry findings. RESULTS: After intratympanic injection of dexamethasone and hyaluronic acid, 14 of the 18 patients with isolated low-frequency sensorineural hearing loss showed a significant improvement in hearing. After intratympanic therapy, 15 patients with a previous history of Ménière's disease and idiopathic isolated low-frequency sensorineural hearing loss showed an improvement in hearing on pure-tone audiometry, four remained unchanged, and two showed a tendency toward a slight deterioration. CONCLUSION: Intratympanic combined dexamethasone/hyaluronic acid application provides a reliable and safe therapeutic option for improvement of hearing in patients with isolated low-frequency idiopathic sudden sensorineural hearing loss or sensorineural hearing loss resulting from Ménière's disease who have failed intravenous steroid and vasoactive treatments.     

Dexametasona intratimpánica como opción terapéutica en hipoacusia neurosensorial súbita

Introduction and objectives: The administration of systemic corticosteroids has demonstrated effectiveness on the treatment of idiopathic sudden sensorineural hearing loss. However, its systemic toxicity and subsequent difficulty for its justification in some patients have led to it being applied intratympanically. The main aim of this study is to determine the effectiveness of intratympanic dexamethasone in these patients. In addition we evaluate the relationship between the prognosis of this condition and the magnitude of initial hearing loss, the presence of vertigo or delay in the beginning of therapy.Methods: We performed a retrospective case study of 18 patients. All of them were treated with intratympanic dexamethasone (4 mg/ml), administered weekly for 3 weeks. The follow-up was 1 month at least. The therapeutic success was arbitrarily defi ned to be a mean improvement of 25 dB or greater.Results: 72.2 % of the population recovered hearing successfully. The mean auditory threshold prior to treatment was 91 ± 25 dB versus 51 ± 35 dB after the end of it (p < 0.0005). In addition, we observed that the initial severity of the hearing loss, the presence of vertigo and the delay in starting therapy cannot be considered as indicators of poor auditory prognosis.Conclusions: Intratympanic dexamethasone appears to be an effective therapeutic option for patients with sudden onset sensorineural hearing loss who, for whatever reason, cannot be treated with systemic steroids. Nonetheless, randomized controlled trials should be instituted to improve levels of scientific evidence.     

Intratympanic corticosteroids for sudden idiopathic sensorineural hearing loss.

OBJECTIVE: To determine whether instillation of intratympanic steroids is effective in the treatment of sudden idiopathic sensorineural hearing loss. METHODS: A retrospective chart review of all patients who underwent intratympanic steroid treatment (methylprednisolone and/or dexamethasone) between 1996 and 2002 at a tertiary care university otology clinic. Thirty-three patients were identified, of which 26 met inclusion criteria for having an idiopathic hearing loss. Pretreatment and posttreatment pure-tone audiograms and speech discrimination scores were compared. RESULTS: Overall, there was a 27.2 +/- 5.7 dB improvement in the pure-tone thresholds and a 25.4 +/- 6.2% improvement in speech discrimination scores. Those treated within 10 days of onset had a statistically significant better outcome than those treated after 10 days. No adverse reactions or complications were reported. CONCLUSION: Instillation of intratympanic steroids represents a safe and potentially effective treatment of sudden idiopathic sensorineural hearing loss.     

鼓室内注射治疗难治性突发性耳聋52例

目的 探讨鼓室内注射激素作为难治性突发性耳聋的补救治疗措施的临床疗效。方法 重度及极重度突发性耳聋患者96例,接受常规治疗加全身应用激素2周效果不佳,其中52例接受鼓室注射激素,另外44例拒绝鼓室内注射而继续口服药物治疗。纯音测听法(PTA)检测患者补救治疗前后听力,比较气导听阈(0.5、1.0、2.0、4.0 kHz四个频率气导之平均值),分析两组患者补救治疗前后听力结果。结果 鼓室注射组听力提高10 dB以上的患者16例,有效率为30.8%;而对照组仅有3例,有效率为6.8%。两组听力改善值之间的差异有统计学意义(P<0.01)。结论 鼓室内激素注射对突发性耳聋常规治疗无效的患者有良好的疗效,可以作为一种补救治疗措施。     

Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy

The purpose of this prospective study was to test whether intratympanic application of dexamethasone/hyaluronic acid improves hearing outcome in patients with pantonal idiopathic sudden sensorineural hearing loss (ISSHL), in patients with sudden deafness or sudden profound SHL and in patients with predominant high-frequency ISSHL who are refractory to intravenous steroid and vasoactive therapy. The study took place in an academic tertiary referral hospital involving 21 patients with pantonal ISSHL, 10 patients with sudden deafness or sudden profound SHL and 9 patients with a high-frequency ISSHL. Intratympanic dexamethasone/hyaluronic acid was administered in the affected ear. Hearing was evaluated by means of standard pure-tone audiometry. The differences between pure-tone hearing thresholds by air conduction before intravenous therapy and before the beginning of the intratympanic therapy, as well as before and after intratympanic therapy, were calculated. Statistical analysis was performed by means of the Wilcoxons test for paired samples. Intratympanic injection of dexamethasone/hyaluronic acid results in a significant global (pantonal) improvement in hearing in patients with pantonal ISSHL. It also effects improvement in hearing at selected frequencies (namely at 1.5 and 3 kHz) in patients with a predominant high-frequency ISSHL and at selected frequencies (namely at 0.5, 0.75 and 1 kHz) in patients with sudden deafness or sudden profound SHL. Neither systemic nor local side effects were observed. Intratympanic administration of dexamethasone/hyaluronic acid provides a safe and efficacious therapeutic option for the treatment of patients with pantonal and high-frequency ISSHL who dont respond to intravenous steroid and vasoactive therapy.Abbreviations dB HL decibel hearing level - (IS)SHL (idiopathic sudden) sensorineural hearing loss - kHz kiloHertz     

地塞米松鼓室内注射治疗难治性突发性感音神经性聋

目的：观察鼓室内地塞米松注射（IDI）治疗难治性突发性感音神经性聋（突聋）的疗效。方法：25例常规方法治疗无效的突聋患者采用IDI，首次剂量为2．5mg，此后，每2天重复注药1次（每次2．5mg），共4次，总剂量10mg。用药期间密切观察记录听力改变、耳鸣和眩晕等情况。结果：2例失访，23例治疗完成后1个月纯音测听检查：显效3例，0．25～4．00kHz听阈平均提高48．5dB；有效5例，平均提高18．5dB；无效15例；有效率为34．8％（8／23）。结论：IDI治疗突聋，能保证药物高浓度作用于内耳，避免全身用药可能产生的不良反应；治疗操作不复杂，创伤性小，为常规方法治疗无效的突聋患者提供了再次治疗的机会。     

鼓室注射甲泼尼龙琥珀酸钠治疗突聋

目的观察甲泼尼龙琥珀酸钠鼓室途径给药治疗系统疗法无效的突发性聋患者的疗效，探索突聋预后影响因素。方法经全身系统治疗无效的突聋患者42例，采用鼓膜穿刺法注入40mg／ml甲泼尼龙琥珀酸钠0．3-0．5ml，隔日1次，连续应用3-7次。比较鼓室注射前后0．5-4kHz气导纯音听阈均值差异，分析相关因素对预后的影响。结果鼓室内注射疗法治疗前后，全组病例气导平均听阂分别为（66．48±17．03）dBHL和（49．9±20．93）dBHL，治疗前后平均听阈差异明显（P〈0．01）；其中19例有效，总有效率为45．2％。听力损失程度、伴有眩晕与否及发病后鼓室注射疗法开始时间等因素对预后影响明显。结论甲泼尼龙琥珀酸钠鼓室注射疗法治疗突聋安全有效，可以作为经全身系统治疗无效突聋患者的后续治疗选择。一般治疗无效者，应尽早采用本疗法。     

Prognostic factors of profound idiopathic sudden sensorineural hearing loss

Profound idiopathic sudden sensorineural hearing loss is thought to have a poor prognosis, but few studies have focused on this condition. We aimed to assess the impact of patient factors, audiologic parameters, and salvage intratympanic steroid injection therapy on the prognosis of profound idiopathic sudden sensorineural hearing loss. The demographic, clinical, and audiologic data, degree of hearing recovery, and efficacy of intratympanic steroid injection therapy in 576 patients with profound idiopathic sudden sensorineural hearing loss (mean age 56.2 ± 14.9 years) who had been admitted at four tertiary referral centers between 2000 and 2011 were retrospectively reviewed. The mean hearing level at the initial presentation was 108.1 ± 9.5 dB. Many patients experienced vertigo (52.1 %) and tinnitus (77.4 %). At the 2-month follow-up, 172 (29.8 %) patients showed some degree of hearing recovery, but only 21 (3.6 %) patients recovered normal hearing. Further, the 116 patients who had received salvage intratympanic steroid injections showed a better audiologic outcome (improvement, 26.1 ± 24.3 vs. 15.7 ± 22.1 dB; P = 0.000) than those who had not (n = 429). In conclusion, a higher degree of hearing loss at the initial presentation indicates a poorer prognosis. Salvage intratympanic steroid injection therapy may improve the hearing of patients with profound idiopathic sudden sensorineural hearing loss after the failure of systemic steroid therapy.     

地塞米松不同给药方式治疗突发性聋的疗效观察

目的:探讨地塞米松不同给药方式治疗突发性聋的疗效。方法:回顾性分析100例突发性聋患者,将其分为2组,A组(50例)全身静脉注射地塞米松,B组(50例)鼓室内注射地塞米松。结果:A、B组治疗总有效率分别为66%、68%,差异无统计学意义(P>0.05)。结论:不管全身方式给药,还是局部鼓室给药,使用地塞米松治疗突发性聋的疗效相仿。