鼓室置管灌注甲泼尼龙挽救性治疗突发性聋的疗效观察

目的探讨经鼓室置管灌注甲泼尼龙挽救性治疗突发性聋的疗效。方法选择常规治疗至少一个疗程(10天)无效的突发性聋患者,根据患者的意愿分成两组:治疗组19例(19耳),对照组20例(20耳),治疗组鼓室置管灌注甲泼尼龙20mg,每日1次,同时两组均继续常规治疗,但不再继续全身应用糖皮质激素;两组均继续治疗10天。治疗后第3个月比较两组的听力恢复情况。结果治疗组:痊愈2例,显效3例,有效4例,无效10例,总有效率47.4%,受损频率PTA平均改善14.0±16.0dB;对照组:显效1例,有效4例,无效15例,总有效率25.0%,受损频率PTA平均改善6.4±10.2dB,两组总有效率及平均PTA改善值比较,差异均无统计学意义(P=0.262,P=0.083)。治疗组发病至开始灌注的平均时间间隔50.2±55.4天;对照组发病至继续常规治疗的平均时间间隔:13.8±3.3天,治疗组长于对照组(P<0.05);治疗组内有效组和无效组的发病至开始灌注的平均时间间隔分别为23.5±14.6、13.8±3.3天,有效组短于无效组(P<0.05)。仅将发病至继续治疗的时间间隔≤60天的病例纳入分析,则实验组和对照组的受损频率平均PTA改善值分别是16.8和6.4dB,实验组优于对照组(P=0.029)。治疗组未发生永久性鼓膜穿孔、听力损失进一步加重等并发症。结论常规治疗无效后尽早选择鼓室置管灌注甲泼尼龙挽救性治疗突发性聋是安全的,可能会获得一定的有效率。     

鼓室置管灌注甲泼尼龙治疗突发性聋的听力疗效分析

目的观察鼓室置管灌注甲泼尼龙治疗突发性聋的听力疗效。方法回顾性分析2008年1月至2012年12月因常规治疗疗效欠佳行鼓室置管灌注甲泼尼龙的87例(87耳)突发性聋患者的听力疗效,均为单耳发病,其中全聋型67例,平坦型16例,低中频下降型2例,中高频下降型2例。发病至鼓室灌注的时间≤15天(A组)、16~30天(B组)和≥31天(C组)组分别为33、33和21例。结果 87例中总有效率为34.48%(30/87),A、B、C三组有效率分别66.67%(22/33),21.21%(7/33)和4.76%(1/21);三组平均PTA改善分别为18.53±13.54、5.92±15.18和3.69±7.00dB,A组疗效优于B组和C组(P<0.01)。不同听阈曲线类型突聋患者的有效率和PTA改善值之间差异无统计学意义,有效的30例中,1例为低中频下降型,其余29例均为全频听力下降(全聋型或平坦型),灌注前后0.25、0.5、1、2、4和8kHz平均听阈改善分别为35.17±18.15、35.38±15.90、31.28±19.74、21.31±17.34、14.97±16.00和13.80±16.35dB,低中频(0.25、0.5和1kHz)的听阈改善程度优于中高频(2、4和8kHz)(P<0.01)。结论常规治疗疗效不佳的突发性聋患者,尽早鼓室置管灌注甲泼尼龙可能会获得更好的听力恢复,且低中频的听力恢复效果优于中高频。     

鼓室注射糖皮质激素治疗伴持续耳鸣的难治性突发性聋疗效观察北大核心CSCD

目的比较鼓室注射甲泼尼龙琥珀酸钠与甲泼尼龙琥珀酸钠加利多卡因治疗伴持续耳鸣的难治性突发性聋的疗效。方法选择经常规全身用药治疗两周无效的伴持续耳鸣的难治性突发性聋患者84例84耳,随机分为治疗组和对照组,每组42例42耳。治疗组鼓室注射甲泼尼龙琥珀酸钠0.4ml和利多卡因注射液0.1ml,对照组注射甲泼尼龙琥珀酸钠0.4ml,每2天注药1次,共5次,治疗10天后比较两组患者耳鸣疗效及0.5~4kHz气导纯音平均听阈差异。结果治疗10天后两组气导平均听阈都较治疗前下降,治疗组由63.27±15.35dB HL下降至47.83±14.58dB HL,对照组由65.24±13.46dB HL下降至53.56±15.79dB HL,治疗组听力改善总有效率(61.90%,26/42)优于对照组(42.86%,18/42),差异有统计学意义(P<0.05);两组耳鸣程度均较治疗前减轻,治疗组有效率73.81%(31/42),对照组有效率52.38%(22/42),差异有统计学意义(P<0.05)。结论激素鼓室给药可以作为挽救性治疗应用于伴持续耳鸣的难治性突发性聋患者,且甲泼尼龙琥珀酸钠和利多卡因联合注射效果更显著。     

鼓膜置管鼓室充气治疗难治性梅尼埃病

目的探讨鼓膜置管灌注甲泼尼龙联合鼓室充气治疗难治性梅尼埃病的疗效。方法回顾性分析2011年8月—2012年8月在邯郸市第三医院住院治疗的12例单侧难治性梅尼病患者,在耳内镜下行鼓膜置管后,鼓室灌注甲泼尼龙联合鼓气耳镜进行鼓室充气治疗,观测患者眩晕、听力及耳鸣变化18-24个月。结果眩晕完全控制2例,基本控制7例,部分控制2例,无明显变化1例。听力0.5、1、2、3KHz气导平均听阈值提高10d BHL2例,提高5 d BHL3例,听力未改善6例,1例听力下降10d BHL。耳鸣消失者4例,明显减轻者6例,无明显变化者2例。结论应用鼓膜置管灌注甲泼尼龙联合鼓室充气治疗难治性梅尼埃病,短期可有效的控制眩晕,明显改善耳鸣,听力改善不明显。对于常规药物治疗无效的MD患者,选择鼓膜置管灌注甲泼尼龙联合鼓气球鼓室充气治疗难治性梅尼埃病是手术操作方便、安全、经济实用的有效治疗方法。     

鼓室置管灌注甲泼尼龙治疗难治性梅尼埃病的疗效观察

目的:探讨鼓室置管灌注甲泼尼龙治疗难治性梅尼埃病(MD)的临床疗效.方法:回顾性分析2008-01-2010-01在南京大学医学院附属鼓楼医院住院的10例难治性MD患者,行患侧鼓室内置管灌注甲泼尼龙的疗效.随访(15.4±5.4)个月.根据MD诊断依据及疗效评估分级标准判定眩晕、听力及活动能力的治疗效果,依据耳鸣致残量表分析耳鸣的治疗效果.结果:7例患者眩晕完全控制(A级),2例患者分别于灌注后9、11个月复发眩晕(B级),但发作频率、眩晕程度、持续时间较前明显减轻,1例患者于灌注后18个月复发,眩晕程度较前无明显减轻(C级).2例患者纯音听阈改善达A级,4例患者听力较前提高达B级,4例患者听力较前无明显变化(C级).10例患者活动能力完全改善(A级).灌注前患者THI得分为48.80±7.25,灌注后患者THI得分为41.90±7.78.无一例发生不可愈合的鼓膜穿孔.结论:鼓室置管灌注甲泼尼龙能有效控制MD患者的眩晕、耳鸣,改善部分患者的听力.对于常规饮食控制及药物治疗无效的MD患者,选择鼓室置管灌注甲泼尼龙是创伤小、安全、有效的治疗方法.     

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.     

鼓室灌注地塞米松治疗难治性突发性感音神经性聋临床分析

目的观察和比较鼓膜穿刺、鼓膜置管和圆窗置管微泵灌注地塞米松3种方法治疗难治性突发性感音神经性聋的疗效。方法55例常规方法治疗无效的突聋患者作为研究对象,其中圆窗置管微泵灌注用药治疗21例(置管组),每次2.5mg/0.5ml,维持1小时,每天两次,连续给药7天,总剂量35mg;鼓膜穿刺注药23例(穿刺组),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;鼓膜切开置管滴药11例(滴药组),首次剂量为0.5%地塞米松0.5ml,经通气管滴入鼓室,每天重复滴药2次(每次2.5mg),共7天,总剂量32.5mg。同期常规方法治疗无效的32例突聋患者,且拒绝鼓室用药者随访作为对照(对照组),比较各组听力恢复及并发症情况。4组治疗前听力无显著差异(P>0.05)。结果治疗完成后1月纯音测听检查:置管组、穿刺组和滴药组平均PTA分别提高9dB、8.6dB和1.7dB,前2组明显高于对照组1.4dB(P<0.05),置管组8例(38.1%)听力改善约15～56dB,无效13例;穿刺组8例(34.8%)听力改善约16～54dB,无效15例;滴药组1例(9.1%)听力改善约26dB,无效10例;对照组3例(9.4%)听力改善约15～36dB,无效29例。结论鼓室灌注地塞米松治疗难治性突聋方法安全有效,为用常规方法治疗无效的突聋患者,提供了再次治疗的机会。     

非手术序列化治疗单侧梅尼埃病48例

目的 探讨按听力分期进行非手术序列化治疗梅尼埃病的疗效。 方法 将单侧梅尼病患者48例按听力分期进行序列化治疗,Ⅰ期患者给予常规饮食控制、扩血管、营养神经及维生素药物治疗;Ⅱ期患者在常规治疗的基础上加用鼓室或耳后乳突骨膜下注射甲泼尼龙琥珀酸钠40 mg,1次/3 d,共3次,效果不佳时加用鼓膜置管及鼓室充气治疗;Ⅲ期患者常规治疗基础上加鼓膜置管后鼓室灌注甲泼尼龙琥珀酸钠40 mg, 1次/3 d,共3次,及应用鼓气球鼓室充气治疗;Ⅳ期患者在常规治疗基础上,加用庆大霉素4万U+0.5%碳酸氢钠0.5 mL鼓室注射1次/周,根据患者眩晕、听力变化、耳鸣情况决定注射次数,一般为2~3次,对于前庭功能低下患者进行前庭功能康复训练。观测48例患者眩晕、听力、活动能力及耳鸣变化18~24个月。 结果 眩晕完全控制12例,基本控制33例,部分控制3例,临床有效率为93%。听力改善为A级(改善>30 dB或各频率<20 dB)12例;B级(改善15~30 dB)6例;C级(改善0~14 dB)29例;D级(改善<0 dB)1例,听力下降10 dB。活动能力完全控制(A级)16例,基本控制(B级)32例,临床有效率为100%。各期耳鸣患者治疗后的耳鸣致残量表得分均低于治疗前,差异有统计学意义,P<0.05。 结论 按听力分级非手术序列化治疗梅尼埃病眩晕基本控制率高,活动能力明显改善,Ⅰ期和Ⅱ期患者听力改善明显,而各期耳鸣均有显著改善。该方法操作简单方便,不良反应少,手术风险避免,患者医疗费用降低。     

外周血单个核的细胞中糖皮质激素受体亚型与突发性聋预后的相关性

目的探讨外周血单个核的细胞(peripheral blood mononuclear cells,PBMCs)中糖皮质激素受体(glucocorticoid receptor,GR)亚型与突发性聋(sudden sensorineural hearing loss,SSNHL)预后的相关性以及糖皮质激素(glucocorticoid,GC)治疗对GR亚型表达的影响。方法选择27例应用GC治疗的SSNHL患者,根据听力预后分为有效组(PTA改善≥15dB)15例和无效组(PTA改善<15dB)12例,6例听力正常的鼻中隔偏曲志愿者为对照组。采用实时荧光定量PCR(quantitative real time PCR,QRT-PCR)检测各组对象外周血单个核细胞中的GRαmRNA、GRβmRNA和SRp30cmRNA的表达水平,并随访3个月以上。分析GRαmRNA、GRβmR-NA、SRp30cmRNA表达量和GRαmRNA/GRβmRNA比值在有效组、无效组和对照组间的差异以及SSNHL患者GC治疗前后的差异。结果 27例SSNHL患者中采用鼓室灌注GC治疗20例,静脉滴注GC治疗7例,治疗后有效15例,无效12例。有效组、无效组和对照组间PBMCs中GRαmRNA、GRβmRNA、SRp30cmRNA表达量和GRαmRNA/GRβmRNA比值比较差异无统计学意义。鼓室灌注GC治疗前后均留取血标本15例,其中有效8例,无效7例,有效组GC灌注后PBMCs中GRαmRNA和GRβmRNA表达量均较灌注前下降(ZGRα=-2.380,PGRα=0.017;ZGRβ=-2.521,PGRβ=0.012),而无效组GC灌注前后两者的表达差异无统计学意义(P>0.05)。结论本组SSNHL患者治疗前PBMCs中GRαmRNA、GRβmRNA、SRp30cmRNA表达量和GRαmRNA/GRβmRNA比值均与SSNHL的听力预后无相关性,尚不能用来预测SSNHL患者对GC的敏感性和听力预后;但鼓室灌注GC治疗后GRαmRNA和GRβmRNA表达量下调可能提示有较好的听力预后。     

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。     

早期联合鼓室注射糖皮质激素治疗突发性聋效果分析

目的　探讨早期联合鼓室注射糖皮质激素治疗突发性聋的疗效。方法　178例突发性聋患者纳入研究,中低频下降型44例,高频下降型50例,平坦型44例,全聋型40例,随机分为两组,其中联合鼓室注射组（CT组）82例,全身口服激素组（OP组）96例,CT组在口服醋酸泼尼松片治疗同时给予鼓室注射甲泼尼龙琥珀酸钠,治疗后 8周复查纯音纯音听力阈值。结果　中低频突发性聋患者中,CT组纯音听力阈及其提高值分别为（26.14±14.91）dB、（41.23±12.61）dB,而OP组为（37.91±13.98）dB、（30.00±13.30）dB,两者差异均具有统计学意义（P 均＜0.05）,而两组在高频型、平坦型及全聋型的差异无统计学意义（P 均＞0.05）,CT组纯音听力阈提高值为（26.52±14.03）dB,高于OP组（22.06±11.17）dB（t =2.361,P ＜0.05）;中低频突发性聋患者中,CT组治愈16 例（72.73%）,OP组治愈9例（40.91%）,差异有统计学意义（χ2=4.539,P＜0.05）,有效、显效及总有效的比较结果显示,两组中低频型突发性聋的治疗效果差异无明显统计学意义,而在高频型、平坦型及全聋型的比较上,CT组与OP组无论是在治愈、有效、显效还是在总有效上,两组差异均无明显统计学意义,CT组共治愈33例（40.24%）,优于OP组的25例（26.04%）（χ2=4.061,P＜0.05）,而两组在显效、有效及总有效率上的差异未见明显统计学意义。结论  中低频型突聋患者,早期联合鼓室注射糖皮质激素会获得更好听力恢复及疗效,对高频型、平坦型及全聋型突聋患者,推荐全身激素用药。     

突发性极重度聋与全聋的预后特点及差异

目的 研究突发性极重度聋和全聋的预后特点及差异.方法 回顾性研究复旦大学附属眼耳鼻喉科医院2007年6月至2008年9月收治的初始平均纯音听阈(pure tone average,PTA)>90 dB、随访完整的204例患者,分为全聋和极重度聋两组,对两组的预后进行比较,并对预后与年龄、并发症、发病-就诊时间进行相关性分析.结果 全聋组57例,极重度聋组147例,耳鸣、眩晕、耳闷三大伴随症状中,耳鸣的伴随率最高,两组均达90%以上,眩晕的伴随率全聋组为64.9%(37/57),极重度聋组为45.6%(67/147),两组间差异有统计学意义(x2=5.72,P=0.017).治疗后全聋组PTA下降(36.4±19.3)dB,极重度聋组下降(40.2±21. 3)dB,差异无统计学意义(t=1.165,P=0.245).两组痊愈者均为1周内接受治疗者,全聋组痊愈率为2.6%(1/38),极重度聋组为14.3%(14/98),两组间差异有统计学意义(Fisher确切概率法,P=0.045).全聋组治疗后PTA≤50 dB的患者占3.5%(2/57),极重度聋组达29.9%(44/147),两组间差异有统计学意义(x2=15.92,P=0.001).两组的预后与发病-就诊的时间有关(P值均为0.01),与年龄无关.结论 初始PTA>90 dB的突发性聋可分为极重度聋与全聋,两者预后有差异,需分开进行研究.     

The efficiency of intratympanic dexamethasone injection as a sequential treatment after initial systemic steroid therapy for sudden sensorineural hearing loss

The effect of intratympanic steroid injection is controversial as salvage or initial treatment option for sudden sensorineural hearing loss (SSNHL) and almost unknown if it is consecutively to use after initial systemic steroids. This study aimed to analyze the efficiency of intratympanic dexamethasone injection (ITDI) as a sequential treatment in the patients who failed initial systemic steroid treatments for SSNHL. Forty-six patients with SSNHL who did not respond to initial systemic steroids were prospectively included in the study. The patients were randomly classified into two groups; the ITDI group (21 patients) did not take four sequential ITDI within 2 weeks after systemic steroids, and the control group (25 patients) took any more medications. Hearing improvement was defined as a 10 dB or more decrease in the pure tone average (PTA) of the four-frequencies (0.5, 1, 2, and 3 kHz). Hearing improvement was observed in 10 (47.6%) of 21 ITDI patients and in 4 (16.0%) of 25 control patients (P = 0.027). An improvement of the mean PTA was 11.4 dB in the ITDI group and 1.7 dB in the control group (P = 0.004). The ITDI group showed significant hearing improvement at low frequency (500 Hz) than the control group. The patients with 70 or more dB in PTA before ITDI showed significant hearing improvement than the other patients with better PTAs (P = 0.038). The sequential ITDI, which is performed immediately after initial systemic steroid therapy, may be a simple, effective second-line treatment of choice for the patients who show poor response to initial treatments for SSNHL.     

Intratympanic dexamethasone injection for refractory sudden sensorineural hearing loss

OBJECTIVE: This case-control study aimed to analyze the effect of intratympanic dexamethasone injection (ITDI) as a treatment option for patients with sudden sensorineural hearing loss (SSNHL) who were refractory to classic oral steroid treatment. METHODS: Sixty-six patients with SSNHL, who were refractory to a course of oral steroid therapy, were included in this study. We prospectively treated consecutive 33 patients (34 ears) with ITDI from August 2002 to January 2004. We then retrospectively collected data from age- and sex-matched previous patients who did not take any more treatments after the initial regimen between March 2000 and July 2002. ITDI was performed in the supine position on four separate occasions over the course of 2 weeks. Hearing was assessed immediately before every injection and at 1 week after therapy. Hearing improvement was defined as more than 10 dB in pure-tone average (PTA). RESULTS: Hearing improvement was observed in 13 (39.4%) of 33 patients who underwent ITDI and in two (6.1%) of 33 patients in the control group. Five of 13 represented hearing improvement over than 20 dB in PTA, and 11 of 20 patients, who showed no improvement in PTA by ITDI, showed improvement over 10 dB in some frequencies. There were no definite prognostic factors between the patients who responded to ITDI and those who did not. CONCLUSION: ITDI may be a simple and effective therapy for patients with refractory SSNHL.     

Comparison between postauricular steroid injection and intratympanic steroid perfusion for refractory severe and profound sudden sensorineural hearing loss

BackgroundTo analyze the clinical efficacy of intratympanic steroid perfusion (ISP) and postauricular steroid injection (PSI) for refractory severe and profound sudden sensorineural hearing loss (SSNHL).MethodsSSNHL patients who failed a conventional treatment with severe to profound hearing loss [pure tone average (PTA, 0.25–8 kHz) > 60 dB] were treated with ISP or PSI plus antioxidant and neurotrophin for 10 consecutive days. Antioxidant and neurotrophin were administrated either intravenously and/or orally. All patients were assigned into the ISP group or the PSI group and followed up for more than three months. The changes in PTA, effective rate and side effects were analyzed in the two groups.ResultsSimilar hearing improvements and effective rates were observed in the two groups. However, a slightly better efficacy was observed in the PSI group compared to the ISP group. Patients with shorter intervals from onset to treatment had significantly more hearing improvements. The route of antioxidant and neurotrophin administration had no impact on treatment effects.ConclusionBoth ISP and PSI could be used as salvage treatments for refractory SSNHL. These salvage treatments should be started as soon as possible once SSNHL patients fail a conventional treatment.     

经咽鼓管鼓室途径注射地塞米松治疗突发性聋

目的 观察经咽鼓管鼓室注入地塞米松（简称PTIDI）治疗突发性聋（突聋）的疗效。方法 对18例常规方法治疗无效的突聋患者采用经咽鼓管鼓室径路注入地塞米松，首次剂量为5mg，此后，每天重复注药1次，每次5mg，共7次，总剂量35mg，用药期间密切观察记录听力改变，耳鸣和眩晕等情况。结果 18例患者于治疗完成后两周复查纯音测听。痊愈1例；显效5例，0．25-4kHz听阈平均提高50．2dB；有效1例，平均提高19dB；无效11例；有效率为38．9％（7／18）。结论 PTIDI治疗突聋疗效好，操作方便，避免全身用药可能产生的不良反应，为常规方法治疗无效的突聋患者提供了再次治疗的机会。     

Intratympanic steroid injection as a first-line therapy in uremia patients with sudden sensorineural hearing loss

Conclusions: ITSI as a first-line therapy in uremia patients with SSNHL offers a valid and safe treatment compared with intravenous systemic steroid treatment. A specific pathophysiology caused by possible sodium pump paralysis may be explained for uremia patients with SSNHL. Objective: To compare the efficacy of intratympanic steroid injection (ITSI) with that of systemic intravenous steroids as a first-line therapy in uremia patients with sudden sensorineural hearing loss (SSNHL). Materials and methods: A total of 23 consecutive uremia patients with SSNHL were enrolled in this study. Patients were divided into two groups: the ITSI group (n = 15) and the non-ITSI group (n = 8), in which patients received intravenous systemic steroid treatment. The two groups were homogeneous in all respects. Results: The hearing improvement and relative gain were statistically significant between the two groups. The value of hearing gain (ΔPTA = PTA _pre – PTA _post) in the ITSI group and the non-ITSI group was 24.6 ± 16.4dB and 8.4 ± 19.3dB. The value of relative gain (ΔPTA/PTA_pre) in the ITIS group and the non-ITSI group was 31.1 ± 22% and 9.4 ± 20.5%. In the ITSI group, 11 patients (73.3%) exhibited hearing recovery (ΔPTA > 10 dB).     

圆窗置管微泵灌注地塞米松治疗难治性突发性感音神经性聋

目的：观察圆窗内置管微泵灌注地塞米松治疗难治性突发性感音神经性聋（突聋）的疗效。方法：13例常规方法治疗4．8周无效的突聋患者，作外耳道皮瓣，圆窗置管经微泵灌注地塞米松，每次2．5mg，维持1h，每天2次，连续给药1周。用药期间观察记录听力改变、耳鸣和眩晕等情况。结果：13例患者治疗完成后1个月纯音测听检查：显效2例，0．25～4．00kHz听阈平均提高30．5dB；有效3例，平均提高16．7dB,无效8例，有效率38．5％（5／13）。结论：圆窗置管微泵灌注地塞米松治疗突聋的方法，能保证药物持续泵入和高浓度作用于内耳，优于鼓膜穿刺注药；操作稍复杂，但创伤小，耗费不高，为常规方法治疗无效的突聋患者提供了再次治疗获效的机会。     

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。     

Analysis of hearing improvement in patients with severe to profound sudden sensorineural hearing loss according to the level of pure tone hearing threshold

Patients with profound sudden sensorineural hearing loss (SSNHL) have a poor prognosis regardless of the type of treatment they receive. However, there is evidence that a proportion of patients with profound hearing loss may exhibit variable degrees of recovery, and this has yet to be specifically investigated. Here, we report a comparison of levels of hearing improvement in patients stratified according to their level of hearing threshold before treatment. We divided patients with severe to profound SSNHL into three groups: patients with an initial hearing threshold of 80–89?dB (n?=?18), 90–99?dB (n?=?16), and ≥100?dB (n?=?34). We compared improvements in hearing threshold at different frequencies and recovery rates between the three groups. No significant differences were observed in hearing threshold improvements at different frequencies in the three groups after treatment. However, in the group with an initial hearing threshold of ≥100?dB, significantly less complete and partial recoveries occurred compared to those in the 80–89 or 90–99?dB groups. Our results suggest that initial hearing threshold in excess of 100?dB alters the likelihood of satisfactory recovery in patients with severe to profound SSNHL.