鼓室内注射甲泼尼龙治疗糖尿病伴突发性耳聋

目的 评估鼓室内微管-微泵注射甲泼尼龙治疗糖尿病伴突发性耳聋的疗效.方法 选择2005年7月至2009年11月,秦皇岛市第一医院耳鼻喉科及内分泌科住院的2型糖尿病伴突发性耳聋患者113例,发病1～10 d,未接受治疗,分为激素注射治疗组和对照组,治疗组利用微管连接微泵,以10 μl/h将甲泼尼龙62.5 mg/ml连续泵入14 d后取出微管.两组同时全身用溶血栓、扩血管、神经营养及胰岛素降血糖治疗.于治疗后10、20 d进行纯音听阈测定并进行疗效评估.结果 治疗组的痊愈、显效、有效、无效的例数分别为6、19、12、11例,总有效率77.08%,优于对照组,差异有统计学意义.治疗前两组的纯音听阈均值(PTA)差异无统计学意义.治疗后10、20 d治疗组的PTA(dB)均低于对照组,差异均有统计学意义(66±21比76±14,50±16比59±12,均P＜0.05).两组中在治疗期间均无低血糖及糖尿病合并症出现,且预后与糖尿病的轻重度无明显相关性.结论 鼓室内微管-微泵注射甲泼尼龙治疗糖尿病伴突发性耳聋具有可行性.

Study of intratympanic methylprednisolone injections in diabetics with a sudden sensorineural hearing loss

Objective To evaluate the effects of intratympanic methylprednisolone injection by microcatheter in diabetics with a sudden hearing loss. Methods From July 2005 to November 2009, 113 diabetics with a sudden hearing loss within an onset of 10 days at our department were recruited. But they received no previous intervention and were assigned to treatment and control groups. Treatment group were made by microcatheter connected with an insulin bump. Microcatheter was placed in a round window niche and methylprednisolone (62. 5 mg/ml) infused at a rate of 10 microl/h for 14 days. Then the microcatheter was extracted. Simultaneously vasodilation, neurotrophy, thrombolysis and insulin hypoglycemia were administered in all patients. Pure tone test was conducted at Days 10 and 20 after intervention. Results The outcome was as follows: cure ( n = 6 ), efficacy ( n = 19 ), effect ( n = 12 ) and no effect ( n = 11 ) respectively. The overall effective rate of 77. 08% in the treatment group was superior to that in the control group. And there was statistical difference ( P ＜0. 05 ). Pure tone average (PTA) of two groups showed no statistical difference. After 10 days, the PTA values were (66 ± 21 ) versus (76 ± 14 ) dB in the treatment and control groups respectively. At Day 20, the values were (50 ± 16) and (59 ± 12) dB respectively. The improvement of pure tone threshold at Days 10 and 20 had significant statistical difference ( P ＜ 0. 05 ).Neither group had hypoglycemia or diabetic complications during treatment. And the prognosis had no obvious correlation with the severity of diabetes. Conclusion The therapy of intratympanic methylprednisolone injection by microcatheter connected with micropump is both effective and feasible in diabetics with a sudden hearing loss.