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。

Efifcacy of early combination treatment with intratympanic glucocorticoid injection for sudden hearing loss

ABSTRACT]OBJECTIVETo investigate the therapeutic effect of early combination treatment with intratympanic glucocorticoid injection for sudden sensorineural hearing loss(SSNHL).METHODSTotal of 178 patients with diagnosis of SSNHL, including 44 with hearing loss at middle-low frequencies,50 at high frequencies,44 at all frequencies and 40 at total deafness, were randomly divided into combination treatment group (CT group) and systemic oral prednisone group (OP group).CT group (82 patients) received intratympanic administration of methylprednisolone and oral prednisone in tapering doses. Pure-tone threshold audiometry (PTA) was performed at week 8 after beginning of therapy. RESULTSIn middle-low frequencies, the final PTA and PTA improvement were 26.14±24.82 dB and 42.23±1.61 dB in CT group respectively, and were 37.91±13.98 dB and 30.00±13.30 dB in OP group respectively (both P<0.05). In high frequencies, all frequencies and total deafness SSNHL group, the differences of the final PTA and PTA improvement were not statistically significant in both groups. The PTA improvement in CT group for total deafness (26.52±14.03) dB was more than that of OP group (22.06±11.17)dB (t=2.361,P<0.05). In middle-low frequencies, the recovery rate was 72.73%(16 cases) in CT group, and 40.91% (9 cases) in OP group, the difference was significant (χ2=4.539,P<0.05), but not in apparent effective rate, effective rate and total effective rate. In high frequencies, all frequencies and total deafness, there were no significant differences in therapeutic effect. The recovery rate of total CT group (40.24%) was significantly increased compared with that of OP group (26.04%)(χ2=4.061,P<0.05), the differences of apparent effective rate, effective rate and total effective rate were not statistically significant in both groups.CONCLUSIONFor low-middle frequencies SSNHL, the early combination treatment with intratympanic glucocorticoid injection leads to higher hearing recovery and therapeutic effect compared with traditional oral prednisone. Systemic application should be applied for high frequencies, all frequencies and total deafness of SSNHL.