两种激素鼓室内灌注治疗主观性耳鸣的近期临床观察

目的:探讨鼓室内灌注醋酸泼尼松龙和地塞米松治疗主观性耳鸣的疗效。方法:选择病史在1个月以上已接受过口服药物治疗的主观性耳鸣患者73例(78耳),醋酸泼尼松龙组鼓室灌注醋酸泼尼松龙注射液,地塞米松组鼓室灌注地塞米松注射液,对照组口服卡马西平。3组均同时口服甲磺酸倍他司汀片、维生素B1片和甲钴胺片。所有患者在治疗前、治疗结束时再次行纯音测听和耳鸣匹配测试,随访6个月。结果:73例患者(78耳)均完成全部的治疗及随访。治疗结束时,醋酸泼尼松龙组、地塞米松组、对照组耳鸣治疗有效率分别为48.6%、33.3%、44.0%;6个月后3组的耳鸣控制率分别是45.7%、27.8%、36.0%。结论:鼓室内应用激素能改善主观性耳鸣,对口服药物无效的患者可以选用鼓室灌注类固醇激素。     

鼓室内注射激素在治疗突发性耳聋中的应用及疗效观察

目的 探讨鼓室内注射激素在治疗突发性耳聋过程中的应用及疗效。方法 将突发性聋70例70耳患者分为两组：治疗组40例(40耳)、对照组30例(30耳),治疗组采取鼓室穿刺注射甲泼尼龙+利多卡因,3次/周,2周为1个疗程,治疗前、后行听力学检查(纯音测听、耳鸣匹配等),评价疗效。结果 治疗组40例(40耳),耳鸣改善22耳,受损频率平均听力提高痊愈+显效8耳,有效19耳,无效13耳,有效率67.5%;对照组30例(30耳)均无明显改善。两组疗效相比,差异有统计学意义(P<0．01),患者未出现鼓室内感染、鼓膜穿孔和听力下降等并发症。结论 鼓室内注射甲泼尼龙+利多卡因治疗突发性耳聋确实有效,可推荐应用。     

主观性耳鸣的分期治疗探讨及预后影响因素分析

目的了解主观性耳鸣分期的必要性并分析影响预后的因素。方法将119例(127耳)主观性耳鸣患者随机分为治疗组和对照组,治疗组60例(65耳),根据病程分为急性期24例(25耳)、亚急性期16例(18耳)和慢性期20例(22耳);根据耳鸣匹配检查分为低中频25例(29耳)和高频35例(36耳),低中频耳鸣者采用改善微循环+激素治疗,高频耳鸣者采用离子通道阻滞剂+激素治疗。对照组59例(62耳),其中,急性期21例(23耳)、亚急性期18例(18耳)和慢性期20例(21耳);低中频25例(26耳)和高频34例(36耳);对照组均采用口服盐酸氟桂利嗪治疗。结果治疗组中急性、亚急性及慢性期患者有效率分别为92.0%、61.11%、18.18%;低中频、高频患者的有效率分别为68.96%、50.0%。对照组中急性、亚急性及慢性期患者的有效率分别为56.52%、27.78%、0;低中频、高频患者的有效率分别为42.31%、19.44%。单因素Logistic回归分析表明,性别、年龄、患耳侧别、单双耳患病、耳鸣程度、是否伴高血压、是否伴听力下降耳鸣患者的预后差异无统计学意义,而耳鸣的组别、治疗方法、频率及分期的预后差异有统计学意义。多因素Logistic回归分析表明,耳鸣的频率和分期是影响预后的主要因素。结论低中频耳鸣患者采用改善微循环和激素治疗,高频耳鸣患者采用离子通道阻滞剂和激素治疗,效果明显好于不按耳鸣频率均口服盐酸氟桂利嗪治疗耳鸣的疗效;低中频耳鸣者的预后好于高频耳鸣者;急性期及亚急性期预后较好,慢性期预后较差。有必要对主观性耳鸣患者进行分期并按不同耳鸣频率采用不同治疗方法。     

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。     

纤维鼻咽镜监视下逆行鼓室注入地塞米松辅助治疗突聋

目的 探讨经咽鼓管逆行鼓室注入地塞米松辅助治疗突发性聋的疗效.方法 将86例(86耳)突聋患者随机分为2组:治疗组44例,在全身应用扩张血管、改善微循环、营养神经药物常规治疗的基础上,采用纤维镜下经咽鼓管行鼓摩注入地塞米松3 mg,每周2次,2周为一疗程.对照组42例(42耳)仅采用常规治疗,用药同治疗组.结果 治疗组总有效率为75.00%(33/44),对照组总有效率为52.38%(22/42);治疗2周后治疗组的听力、耳鸣的疗效均明显优于对照组(P<0.05),未见不良反应及副作用.结论 纤维鼻咽镜监视下经咽鼓管注入地塞米松治疗突聋疗效好,操作方便,安全,可避免全身应用激素的副作用.     

鼠神经生长因子联合鼓室内注射地塞米松治疗突发性耳聋的临床应用

目的探讨常规用药联合鼠神经生长因子及鼓室内注射地塞米松治疗突发性耳聋的临床疗效。方法 80例突聋患者随机分为实验组和对照组。对照组38例(40耳)常规治疗方案(扩张血管、溶栓、改善微循环、高压氧),实验组42例(45耳)在常规治疗基础上应用鼠神经生长因子肌肉注射联合鼓室内注射地塞米松。结果实验组38耳有效,7耳无效,总有效率84.4%(38/45);对照组25耳有效,15耳无效,总有效率62.5%(25/40),实验组疗效显著高于对照组(P<0.05);结论鼠神经生长因子肌肉注射联合鼓室内注射地塞米松对治疗突发性耳聋优于常规治疗。     

急性低频感音神经性聋的短期临床疗效分析

目的探讨小剂量、短疗程皮质类固醇激素对急性低频感音神经性聋的疗效。方法选取28例(30耳)急性低频感音神经性聋患者作为研究对象,随机分为强的松治疗组16例(耳)与对照组12例(14耳),两组患者在口服等剂量强的松基础上,对照组加用血管扩张剂和神经营养剂治疗,1周后观察疗效。结果两组患者总有效率(完全恢复和部分恢复)为83.3%(25/30),总治愈率(完全恢复)46.7%(14/30);激素治疗组的有效率87.5%(14/16),治愈率50.0%(8/16),对照组有效率78.6%(11/14),治愈率42.9%(6/14),两组间的疗效比较,差异无统计学意义(P>0.05)。结论急性低频感音神经性聋的治疗有别于突发性耳聋,治疗上无需使用血管扩张剂及神经营养剂等,初始小剂量皮质类固醇激素治疗本病有效。     

鼓室内注射激素及高压氧在难治性高频下降型突发性聋治疗的应用价值

目的　评估鼓室内注射激素及高压氧应用于难治性高频下降型突发性聋患者治疗的价值。方法　回顾2015年10月～2017年10月就诊的难治性高频下降型突发性 聋患者,24例给予鼓室内注射地塞米松（激素组）,30例应用高压氧治疗（高压氧组）。分析两种治疗方式的疗效。结果  比较两组听力改善总有效率,差异无统计学意义。对耳鸣改善激素组显著好于高压氧组（χ2=4.484,P =0.036）。另外两种治疗方式对2 kHz和4 kHz听力改善均无明显差别,但8 kHz听力改善激素组好于高压氧组（F =4.940,P =0.031）。结论　相比高压氧治疗,鼓室内注射激素能显著改善难治性高频下降型突发性聋患者耳鸣症状及8 kHz听力,但两种治疗方式对患者受损频率平均听力提高均不明显。     

全身应用联合连续鼓室内注射地塞米松对中度以上突发性聋的效果分析

目的研究并分析全身应用联合连续鼓室内注射地塞米松对中度以上突发性聋的临床效果。方法选取本院耳鼻咽喉头颈外科2019年1～12月住院治疗的听力损失在中度以上的突发性聋患者80例(80耳),按照随机分配的方式将患者划分为对照组和观察组,各40例(40耳)。在激素的使用方式上,对照组患者给予静脉滴注地塞米松(起始剂量10mg/d,5日后减为5mg/d,共10d),观察组患者在同样方法静脉使用地塞米松的基础上,联合鼓室内注射地塞米松(5mg/次,1次/d,连续7日共7次),疗程结束后统计并比较对照组与观察组的疗效。结果对照组与观察组总有效率分别为52.50%、75.00%,经比较差异有统计学意义(P<0.05);观察组患者治疗后耳鸣致残量表(THI)评分小于对照组,差异具有统计学意义(P<0.05),观察组患者鼓室注射治疗后均无严重并发症发生。结论全身应用联合连续鼓室内注射地塞米松治疗听力损失在中度以上的突发性聋,疗效确切,安全性好。     

地塞米松鼓室内注射补救治疗突发性聋

目的 观察地塞米松鼓室内注射对经过常规治疗没有痊愈或无效的突发性聋的疗效.方法选择门诊经过常规治疗没有痊愈的突发性聋患者45耳,随机分成2组,实验组21耳,地塞米松经鼓膜穿刺鼓室内注射2毫克/次,2次（一周）一个疗程;对照组24耳,给谷维素及复合维生素B口服,用药一周.观察治疗前后纯音听阈及耳呜、耳闷感的变化情况.结果纯音测听结果显示实验组6耳有效（6/21）,对照组1耳有效（1/24）,两组比较差异有统计学意义（P＜0.05）;耳呜改善实验组有5耳（5/15）,对照组1耳（1/19）,两组比较差异有统计学意义（P＜0.05）;耳闷感改善实验组有3耳（3/11）,对照组1耳（1/13）,两组比较差异无统计学意义（P＞0.05）.结论地塞米松鼓室内注射可以改善常规治疗没有痊愈的突发性聋患者的听力及耳鸣症状.     

Transtympanic steroids as a salvage therapy in sudden hearing loss: preliminary results

PURPOSE: To understand the real efficacy of transtympanic steroid therapy for sudden sensorineural hearing loss (SSHL) in patients in whom traditional therapies have failed. PROCEDURES: A prospective study was designed in order to evaluate hearing improvement in SSHL patients treated with transtympanic therapy. A solution of methyl-prednisolone (MP) and sodium bicarbonate was administered via a transtympanic injection to 8 patients. Hearing level was evaluated before therapy and at days 1, 7 and 30. RESULTS: Hearing improvement was obtained in 75% of the patients. The patients in this category are usually considered untreatable. CONCLUSION: Transtympanic steroid therapy is an efficacious solution for patients affected by SSHL in whom traditional therapies have failed. Further studies will be required to identify the most favourable dosage, route of administration and type of steroid. Transtympanic steroid application is safe, inexpensive, easy to perform and efficacious in cases of SSHL not responsive to traditional therapy.     

Transtympanic corticoid therapy for acute profound hearing loss

The prognosis of idiopathic sudden hearing loss depends on its severity; acute complete deafness, for example, has a particularly bad prognosis. The treatment of acute deafness is based on a systemic application of corticosteroids. Corticoid concentrations in the cochlea are higher after transtympanic application in comparison to systemic application. We therefore investigated whether an additional transtympanic corticoid therapy gives an advantage over systemic standard therapy. We report on 27 patients with sudden idiopathic profound hearing loss or deafness who were treated in the Department of Otorhinolaryngology, University of Essen, Germany. Fourteen patients were treated with a rheologic infusion therapy with systemic prednisolone. Thirteen patients were treated additionally with methylprednisolone (Urbason) transtympanically through a ventilation tube. In the first group of patients who were treated with infusion therapy and corticoids systemically, three patients had good recovery of hearing. Another five patients had a partial recovery of hearing. The average hearing gain from 0.5–4 kHz was 15 dB. In the group of patients who were treated additionally with local corticoids, two patients reported a good recovery of hearing and another two patients only had a partial recovery of hearing. The average hearing gain in the above-mentioned frequency range was 11 dB. In our patients the additional transtympanic application of corticoids did not result in a significantly improved recovery of hearing in comparison to the patients treated with the standard therapy alone.     

Sustained-release delivery of leupeptin in the chinchilla: hearing results

Transtympanic medical therapy is becoming an increasingly popular modality for the treatment of "inner-ear disorders." While investigators continue to examine the best dosing paradigms for gentamicin in the treatment of Ménière's disease and for steroids in the treatment of hearing loss, they have also begun to focus on the use of other agents. In particular, transtympanic therapy has been advocated as a plausible route for the treatment of tinnitus. Transtympanic therapy for tinnitus is not new, and a number of groups have reported success in the past. Despite this success, a number of laboratories have been focusing on newer agents that might yield higher success rates in the treatment of tinnitus and other inner-ear disorders. Many of these agents could have systemic side effects when delivered in high enough doses; therefore, they are ideal candidates for transtympanic administration. The goal of this study is to begin to define the effects of one of these agents--leupeptin, a calpain antagonist--on the normal inner ear of an animal model. In this investigation, we demonstrate the effects of sustained-release delivery of leupeptin (2.5 micrograms/ml) on the hearing of chinchillas. The medicine produced no hearing loss at the early time points but did produce some hearing loss at later time points. We discuss these results and begin to outline the next steps in the investigation of this agent.     

早期经鼓室应用类固醇激素治疗“不良预后”突发性聋

目的探讨早期经激光鼓膜穿孔鼓室内应用甲强龙(甲泼尼龙琥珀酸钠)治疗"不良预后"突发性耳聋的疗效。方法 79例被诊断为"不良预后"突发性耳聋患者经过7天常规治疗后无效,被随机分为经鼓室给药组和对照组,其中对照组40例患者继续应用常规激素治疗,经鼓室给药组39例患者应用常规激素治疗的同时增加4次经鼓膜注射甲强龙治疗。经鼓室应用甲强龙的方法:常规消毒外耳道,用布明氏液作鼓膜局部麻醉,在耳内窥镜或手术显微镜监视下用YAG激光在鼓膜后下方穿一0.5mm的小孔,经小孔滴入加温至37℃的甲强龙0.4m(l40mg/ml),之后患者取平卧,下颌上抬,头偏向健侧体位,并维持30min。2天注射一次,4次为1个疗程。所有患者在治疗前、7天常规治疗后和治疗结束后8周查纯音测听(pure tone average,PTA)和言语分辨率(speech discrimination score,SDS)。结果所有患者7天常规治疗后的PTA和SDS无明显变化;治疗结束后8周纯音测听结果:经鼓室给药组PTA恢复≥15dB为48.7%(19/39)、对照组为22.5%(9/40);治疗结束后8周言语分辨率检测结果:经鼓室给药组SDS提高≥15%为46.2%(18/39)、对照组为20.0%(8/40)。经x2检验,治疗结束后8周经鼓室给药组和对照组的PTA和SDS结果差异显著(P<0.01)。结论早期经激光鼓膜穿孔鼓室内应用甲强龙治疗"不良预后"突发性聋可获得较常规激素治疗更好的疗效。     

Treatment of cochlear tinnitus with transtympanic infusion of 4% lidocaine into the tympanic cavity

Tinnitus is an otological symptom that is encountered often, yet its treatment is difficult. If tinnitus is of cochlear origin, a reasonable assumption is that a total depression of the cochlear function will abolish cochlear tinnitus. To achieve this depression, transtympanic infusion of a local anesthetic (4% lidocaine) to anesthetize the inner ear was conducted in a patient suffering from tinnitus. Transtympanic infusion of 4% lidocaine was performed as a treatment for cochlear tinnitus, and its efficacy was investigated. The overall efficacy rate for the 292 patients with 369 affected ears was 81%. In the investigation of the treatment results in cases of different underlying ear diseases, the efficacy rate was high for tinnitus accompanying sudden deafness and labyrinthine vertigo. However, vestibular symptoms, such as vertigo and nausea, developed after lidocaine infusion. No permanent side effects were noted. Lidocaine infusion is thought to be a useful treatment option for tinnitus and should be considered before surgical treatment. Inner ear anesthesia into the tympanic cavity has been carried out in patients who had cochlear tinnitus and in whom conservative methods of therapy, such as oral medication, had proved unsuccessful. This treatment method is useful as a local therapy for cochlear tinnitus.     

耳后注射甲泼尼龙琥珀酸钠联合常规药物治疗重度突发性聋

目的　研究耳后注射甲泼尼龙琥珀酸钠（甲强龙）联合常规药物治疗重度突发性聋的临床效果及副反应,探讨耳后局部给药是否可取代传统全身激素给药方式。方法　选取2014年6月～2015年5月就诊于首都医科大学附属北京安贞医院,符合研究条件的60例（61耳）突发性聋患者,均给予改善微循环及营养神经等常规治疗2周。患者 随机分为两组：对照组（31耳）经静脉给予地塞米松磷酸钠注射液10 mg,每日1次,共5 d;耳后注射组（30耳）耳后注射甲强龙40 mg,每日1次,共5 d。采用SPSS 16.0软件进行统计学分析,比较治疗前后的疗效变化及副反应。结果  给药后两周耳后注射组及对照组总有效率分别为76.67%和74.19%,显效率分别为36.67%,38.71%,差异无统计学意义。耳后注射组血压及血糖无明显变化。结论　耳后注射甲强龙联合常规药物治疗突发性聋可获得满意疗效。耳后注射甲强龙有可能取代传统静脉激素给药用于突发性聋的治疗。     

Contribution to the differentiation of peripheral versus central tinnitus via auditory brain stem response evaluation

Auditory brain stem response (ABR) parameters were evaluated in 54 subjects with unilateral idiopathic subjective tinnitus in order to verify the possibility of detecting its site of origin. All the subjects had normal hearing or a symmetrical bilateral sensorineural hearing loss. All the cases in whom middle or inner ear disease had been diagnosed, were excluded. Subjects, classified on the basis of their mean auditory threshold and masking curves according to Feldmann, underwent a residual inhibition (RI) test and ipsilateral narrow-band noise masking before a second ABR test was performed. Patients with positive RI made up the A+ group, while those with negative RI made up the A- group. The main characteristics observed were an increase of the mean latency values of wave I in the tinnitus ear in the A+ group while, after masking, the values of the affected and unaffected ears almost overlapped. An increase in the latency values of wave V, unaffected by the masking procedure, could be observed in A- patients. The occurrence of waves I and III was often affected in the tinnitus ears in both groups, but it increased, after masking, only in the A- patients. Based on the obtained data, the authors conclude that there may be a substantial difference concerning ABR parameters between the patients in whom residual tinnitus masking is demonstrable compared with those in whom it is not.     

Therapy of tinnitus. Tympanic cavity infusion of lidocaine and steroid solution

Tinnitus is an otological symptom which is often encountered and is yet difficult to treat. If tinnitus is of cochlear origin then it seems reasonable to assume that a total depression of the cochlear function will abolish cochlear tinnitus. To achieve this depression, transtympanic injections of a local anesthetic (4% Lidocaine) to anesthetize the inner ear and of Decadoron were conducted in a patient suffering from tinnitus. One hundred and sixty-eight patients (220 ears) who had suffered from relatively long-term tinnitus were included in this study. In almost all of the cases the clinical symptoms and the otological findings (i.e., the audiogram and caloric test) indicated that the probable lesion underlying the tinnitus was located within the end organ. In some cases this injection brought a transient (for few days), slight, neurosensorial deafness in the low-frequency range. This auditory disorder, however, was completely restored without sequelae. Our results are summarized as follows: in 76 ears, tinnitus was abolished completely, in 109 ears, tinnitus was considerably ameliorated, in 35 ears, tinnitus was slightly ameliorated or no effect. One hundred and nine patients (138 ears) who had suffered from tinnitus were included in this study. Decadoron was applied to the middle ear cavity by transtympanic injection. Our results are summarized as follows: in 87 ears, tinnitus was abolished, in 39 ears, tinnitus was considerably ameliorated, in 14 ears, tinnitus was slightly ameliorated or no effect.