鼓室内和耳后应用糖皮质激素治疗难治性突发性聋的Meta分析

目的探讨鼓室内和耳后使用糖皮质激素对于难治性突发性聋的有效性。方法通过关键词在中国知网、万方、维普、PubMed、Cochrane等数据库检索2005～2020年国内外公开发表的鼓室内与耳后使用糖皮质激素进行对比治疗难治性突发性聋的随机对照研究,使用Review Manager 5.4和Stata软件包对符合质量标准的研究进行Meta分析。结果本次研究共检索文献数量517篇,最终纳入5篇,均为中文文献,Meta分析显示在难治性突聋的治疗方面,鼓室内注射组总有效率显著大于耳后注射组(RR=0.87,95%CI为0.78～0.97,P=0.01);两种途径的痊愈率无统计学差异(RR=0.71,95%CI为0.50～1.02,P=0.07)。结论难治性突发性聋的治疗中,鼓室内注射糖皮质激素的总有效率优于耳后注射,是难治性突聋较为理想的治疗方法,但需要更大的样本量、更严格的统计学方法和分型更细致的临床试验来证实。     

鼓室内注射地塞米松治疗难治性突发性聋

目的探讨鼓室内注射地塞米松治疗伴有糖尿病、高血压的突发性耳聋（难治性突发性耳聋）患者的疗效。方法观察组35例（35耳）,高血压13例,糖尿病15例,7例高血压加糖尿病。鼓室内注射地塞米松溶液5mg,隔日注射一次,共注射5次。对照组71例（71耳）,静脉注射地塞米松10mg,连续7天,后减为5mg治疗7天。结果观察组：35例,有效率为77.14%（27/35）。对照组：有效率为80.28%（57/71）。两组比较χ^2=0.14,P〉0.05,差异无统计学意义;观察组耳鸣消失率为78.57%（22/28）;对照组耳鸣消失率为71.15%（37/52）。两组比较χ^2=0.52,P〉0.05,差异无统计学意义;两组患者眩晕均全部消失。结论在不能全身使用激素的情况下,采用鼓室内注射的途径可以获得相同的治疗效果,至少是一种备选方案。     

连续鼓室注射糖皮质激素初始治疗突发性聋的效果分析

目的：探讨连续鼓室注射糖皮质激素作为突发性聋初始治疗的疗效。方法将91例（91耳）突发性聋患者随机分为鼓室注射组42例（42耳）和口服组49例（49耳）,鼓室注射组采用甲强龙鼓室注射,每天一次,共7天;口服组采用口服强的松片,疗程14天,两组对象分别于治疗前及治疗后第1、2、4、8周测试纯音听阈,所有病例听力随访至少8周。结果在第1、2周,鼓室注射组纯音听阈均值分别为61．57±24．82、56．76±25．06 dBHL,而口服组分别为71．90±19．22、66．47±19．77 dBHL,差异均有统计学意义（均为 P＜0．05）;在第1、2、4周鼓室注射组（听力分别提高15．38±14．11、20．19±13．83、23．36±13．87 dB ,优于口服组（分别为6．18±8．07、11．57±9．16、17．88±11．76 dB ）（均为 P＜0．05）;在治疗第1周结束后,鼓室注射组痊愈6例（14．29％,6／42）,总有效14例（33．33％,14／42）,口服组痊愈1例（2．04％,1／49）,总有效3例（6．12％,3／49）,差异均有统计学意义（均 P＜0．05）;在第2周,鼓室注射组总有效率（52．38％,22／42）高于口服组（26．53％,13／49）（P＜0．05）,而在第4、8周,两组间痊愈、显效、有效及总有效差异均无统计学意义（均为 P＞0．05）。结论连续鼓室注射糖皮质激素作为突发性聋的初始治疗,可在较短时间内取得更好的听力改善。     

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。     

糖皮质激素不同给药方式治疗突发性聋的临床疗效及安全性研究

目的 观察糖皮质激素不同给药方式治疗突发性聋的临床疗效及安全性。 方法 将耳鼻喉科2017年1月至2018年3月收治的150例突发性聋患者按照住院顺序随机分为3组, 在应用改善微循环、营养神经药物治疗的基础上,鼓室穿刺组加用鼓室穿刺注射糖皮质激素,静脉滴注组加用静脉滴注糖皮质激素,耳后乳突组加用耳后乳突注射糖皮质激素。比较治疗后3组患者听力提高疗效及不良反应情况等。 结果 与治疗前相比,治疗2周后耳后注射糖皮质激素组疗效均优于静脉滴注糖皮质激素与鼓室穿刺注射糖皮质激素组,差异均有统计学意义(P<0.05)。3组不良反应及并发症比较,差异无统计学意义(P>0.05)。 结论 糖皮质激素耳后乳突区局部注射糖皮质激素治疗突发性聋的临床疗效更佳,不良反应发生率低,更安全可靠。     

不同方式局部应用糖皮质激素初始治疗突发性聋临床疗效的Meta分析北大核心CSCD

目的系统评价不同方式局部应用糖皮质激素治疗突发性聋的有效性。方法通过检索PubMed、Cochrane、CBM、CNKI、维普、万方数据库,系统收集2019年1月之前耳后及鼓室内注射糖皮质激素治疗突发性聋的随机对照试验相关文献,对符合纳入标准的文献数据中的疗效进行Meta分析。结果本研究共检索文献934篇,通过筛选后共纳入符合要求的文献6篇,均为中文文献,包括551例患者,其中,耳后注射组276例(276耳),鼓室注射组275例(275耳)。Meta分析结果显示:耳后注射治疗组总有效率78.99%(218/276),鼓室内注射治疗组总有效率68.45%(191/275),两组有效率比较差异有统计学意义(OR=1.70,95%,CI为1.15-2.53,P=0.008)。结论糖皮质激素作为突发性聋的一线治疗用药已得到普遍认可,耳后注射疗效优于鼓室内注射。     

不同方式局部应用糖皮质激素初始治疗突发性聋临床疗效的Meta分析北大核心CSCD

目的系统评价不同方式局部应用糖皮质激素治疗突发性聋的有效性。方法通过检索PubMed、Cochrane、CBM、CNKI、维普、万方数据库,系统收集2019年1月之前耳后及鼓室内注射糖皮质激素治疗突发性聋的随机对照试验相关文献,对符合纳入标准的文献数据中的疗效进行Meta分析。结果本研究共检索文献934篇,通过筛选后共纳入符合要求的文献6篇,均为中文文献,包括551例患者,其中,耳后注射组276例(276耳),鼓室注射组275例(275耳)。Meta分析结果显示:耳后注射治疗组总有效率78.99%(218/276),鼓室内注射治疗组总有效率68.45%(191/275),两组有效率比较差异有统计学意义(OR=1.70,95%,CI为1.15-2.53,P=0.008)。结论糖皮质激素作为突发性聋的一线治疗用药已得到普遍认可,耳后注射疗效优于鼓室内注射。     

不同方式局部应用糖皮质激素初始治疗突发性聋临床疗效的Meta分析北大核心CSCD

目的系统评价不同方式局部应用糖皮质激素治疗突发性聋的有效性。方法通过检索PubMed、Cochrane、CBM、CNKI、维普、万方数据库,系统收集2019年1月之前耳后及鼓室内注射糖皮质激素治疗突发性聋的随机对照试验相关文献,对符合纳入标准的文献数据中的疗效进行Meta分析。结果本研究共检索文献934篇,通过筛选后共纳入符合要求的文献6篇,均为中文文献,包括551例患者,其中,耳后注射组276例(276耳),鼓室注射组275例(275耳)。Meta分析结果显示:耳后注射治疗组总有效率78.99%(218/276),鼓室内注射治疗组总有效率68.45%(191/275),两组有效率比较差异有统计学意义(OR=1.70,95%,CI为1.15-2.53,P=0.008)。结论糖皮质激素作为突发性聋的一线治疗用药已得到普遍认可,耳后注射疗效优于鼓室内注射。     

糖皮质激素治疗青少年突发性聋疗效观察

突发性聋 (突聋 )病因尚未完全清楚 ,现认为与病毒感染、血液循环障碍等有关 ,而青少年患者由病毒感染引起的可能性较大〔1〕,临床上多给予糖皮质激素治疗。为了解其疗效 ,现将我院 1 995年以来收治的 49例 ( 61耳 )青少年突聋患者报告分析如下。1　资料和方法1 .1 　 临床资料49例 ( 61耳 )均符合中华耳鼻咽喉科学会制定的突聋诊断依据。其中男 36例 ( 4 5耳 ) ,女 1 3例( 1 6耳 ) ,年龄 1 1～ 2 5岁 ,平均 1 8.9岁。发病至初诊时间 1～ 2 3ｄ ,≤ 7ｄ就诊者 37例 ( 4 7耳 )。伴眩晕1 5例 ( 30 .6% ) ,耳鸣 5 4耳 ( 88.5 % )。初诊时纯音听…     

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.     

Intratympanic Methylprednisolone as Rescue Therapy in Sudden Sensorineural Hearing Loss

Treatment in sudden sensorineural hearing loss is a contentious issue, today, oral steroids are the most common choice and considered the best treatment option, but the use of intratympanic steroids has become an attractive alternative, especially in cases when systemic therapy fails, or to avoid the side effects of the systemic use of steroids.AimTo describe the results of intratympanic methylprednisolone in idiopathic sudden sensorineural hearing loss after failure of oral prednisolone.MethodsIn a prospective study fourteen patients with idiopathic sudden sensorineural hearing loss were treated with intratympanic methylprednisolone after failing in the treatment with systemic steroids. Pretreatment and post-treatment audiometric evaluations including pure tone average (PTA) and speech reception thresholds (SRT) were analyzed.ResultsTen from 14 patients treated with intra-tympanic methylprednisolone presented with hearing recovery > 20 dB in PTA or 20% in SRT.ConclusionThree intratympanic injections of methylprednisolone improved pure-tone average or speech discrimination scores for a subset of sudden hearing loss subjects that failed to benefit from oral steroids.     

Sudden Bilateral Sensorineural Hearing Loss

Most cases of sudden sensorineural hearing loss (SHL) remain idiopathic, and the majority are unilateral. From 1989 to 1993, 823 patients with sudden SHL were evaluated. Of these, 14 (1.7%) had sudden bilateral SHL. We reviewed the charts of these 14 patients to compare sudden bilateral SHL with sudden unilateral SHL. Usually, bilateral SHL was asymmetric. Most bilateral cases received combined steroid and vasodilator treatment, while unilateral cases were more likely to receive only one of these treatments. By audiological criteria, 67% of bilateral SHL cases improved, while the improvement rate in unilateral SHL was 52%; however, this difference was not statistically significant. In bilateral SHL patients showing improvement, both ears responded. Bilateral SHL patients were older at the onset of hearing loss, had a higher incidence of vascular disease, and were more likely to have positive antinuclear antibody titer. Recognition of similarities and differences between sudden unilateral and bilateral SHL can help in counseling patients.     

Idiopathic Sudden Sensorineural Hearing Loss With Minimal Hearing Impairment

Objectives

The aim of the study was to determine the characteristics of patients who did not match the audiometric criteria of idiopathic sudden sensorineural hearing loss (SSNHL) but complained of acute hearing loss.

Methods

By thorough medical chart reviews, historical cohort study was performed with consecutive data of 589 patients complaining of acute unilateral sensorineural hearing loss without identifiable causes between 2005 and 2013. Those patients demonstrating a hearing loss of at least 30 dB at three consecutive frequencies based on pure tone audiometry were classified as group I; the others were classified as group II. Patients'' characteristics, final hearing, and hearing improvement rate (HIR) between the two groups were compared.

Results

Group II exhibited distinctive characteristics, including an early age of onset of the hearing loss (P<0.01), an absence of accompanying diabetes (P<0.01) and hypertension (P<0.01), and better unaffected hearing and final hearing compared with group I (P<0.001). However, the HIR of the patients in the two groups was not significantly different (P>0.05).

Conclusion

Patients who did not meet the audiological criteria of SSNHL exhibited distinctive characteristics compared to SSNHL patients.     

鼓室内灌注醋酸泼尼松龙治疗突发性聋的初步观察

目的探讨鼓室内灌注醋酸泼尼松龙对常规治疗无效的突发性聋患者的治疗效果。方法选择病史在2个月以上常规治疗无效和未治的突发性聋患者12例,鼓室内注入醋酸泼尼松龙,观察治疗前后0.25～4kHz听阈变化。结果本组患者治疗前的平均听阈为62.75±9.71dBHL,治疗后听力提高了12.97±7.28dB;其中,痊愈2例,有效4例。结论鼓室内应用激素能改善常规治疗无效的突发性聋患者的听力。     

Sudden Sensorineural Hearing Loss After General Anesthesia for Nonotologic Surgery

Sudden sensorineural hearing loss (SNHL) is a well-recognized phenomenon that is attributed to a variety of etiologies. Sudden SNHL after cardiopulmonary bypass surgery has been well reported and is thought to be due to microemboli. However, a review of the English literature revealed only 15 cases of SNHL after general anesthesia for nonotologic surgery. Several etiologies for this loss have been suggested, but no proven pathogenesis is yet available. This report adds to the literature three additional cases of sudden SNHL after general anesthesia for nonotologic surgery. The literature is reviewed and proposed mechanisms of injury are discussed.     

糖皮质激素鼓室给药治疗突发性聋的现况分析

突发性聋是耳鼻喉科常见的急症,目前临床上全身使用糖皮质激素治疗突发性聋获得较为肯定的疗效,但全身使用糖皮质激素的禁忌症及可能引起严重的不良反应,使得糖皮质激素鼓室给药治疗突发性聋逐渐得到应用并成为广泛关注的热点。本文将对糖皮质激素鼓室给药的疗效进行评估,以及对其临床运用的现况进行阐述。     

全身应用联合鼓室注射糖皮质激素治疗重度和极重度突发性聋

目的比较全身应用联合鼓室注射糖皮质激素与单独全身应用糖皮质激素治疗重度和极重度突发性聋的疗效。方法回顾性比较47例(47耳)重度和极重度突聋患者的临床资料和治疗效果,将患者分为口服糖皮质激素组(口服组,19例,晨起顿服强的松片1mg.kg-1.d-1,5天后每2天递减10mg)、口服加鼓室内注射糖皮质激素组[口服加鼓室给药组,9例,在口服强的松片(用法同口服组)的同时鼓室内注入地塞米松5mg,隔2天一次,平均4次]、静脉滴注糖皮质激素组(静滴组,12例,静脉滴注地塞米松10mg,每日一次,每隔5日减半量)和静脉滴注加鼓室内注射糖皮质激素组(静滴加鼓室给药组,7例,方法、剂量同静滴组及上述鼓室给药法)。疗程结束后,比较各组的疗效。结果口服组和口服加鼓室给药组的总有效率分别为52.63%和66.67%,显效率分别为36.84%和22.22%,两组间的总有效率和显效率差异均无统计学意义(P>0.05)。静滴组和静滴加鼓室给药组的总有效率分别为83.33%和71.43%,显效率分别为66.67%和71.43%,两组间的总有效率和显效率差异均无统计学意义(P>0.05)。结论全身应用(口服或静滴)联合鼓室内注射糖皮质激素治疗重度和极重度突聋并不能得到较全身单独用药更好的疗效。     

Outcomes of Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss

Objectives

While a severe to profound sudden sensorineural hearing loss (SSNHL) may cause serious disability in verbal communication, there have been little studies focusing on this high degree SSNHL. The present study was aimed to investigate the characteristics of hearing recovery in a high degree SSNHL (>70 dB).

Methods

Three hundred and two SSNHL patients were enrolled. For a long-term follow-up, 46 patients were evaluated. Hearing level was examined by pure tone audiometry on day 1, week 3, month 3, month 6, and year 1 or after. According to the degree of the initial hearing loss, the patients were divided into 4 groups from 70 to ≥100 dB.

Results

After 3 weeks, the recovery rate and mean hearing gain was 61%, 23.85 dB in the 70 dB group, whereas 10%, 6.61 dB in the ≥100 dB group. There was a significant correlation between 3-week recovery and final hearing outcome. However, there was almost no recovery after 3 months.

Conclusion

An early recovery can be a prognostic factor for the final recovery in severe to profound SSNHL. Since recovery after 3 months is rare, an early hearing intervention like hearing aid or cochlear implantation should be considered in the high degree SSNHL to restore the patient''s verbal communication.     

Relationship between Sudden Sensorineural Hearing Loss and Vascular Risk Factors

Objective To explore the relationship between sudden sensorineural hearing loss(SSNHL) and vascular risk factors (including serum lipids and uric acid). Method This is a retrospective analysis of 100 cases of SSNHL seen at the Drum Tower Hospital, Nanjing Medical University, between Jan. 2007 and Apr. 20080 Patient history, blood test results and imaging scans were analyzed. Levels of triglyceride (TG), cholesterols (CHO), high density lipoprotein-cholesterol (HDL-CH), low density lipoprotein-cholesterol (LDL-CH), apolipoprotein AI (ApoAI), apolipoprotein B(ApoB) and uric acid(UA) from these patients were compared with a control group of 56 patients treated for vocal cord polyps or nasal septum deviation during the same period. Patients with hyperten-sion, diabetes, heart, brain, liver or kidney disorders are excluded from the present investigation. Results HDL-CH level was higher and UA level lower in the study group than the control group (P< 0.05). HDL-CH and UA showed no significant differences among different age-groups (P > 0.05). There were no significant differences in the levels of TG, CHO, LDL-CH, ApoAI and ApoB (P > 0.05). Conclusion These data indicate that metabolic disturbances of serum lipids and/or uric acid may be potential risk factors for SSNHL