鼓室注射地塞米松治疗突发性聋的疗效及影响因素分析

目的观察鼓室内注射地塞米松作为突发性聋初始治疗的疗效,并探讨影响其预后的因素。方法76例（76耳）突发性聋患者随机分为2组,鼓室注射组（38例,男16例,女22例）：除常规治疗（改善微循环、营养神经）外行鼓室内注射地塞米松1 ml（5 mg/ml）,每日一次,连续治疗10天;全身给药组（38例,男14例,女24例）：除常规治疗外给予全身静脉滴注地塞米松,治疗2周后复查听力,比较两组疗效。结果鼓室注射组总有效率（84．2％）明显高于全身给药组（60．5％）（ P＜0．05）,鼓室注射组极重度聋患者治疗有效率（85．7％）明显高于全身给药组（14．3％）（ P＜0．05）。鼓室注射组及全身给药组中病程≤1周患者治疗有效率（分别为95．7％和76．0％）明显高于＞1周患者（分别为66．7％和30．8％）（ P＜0．05）,全身给药组中度聋患者疗效明显高于极重度聋患者（ P＜0．05）,鼓室给药组患者听力损失程度与预后无明显相关性（P＞0．05）,患者性别、年龄、有无眩晕、耳鸣及听力曲线类型对预后无明显影响（P＞0．05）。结论鼓室内注射地塞米松可作为突发性聋患者的初始治疗,特别适于全身应用激素禁忌的患者,对于极重度聋患者建议尽早采用鼓室内注射激素治疗。     

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。     

影响鼓室内激素治疗突发性耳聋的多因素分析

目的 分析鼓室内注射类固醇激素对突发性耳聋的疗效及影响因素.方法 120例病人分为治疗组和对照组,治疗组鼓室内注射甲基强的松龙,对照组静脉给予地塞米松,疗程均为10天,观察听力恢复情况.结果 治疗组总有效率为72.97%,对照组总有效率为52.17%,差异有统计学意义(P<0.05).影响因素中年龄越大、病程越长、伴有眩晕、伴有糖尿病者疗效差.结论 鼓室内注射类固醇激素治疗突发性耳聋安全、有效,早期治疗及控制血糖可以提高疗效.     

鼓室注射地塞米松治疗糖尿病伴突发性耳聋的临床研究

目的观察鼓室内注射地塞米松治疗糖尿病伴突发性耳聋的疗效。方法将46例Ⅱ型糖尿病伴突发性耳聋患者按其意愿分为治疗组(21例)和对照组(25例),每组均采用扩血管、营养神经及胰岛素降糖等治疗;治疗组加用经鼓室注射地塞米松(5 g/L),隔日注射1次,共5次,疗程结束(10 d)后复查纯音听阈。结果治疗组未出现化脓性中耳炎、鼓膜穿孔、听力下降,其总有效率(15/21,71.4%)明显优于对照组(10/25,40.0%),两组差异具有统计学意义(P<0.05)。结论鼓室注射地塞米松治疗糖尿病伴突发性耳聋有效,它可避免全身激素用药的不良反应,作为糖尿病伴突发性耳聋患者的初始治疗是一个合理的选择。     

鼓室激素注射为初始治疗的突发性聋听力恢复的时间规律

目的 探讨鼓室激素注射作为初始治疗突发性聋患者方案的听力恢复时间规律,寻求最佳鼓室给药时机。方法 将突发性聋患者135例纳入研究,均接受为期2周的全身激素治疗。其中63例仅接受全身激素治疗,另72例在全身激素治疗开始的同时联合鼓室内激素注射。所有病例随访2个月。结果 治疗后第3天、第7天、第14天、1个月、2个月每个时间点两组间总有效率差异均无统计学意义。全身激素治疗联合鼓室注射组第7天与第14天疗效差异无统计学意义(P=0.065),而单纯全身激素治疗者第7天与第14天疗效比较差异有统计学意义(P=0.029)。结论 鼓室激素注射联合全身激素治疗作为初始治疗方案,其疗效并不优于单纯全身激素治疗,但听力改善峰值的时间前者总体早于后者。     

针刺结合鼓室注射激素治疗突发性耳聋的疗效研究

目的 研究突发性耳聋患者行针刺+鼓室注射激素治疗效果。方法 数据遴选本院2019年5月-2021年8月收治的86例突发性耳聋患者,“随机抽样法”分单一组(鼓室注射激素,n=43)、联用组(鼓室注射激素+针刺,n=43),2组临床疗效比较。结果 治疗前比较纯音听阈值无差异,治疗后比较不良反应也无差异,P>0.05;治疗后与单一组比较,联用组500Hz、1000Hz、2000Hz指标更低;联用组治疗有效率(97.67%)高于单一组(81.40%),χ²=4.468,0.035,P<0.05(具有统计学意义)。结论 针刺+鼓室注射激素治疗突发性耳聋患者能改善听力水平、增强疗效,保证治疗安全、值得推崇。     

不同时机鼓室内注射糖皮质激素治疗重度以上突发性聋的疗效分析

目的 观察全身联合不同时机鼓室内注射糖皮质激素治疗重度以上突发性聋的疗效,探讨鼓室内注射时机,分析影响重度以上突发性聋预后的因素.方法 回顾性分析108例重度以上突发性聋患者的临床资料及治疗效果,其中全身联合初始鼓室组64例,全身联合延后鼓室组44例;对两组患者出院时与随访时疗效分别进行比较,并分析治疗有效组和无效组临...     

鼓室内与静脉注射糖皮质激素治疗伴糖耐量异常突发性聋疗效比较

目的比较糖皮质激素鼓室内注射与静脉给药对伴糖耐量异常的突发性聋患者的疗效。方法采用随机数字法,将50例伴糖耐量异常的初治单侧突发性聋患者随机平均分为鼓室注射组(地塞米松鼓室内注射)和静脉给药组(地塞米松静脉滴注),两组患者均同期接受相同的改善微循环及营养神经药物治疗。治疗期间每隔3天对患者进行纯音听阈测试,比较两组患者疗效。结果所有患者在治疗过程中平均听阈均逐渐下降,治疗后15天时静脉注射组患者平均听阈由治疗前的85.4±5.6dB HL下降至48.2±4.9dB HL,鼓室给药组由84.8±5.6dB HL下降至31.7±4.6dB HL,鼓室注射组患者总有效率为84.00%(21/95),较静脉给药组(68.00%,17/25)高(P<0.05)。结论采用糖皮质激素鼓室内注射对伴糖耐量异常的突发性聋患者的疗效较静脉给药的疗效更好。     

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。     

鼓室内注射甲基强的松龙治疗难治性突聋的短期效果观察

目的 研究鼓室内注射甲基强的松龙治疗难治性突发性聋的临床疗效及其并发症.方法 选取2006年1月至2007年1月在中山大学附属第二医院耳鼻咽喉科住院治疗的突发性聋患者30例,所有患者均为常规全身用药治疗两周无效,再接受鼓室注射治疗.采用耳内镜辅助下行鼓室内注射甲基强的松龙,每周一次,共三次.治疗结束后一个月复查纯音测听及鼓膜情况,分别比较治疗前后250、500、1 000、2 000、4 000 Hz的听阈,疗效评价采用平均听阈下降10 dB为有效.结果 30名患者中,9名有效,有效率30%.治疗后500、1 000、2 000 Hz的平均听阈下降明显,有统计学意义(P＜0.01).无鼓膜穿孔及眩晕、听力下降的病例.结论 鼓室内注射激素可作为突发性聋的挽救性治疗方法 .     

Effectiveness of intratympanic dexamethasone for refractory sudden sensorineural hearing loss

The purpose of this study was to investigate the effectiveness of intratympanic steroids in patients with idiopathic sudden sensorineural hearing loss who did not respond to initial systemic steroid therapy. This retrospective study involved 51 patients, who did not respond to systemic steroids as a first-line treatment. Initial systemic steroid therapy consisted of administration of methylprednisolon intravenously (250 mg) at the first day and followed by orally (1 mg/kg) tapering for 14 days. Twenty-one patients accepted intratympanic treatment, and the remaining 30 patients who refused intratympanic treatment were evaluated as the control group. Steroids (dexamethasone drops, 1 mg/mL) were administered through a ventilation tube. Hearing was assessed immediately before treatment and 2 months after treatment. Recovery of hearing was defined as an improvement of >20 dB in the pure tone average. We tested 250, 500, 1,000, 2,000, 4,000, and 8,000 Hz frequencies for the pure tone audiometric evaluation. Statistically Student’s t test, Mann–Whitney U test, Chi-squared and Fisher’s exact tests were used. The pure tone average improved in 47.6 % of the intratympanic group and in 10 % of the control group (p = 0.002), with pure tone average improvements of 19.9 ± 16.5 and 4.76 ± 9.6 dB in the intratympanic and control groups, respectively. When the hearing threshold at each frequency was analyzed, improvements at all frequencies were significantly greater in the intratympanic steroid group when compared with the control group (p < 0.01). Intratympanic steroid administration is an effective therapy for sudden sensorineural hearing loss in patients, who are refractory to primary systemic steroid therapy.     

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.     

Idiopathic sudden sensorineural hearing loss: Effectiveness of salvage treatment with low-dose intratympanic dexamethasone

Objectives:To evaluate hearing outcome of salvage treatment with intratympanic steroids(ITS)in idiopathic sudden sensorineural hearing loss(ISSNHL)refractory to initial systemic steroid(SS)therapy.Material and methods:A retrospective medical chart review was conducted on 54 consecutive patients with ISSNHL refractory to SS.Salvage treatment with a low dose intratympanic dexamethasone(4 mg/ml)was offered after one week of primary treatment.Patients were divided into two groups:25 patients accepted ITS(treatment group)and 29 patients did not undergo additional treatment(control group).A pure tone average(PTA)gain of at least 10 dB was considered hearing improvement.Results:Hearing improvement rate was higher in ITS group compared to control group(40%vs.13.8%,p=0.035).A mean PTA improvement of 8.6±9.8 dB was observed in the ITS group and,whereas the control group had an average hearing gain of 0.7±2 dB(p<0.001).Audiometric analysis revealed a significant hearing gain in ITS group at all tested frequencies compared to control group(p<0.05).Analysis of the selected variables,identified intratympanic steroid treatment as the only independent prognostic factor for hearing improvement(OR=4.2,95%CI:1.1e15.7;p=0.04).Conclusion:Intratympanic low dose dexamethasone is effective in patients with incomplete hearing recovery after primary systemic steroid treatment.     

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.     

Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy

The purpose of this prospective study was to test whether intratympanic application of dexamethasone/hyaluronic acid improves hearing outcome in patients with pantonal idiopathic sudden sensorineural hearing loss (ISSHL), in patients with sudden deafness or sudden profound SHL and in patients with predominant high-frequency ISSHL who are refractory to intravenous steroid and vasoactive therapy. The study took place in an academic tertiary referral hospital involving 21 patients with pantonal ISSHL, 10 patients with sudden deafness or sudden profound SHL and 9 patients with a high-frequency ISSHL. Intratympanic dexamethasone/hyaluronic acid was administered in the affected ear. Hearing was evaluated by means of standard pure-tone audiometry. The differences between pure-tone hearing thresholds by air conduction before intravenous therapy and before the beginning of the intratympanic therapy, as well as before and after intratympanic therapy, were calculated. Statistical analysis was performed by means of the Wilcoxons test for paired samples. Intratympanic injection of dexamethasone/hyaluronic acid results in a significant global (pantonal) improvement in hearing in patients with pantonal ISSHL. It also effects improvement in hearing at selected frequencies (namely at 1.5 and 3 kHz) in patients with a predominant high-frequency ISSHL and at selected frequencies (namely at 0.5, 0.75 and 1 kHz) in patients with sudden deafness or sudden profound SHL. Neither systemic nor local side effects were observed. Intratympanic administration of dexamethasone/hyaluronic acid provides a safe and efficacious therapeutic option for the treatment of patients with pantonal and high-frequency ISSHL who dont respond to intravenous steroid and vasoactive therapy.Abbreviations dB HL decibel hearing level - (IS)SHL (idiopathic sudden) sensorineural hearing loss - kHz kiloHertz     

Hyperbaric oxygen therapy for sudden sensorineural hearing loss after failure from oral and intratympanic corticosteroid

Systemic and intratympanic steroids are most widely used for treating idiopathic sudden sensorineural hearing loss. Other treatments include vasodilator, immunosuppressant and antiviral medication. However, only 61% of patients achieve full recovery, and controversies about the standard treatment still exist. In this case report, we present a patient with idiopathic sudden sensorineural hearing loss who failed to respond to systemic and intratympanic steroid treatments but subsequently recovered after undergoing hyperbaric oxygen therapy.     

Intratympanic dexamethasone perfusion versus injection for treatment of refractory sudden sensorineural hearing loss

Intratympanic steroid treatment for the sudden sensorineural hearing loss (SSNHL) has a long history and many techniques have been developed. The efficacies are varied in different studies owing to different criteria, steroid type and dose, delivery methods, or absence of comparison groups. Recently, animal experiments suggested that continuous delivery systems produce the higher inner ear drug concentrations than other ways. This study was aimed at evaluating the efficacies of intratympanic dexamethasone perfusion versus injection for treatment of refractory sudden sensorineural hearing loss (RSSNHL). A total of 136 patients were enrolled in this nonrandomized, prospective, controlled study. Thirty-two patients were treated with continuous intratympanic dexamethasone perfusion via round window microcatheter by an electronic pump at a rate of 10 μl/min twice daily for 7 days and 34 patients underwent intratympanic dexamethasone injection of the same dosage. Seventy patients who refused to undertake further treatment were selected as a control group. Pure-tone audiometry results were obtained before and after treatments. Minimum follow-up time from the last treatment was 1 month. There were no serious adverse events in the treatment groups. Hearing improvement rate (HIR) of SSNHL in perfusion group was 40.6 %, which was significantly higher than in the injection and control groups (20.6 and 7.7 %, respectively). HIR had no relation with sex, age, and associated symptoms. Results indicated that intratympanic dexamethasone perfusion by external electronic pump with gelatin sponge placement in round window niche is an efficacious and safe method for the treatment of RSSNHL, showing superiority to simple injection through the drum.     

Outcomes research analysis of continuous intratympanic glucocorticoid delivery in patients with acute severe to profound hearing loss: basis for planning randomized controlled trials

CONCLUSIONS: The data presented herein form the basis for conducting randomized placebo-controlled clinical trials evaluating the safety and efficacy of salvage treatment in patients with idiopathic sudden severe sensorineural hearing loss (but not anacusis) refractory to initial systemic therapy. Comparison of different application protocols and drug delivery systems will allow assessment of the value of continuous versus intermittent intratympanic glucocorticoid drug delivery. OBJECTIVES: To describe and critically evaluate the results of continuous intratympanic glucocorticoid delivery in patients with acute unilateral severe and profound sensorineural hearing loss refractory to initial systemic therapy and to compare the outcome with a historical control group. MATERIAL AND METHODS: In a retrospective chart review, treatment results were analyzed in 23 patients with acute severe and profound hearing loss and failure of systemic standard therapy who received a continuous intratympanic delivery of glucocorticoids as a salvage treatment. Audiological results were compared within the local therapy group and with the results of an historical control group who did not receive salvage treatment. The study and control groups were matched with respect to hearing loss after initial systemic treatment failure. RESULTS: The average pure-tone threshold after intratympanic salvage treatment showed a statistically significant improvement of 15 dB (95% CI 7-24 dB; p<0.001). After exclusion of patients with complete anacusis, i.e. a non-measurable hearing threshold, the local therapy group showed a significantly better improvement (mean 19 dB; 95% CI 6-32 dB) than the historical control group (mean 5 dB; 95% CI -2-11 dB; p<0.05).     

Prognostic factors of profound idiopathic sudden sensorineural hearing loss

Profound idiopathic sudden sensorineural hearing loss is thought to have a poor prognosis, but few studies have focused on this condition. We aimed to assess the impact of patient factors, audiologic parameters, and salvage intratympanic steroid injection therapy on the prognosis of profound idiopathic sudden sensorineural hearing loss. The demographic, clinical, and audiologic data, degree of hearing recovery, and efficacy of intratympanic steroid injection therapy in 576 patients with profound idiopathic sudden sensorineural hearing loss (mean age 56.2 ± 14.9 years) who had been admitted at four tertiary referral centers between 2000 and 2011 were retrospectively reviewed. The mean hearing level at the initial presentation was 108.1 ± 9.5 dB. Many patients experienced vertigo (52.1 %) and tinnitus (77.4 %). At the 2-month follow-up, 172 (29.8 %) patients showed some degree of hearing recovery, but only 21 (3.6 %) patients recovered normal hearing. Further, the 116 patients who had received salvage intratympanic steroid injections showed a better audiologic outcome (improvement, 26.1 ± 24.3 vs. 15.7 ± 22.1 dB; P = 0.000) than those who had not (n = 429). In conclusion, a higher degree of hearing loss at the initial presentation indicates a poorer prognosis. Salvage intratympanic steroid injection therapy may improve the hearing of patients with profound idiopathic sudden sensorineural hearing loss after the failure of systemic steroid therapy.