经咽鼓管鼓室途径注射地塞米松治疗突发性聋

目的 观察经咽鼓管鼓室注入地塞米松（简称PTIDI）治疗突发性聋（突聋）的疗效。方法 对18例常规方法治疗无效的突聋患者采用经咽鼓管鼓室径路注入地塞米松，首次剂量为5mg，此后，每天重复注药1次，每次5mg，共7次，总剂量35mg，用药期间密切观察记录听力改变，耳鸣和眩晕等情况。结果 18例患者于治疗完成后两周复查纯音测听。痊愈1例；显效5例，0．25-4kHz听阈平均提高50．2dB；有效1例，平均提高19dB；无效11例；有效率为38．9％（7／18）。结论 PTIDI治疗突聋疗效好，操作方便，避免全身用药可能产生的不良反应，为常规方法治疗无效的突聋患者提供了再次治疗的机会。     

Intratympanic steroids in severe to profound sudden sensorineural hearing loss as salvage treatment

Objectives

Intratympanic steroids are being increasingly used in the treatment of sudden sensorineural hearing loss (SSNHL) after the failure of systemic therapy. This study evaluated the efficacy of administering intratympanic dexamethasone (ITD) as a salvage treatment for severe to profound SSNHL.

Methods

We reviewed the medical records of patients who presented with severe to profound SSNHL between January 2007 and December 2009. ITD was given about 14 days after the initial systemic treatment. Successful recovery was defined as complete or partial recovery using Sigel''s criteria. We compared the results of treatment between the severe SSNHL (S-SSNHL) and profound SSNHL (P-SSNHL) groups.

Results

All the patients in the S-SSNHL group showed significant improvement, as compared to the P-SSNHL group (P=0.017). The recovery rate after the initial systemic treatment was 36% (9/25) in the S-SSNHL group and 18.1% (4/22) in the P-SSNHL group (P=0.207). In comparison, the recovery rate of ITD as a salvage treatment was 37.5% (6/16) in the S-SSNHL group and 5.5% (1/18) in the P-SSNHL group (P=0.03).

Conclusion

Our comparative study dose not support the efficacy of ITD as salvage treatment for patients with P-SSNHL as compared with that for S-SSNHL. We recommend that patients with P-SSNHL be informed about the low efficacy of ITD as a salvage treatment.     

Sudden sensorineural hearing loss treated with intratympanic dexamethasone injection

Objective To evaluate the effect of different protocols of intratympanic dexamethasone injection in patients with unilateral sudden sensorineural hearing loss (SSNHL) who have failed to respond to typical medical treatment (including systemic steroid treatment). Methods From January 2005 to January 2008, 71 patients who were diagnosed with unilateral SSNHL and failed typical medical treatment received intratympanic dexamethasone injection. Four injection protocols were employed: injection of 0.3 ml dexamethasone(5 mg/ml) three times a week for 3 weeks for a total dose of 13.5 mg (Group Ⅰ, n=16); injection of 0.6 ml (5 mg/mi) dexamethasone three times a week for 3 weeks for a total dose of 27 mg (Group Ⅱ, n=18); injection at 0.3 ml(5 mg/ml) week for 6 weeks for a total dose of 9 mg (Group Ⅲ, n=18); injection at 0.3 ml (5 mg/ml)/2 days for a total dose of 4.5 mg (Group IV n=19). Hearing recovery was assessed by pure tone audiogram. Results The total effective rate was 37.5%,38.89%, 33.33% and 36.84% for each treatment protocol, respectively, with no statistical difference between them (P>0.05). The results suggest that a total dose of 4.5 mg (injected once a week for 3 weeks) is the most adequate protocol, and increasing dose or injection frequency yields no additional benefits. Conclusion Intratympanic dexamethasone significantly improves the prognosis of SSNHL. Small dose at low injection frequency is sufficient.Further malticenter studies are needed to determine the standard treatment protocol.     

鼓室灌注地塞米松治疗难治性突发性感音神经性聋临床分析

目的观察和比较鼓膜穿刺、鼓膜置管和圆窗置管微泵灌注地塞米松3种方法治疗难治性突发性感音神经性聋的疗效。方法55例常规方法治疗无效的突聋患者作为研究对象,其中圆窗置管微泵灌注用药治疗21例(置管组),每次2.5mg/0.5ml,维持1小时,每天两次,连续给药7天,总剂量35mg;鼓膜穿刺注药23例(穿刺组),首次剂量为2.5mg,此后,每2天重复注药1次(每次2.5mg),共4次,总剂量10mg;鼓膜切开置管滴药11例(滴药组),首次剂量为0.5%地塞米松0.5ml,经通气管滴入鼓室,每天重复滴药2次(每次2.5mg),共7天,总剂量32.5mg。同期常规方法治疗无效的32例突聋患者,且拒绝鼓室用药者随访作为对照(对照组),比较各组听力恢复及并发症情况。4组治疗前听力无显著差异(P>0.05)。结果治疗完成后1月纯音测听检查:置管组、穿刺组和滴药组平均PTA分别提高9dB、8.6dB和1.7dB,前2组明显高于对照组1.4dB(P<0.05),置管组8例(38.1%)听力改善约15～56dB,无效13例;穿刺组8例(34.8%)听力改善约16～54dB,无效15例;滴药组1例(9.1%)听力改善约26dB,无效10例;对照组3例(9.4%)听力改善约15～36dB,无效29例。结论鼓室灌注地塞米松治疗难治性突聋方法安全有效,为用常规方法治疗无效的突聋患者,提供了再次治疗的机会。     

鼓室置管灌注甲泼尼龙治疗难治性突发性聋的听力疗效再分析

目的 探讨经耳道鼓室置管灌注甲泼尼龙治疗难治性突发性聋(sudden sensorineural hearing loss,SSNHL)的安全性和有效性.方法 对常规治疗至少一个疗程(10天)无效的SSNHL,根据病人的意愿分成灌注组和对照组分别继续治疗10天.灌注组给予鼓室置管灌注甲泼尼龙+常规治疗,对照组继续常规治疗,比较治疗结束后3个月时两组的听力改善结果.结果 灌注组26例和对照组23例,两组的有效率分别是50.0%和21.7%,继续治疗前后PTA改善分别是16.7 dB和9.2 dB,两组比较灌注组的有效率高于对照组(P=0.041); 若仅将发病至继续治疗的时间间隔≤60天的病例纳入分析,则灌注组为21例,对照组仍为23例,有效率分别是61.9%和21.7%,PTA改善分别为20.2 dB和9.2 dB,灌注组均优于对照组(P_(有效率)=0.007,P_(PTA 改善)=0.011);鼓室灌注前后低频区(0.25 kHz,0.5 kHz)、中频区(1 kHz、2 kHz)和高频区(4 kHz、8 kHz)的听阈分别改善19.8 dB、16.0 dB和13.4 dB,低频区听力改善大于高频区(P=0.046).结论 鼓室置管灌注甲泼尼龙联合常规治疗用于难治性SSNHL是安全的、有效的,疗效优于继续常规治疗,且低频区的听力改善优于高频区,发病后宜尽早采用.     

The effect of intratympanic steroid injection frequency in idiopathic sudden sensorineural hearing loss

Purpose

To evaluate the effect of intratympanic steroid injection frequency on hearing outcomes for patients with idiopathic sudden sensorineural hearing loss.

鼓室内注射治疗难治性突发性耳聋52例

目的 探讨鼓室内注射激素作为难治性突发性耳聋的补救治疗措施的临床疗效。方法 重度及极重度突发性耳聋患者96例,接受常规治疗加全身应用激素2周效果不佳,其中52例接受鼓室注射激素,另外44例拒绝鼓室内注射而继续口服药物治疗。纯音测听法(PTA)检测患者补救治疗前后听力,比较气导听阈(0.5、1.0、2.0、4.0 kHz四个频率气导之平均值),分析两组患者补救治疗前后听力结果。结果 鼓室注射组听力提高10 dB以上的患者16例,有效率为30.8%;而对照组仅有3例,有效率为6.8%。两组听力改善值之间的差异有统计学意义(P<0.01)。结论 鼓室内激素注射对突发性耳聋常规治疗无效的患者有良好的疗效,可以作为一种补救治疗措施。     

强的松龙联合鼓室注射地塞米松治疗双耳突发性感音神经性聋临床疗效

目的本研究旨在分析注射强的松龙同时鼓室内注射地塞米松治疗双侧突发性感音神经性聋(SSNHL)的临床疗效。方法回顾性分析2007年3月至2020年3月就诊于我院同期治疗的双侧SSNHL病例。早期(2007年3月至2012年2月),这些病例仅用静脉注射泼尼松龙治疗,并分为A组。晚期(2012年2月至2020年3月),采用静脉强的松龙治疗联合鼓室内注射地塞米松治疗双侧SSNHL,这些患者被纳入B组。比较了A组和B组两种治疗方式的有效率。结果A组痊愈3耳,有效4耳,有效率为17.5%(7/40耳)。相比之下,B组痊愈6只,有效10只,有效率为36.4%(16/44只)。两组有效率有显著性差异。结论静脉注射强的松龙同时鼓室内注射地塞米松治疗双侧SSNHL是较好选择。     

Comparison of intratympanic dexamethasone therapy and hyperbaric oxygen therapy for the salvage treatment of refractory high-frequency sudden sensorineural hearing loss

Objective

This study aimed to compare the efficacy of intratympanic dexamethasone (ITD) therapy and hyperbaric oxygen(HBO) therapy for the salvage treatment of patients with high-frequency sudden sensorineural hearing loss (SSNHL) after the failure of conventional therapy.

Intratympanic injection of dexamethasone after failure of intravenous prednisolone in simultaneous bilateral sudden sensorineural hearing loss

Purpose

This study aimed to analyze outcomes of intratympanic injection of dexamethasone after failure of intravenous prednisolone in simultaneous bilateral sudden sensorineural hearing loss (SSNHL).

妊娠期突发性聋的临床特点及预后

目的分析妊娠期突发性聋的临床特点及预后,并探讨其治疗方案,提高临床医师对该病的认识。方法收集2013年1月~2017年1月在南华大学附属第一医院诊断并住院治疗的16例妊娠期突发性聋患者的一般临床资料。16例患者均为单侧发病,左侧8耳,右侧8耳;3例妊娠早期发病,7例妊娠中期发病,6例妊娠晚期发病;10例伴有耳鸣,4例伴有眩晕,患者入院平均听阈为（64.45±27.83 ）dBHL,所有患者入院后均予低分子右旋糖酐静脉滴注及鼓室内注射地塞米松治疗。结果治疗后平均听阈为（46.48±29.81）dBHL,平均听阈改善值为（17.34±15.70） dBHL,与治疗前比较差异具有统计学意义（P<0.05）。痊愈5耳,显效2耳,有效6耳,无效3耳。结论妊娠期突发性聋常发病于妊娠中晚期,听力损失较重且常伴有耳鸣,听力曲线以全聋型和平坦型为主;给予鼓室内注射地塞米松联合低分子右旋糖酐静脉滴注治疗安全有效。     

Intratympanic steroid delivery by an indwelling catheter in refractory severe sudden sensorineural hearing loss

Objective

Many studies over the last decade showed favorable outcomes with intratympanic (IT) steroid treatment, alone as salvage treatment or in combination with conventional systemic therapy (ST). However, in severe to profound sensorineural hearing loss resistant to ST, the optimal infusion mode, the type and concentration of the solution, the preferable drug, its total amount, and the duration and fractionation of the treatment are still debated. Aim of the study was to investigate the feasibility and the outcomes of a direct and constant IT delivery of dexamethasone (DEX) by means of a new indwelling catheter.

Frequency-specific efficacy of intratympanic steroid on idiopathic sudden sensorineural hearing loss

Abstract

Background: Hearing recovery would be different in each sound frequency in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

Aims/objectives: To analyze frequency-specific efficacy of intratympanic steroid on ISSNHL.

Materials and methods: Of a total of 381 patients with ISSNHL (hearing threshold ≥40?dB; ≤30?days until treatment), 174 patients (174 ears) received systemic steroid plus hyperbaric oxygen therapy (HBO group), and 207 patients (208 ears) received systemic plus intratympanic steroid (IT group). Hearing thresholds at 125–8000?Hz were measured at every octave before and after treatment.

Results: % of patients with hearing gains ≥10?dB in the IT group was significantly higher for 500?Hz and the average of 5 mid-frequencies, tended to be higher for 1000?Hz, but was significantly lower for 8000?Hz, compared to the HBO group. Multiple regression analysis showed that hearing recovery was negatively correlated with patients’ age for 125/2000/4000/8000?Hz and with days from onset to treatment for all frequencies, and also revealed better hearing recovery at 500/1000?Hz in the IT group than in the HBO group.

Conclusions: Intratympanic steroid is more effective than hyperbaric oxygen to yield better hearing outcomes at mid-frequencies and would be advantageous to restore sound/speech perception.

Significance: Superiority of intratympanic steroid over hyperbaric oxygen for treating ISSNHL was verified.     

Idiopathic sudden sensorineural hearing loss and acute low-tone sensorineural hearing loss: a comparison of the results of a nationwide epidemiological survey in Japan

Abstract

Objectives: The aim of this study was to investigate the differences between idiopathic sudden sensorineural hearing loss (SSNHL), and acute low-tone sensorineural hearing loss (ALHL) using the results of a nationwide survey database in Japan and to analyze the variables associated with their clinical features and the severity of hearing impairment, treatment, and prognosis.

Methods: Participants were patients registered between April 2014 and March 2016 in a multicenter epidemiological survey database involving 30 university hospitals and medical centers across Japan. Statistical analysis was performed to clarify the factors associated with their clinical characteristics and the severity of hearing impairment, treatment, and prognosis.

Results: Idiopathic SSNHL and ALHL differed significantly in terms of male-to-female ratio, age distribution, and time from onset to start of treatment. The treatment methods and hearing prognosis also differed markedly between the two diseases. A majority (92%) of idiopathic SSNHL patients were administered some type of corticosteroid, while half of the ALHL patients received corticosteroids and a diuretic agent.

Conclusion: The results suggested that idiopathic SSNHL and ALHL belonged to different categories of inner ear disease.     

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...     

Current concepts in the diagnosis and treatment of sudden sensorineural hearing loss

Sudden hearing loss (SHL) has been a controversial topic in the literature for the past several decades. Although much theoretical work has been done regarding its diagnosis and treatment, no useful practical guidelines exist for application to current patient management. Many authors have discussed the various treatment protocols available to treat this entity, but only a handful of dated, clinical studies supporting these treatments are available. More recent studies applying treatment protocols including vasodilators, plasma expanders, anti-coagulants, and carbogen inhalations have shownno improvement over the rate of spontaneous recovery without therapy. Except in cases of therapy directed toward known predisposing factors, there is insufficient evidence in the literature to support medical treatment for SHL, although steroid therapy appears to be useful in selected patients. Our own review of 14 patients with SHL is presented. A standard diagnostic and therapeutic approach based on a comprehensive review of the literature is described that can be applied to most patients presenting with SHL.     

Chikungunya virus induced sudden sensorineural hearing loss

The aim of this study is to demonstrate the association of Chikungunya virus and sudden sensorineural hearing loss. In the case report described we had a case which developed sudden unilateral sensorineural hearing loss following chikungunya fever. A 15-year-old female presented to us with the complains of unilateral sudden onset of hearing loss following an episode of fever, arthralgia and rashes 1 month ago. At the time of these symptoms there were many cases of chikungunya fever in the city, three being in her locality. Clinically Chikungunya fever was suspected and a positive serological test further confirmed our diagnosis. The hearing loss could thus be attributed to Chikungunya virus. Viruses have always been implicated in causing sudden sensorineural hearing loss but Chikungunya virus as a cause has not been documented earlier making this case report a unique one.     

鼓室注射甲泼尼龙琥珀酸钠治疗突聋

目的观察甲泼尼龙琥珀酸钠鼓室途径给药治疗系统疗法无效的突发性聋患者的疗效，探索突聋预后影响因素。方法经全身系统治疗无效的突聋患者42例，采用鼓膜穿刺法注入40mg／ml甲泼尼龙琥珀酸钠0．3-0．5ml，隔日1次，连续应用3-7次。比较鼓室注射前后0．5-4kHz气导纯音听阈均值差异，分析相关因素对预后的影响。结果鼓室内注射疗法治疗前后，全组病例气导平均听阂分别为（66．48±17．03）dBHL和（49．9±20．93）dBHL，治疗前后平均听阈差异明显（P〈0．01）；其中19例有效，总有效率为45．2％。听力损失程度、伴有眩晕与否及发病后鼓室注射疗法开始时间等因素对预后影响明显。结论甲泼尼龙琥珀酸钠鼓室注射疗法治疗突聋安全有效，可以作为经全身系统治疗无效突聋患者的后续治疗选择。一般治疗无效者，应尽早采用本疗法。     

Efficacy of intratympanic corticosteroid,intravenous batroxobin and combined treatment for sudden sensorineural hearing loss with type-2 diabetes

Background: Intratympanic corticosteroid (IC), intravenous batroxobin (IB) as the treatment for sudden sensorineural hearing loss (SSNHL) has been reported. However, the data on combination therapy (CT) was scarce.

Objective: The aim of this retrospective study was to compare the efficacy of IC, IB, and CT in the treatment of SSNHL with diabetes.

Material and Methods: A total of 212 SSNHL patients with diabetes, who were initially treated within 14 days of onset of disease, were divided into three groups by treatment modality. The hearing recovery was evaluated by the results of pure-tone test after completion of treatment. The prognostic factors, including age, severity of initial hearing loss, duration to onset of treatment, and audiometric curve type, were further compared.

Results: There was a significant difference in hearing recovery by the treatment (p?<?.05). Recovery rates in the CT group were significantly higher in patients with early treatment than with delayed treatment (p?=?.021). However, duration and recovery rate was not significantly correlated in IC and IB group (p?>?.05). In patients recieving early treatment, the recovery rate in CT group was significantly higher than that in IC (p?=?.013) and IB group (p?=?.029). Regardless of treatment, the recovery rates were higher in patients with flat and ascending audiograms (p?<?.05).

Conclusions and Significance: Patients receiving combined therapy, especially in the early stage of SSNHL, could achieve significantly superior recovery in the treatment of SSNHL with diabetes, compared with those using IC or IB alone.