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。     

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。     

地塞米松鼓室内注射治疗难治性突发性感音神经性聋

目的：观察鼓室内地塞米松注射（IDI）治疗难治性突发性感音神经性聋（突聋）的疗效。方法：25例常规方法治疗无效的突聋患者采用IDI,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。用药期间密切观察记录听力改变、耳鸣和眩晕等情况。结果：2例失访,23例治疗完成后1个月纯音测听检查：显效3例,0．25～4．00kHz听阈平均提高48．5dB;有效5例,平均提高18．5dB;无效15例;有效率为34．8％（8／23）。结论：IDI治疗突聋,能保证药物高浓度作用于内耳,避免全身用药可能产生的不良反应;治疗操作不复杂,创伤性小,为常规方法治疗无效的突聋患者提供了再次治疗的机会。     

鼓室注射地塞米松治疗突发性聋

目的：报告鼓室注射地塞米松治疗突发性感音神经性聋（突聋）的疗效。方法：对1例双耳突聋患者行鼓室注射地塞米松治疗。结果：双耳纯音气导听阈下降40dB以上。结论：鼓室注射地塞米松是治疗突聋的有效方法。     

鼓室内注射地塞米松治疗突聋的临床研究

目的:观察鼓室内注射地塞米松治疗突聋的临床效果。方法:对21例突聋患者采用鼓膜穿刺注入5 g/L地塞米松1 ml治疗,每日1次,7 d为1个疗程。比较地塞米松鼓室内注射前后4个频率(500、1 000、2 000、4 000 Hz)气导纯音听阈均值(PTA),下降10 dB以上为有效。结果:21例患者鼓室内注射地塞米松前后PTA分别为(65.65±24.73)dB HL和(50.25±25.59)dB HL,有明显下降,P<0.01。10例有效,11例无效,总有效率为47.6%。对发病至治疗的时间短、不伴眩晕的突聋患者应用鼓室内注射地塞米松治疗效果好。本组病例未出现鼓室内感染、鼓膜穿孔和听力下降。结论:鼓室内注射地塞米松治疗突聋安全、有效,发病至治疗的时间以及是否伴有眩晕是影响预后的因素。     

鼻内镜下经咽鼓管鼓室内注入地塞米松辅助治疗难治性突发性耳聋

目的 探讨鼻内镜下经咽鼓管鼓室内注入地塞米松辅助治疗突发性聋(SSNHL)的疗效.方法 对20例常规方法治疗无效的SSNHL患者采用鼻内镜下经咽鼓管鼓室径路注入地塞米松,首次剂量为5 mg,此后每天重复注药1次,每次5 mg,共7～10次,总剂量35 ～ 50 mg,用药期间密切观察记录听力改变、耳鸣及眩晕等情况.结果 20例于治疗完成后复查纯音电测听,痊愈1例;显效3例,听阈平均提高32 dB;有效5例,听阈平均提高18 dB;无效11例;有效率为45％(9/20).结论 鼻内镜下经咽鼓管鼓室内注入地塞米松辅助治疗SSNHL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SSNHL患者提供了再次治疗的机会.     

经鼓室插管注入地塞米松液治疗突发性耳聋

目的通过中耳直接给予类固醇激素治疗突发性感音神经性聋(突聋),探索其疗效。方法对25例突聋病人通过鼓室插管,将地塞米松液注入鼓室,使药液经圆窗膜渗入内耳,称之为鼓室插管组;另25例以口服强地松者作为对照组,将两组疗效进行对比。结果插管组痊愈7例,显效5例,有效10例,无效3例,总有效率88.0%;对照组痊愈2例,显效5例,有效6例,无效1 2例,总有效率52.0%。两组疗效比较,差异有统计学意义(P<0.05)。结论经鼓室插管中耳给药治疗突聋,具有较好的疗效,避免了全身用药的毒副作用。     

地塞米松鼓室内灌注治疗突发性聋

目的观察鼓室内灌注地塞米松治疗突发性聋的效果。方法 126例（151耳）突聋患者分为初始治疗组和挽救治疗组,初始治疗组再分为鼓室给药组（A组,42耳）和全身给药组（B组,34耳）,挽救治疗组再分为鼓室给药组（C组,40耳）和全身给药组（D组,35耳）,鼓室给药组鼓室灌注地塞米松,全身给药组静脉滴注地塞米松,治疗2周后复查听力,比较疗效。结果在初始治疗组中,A组37耳有效,5耳无效,总有效率88.1%（37/42）;B组21耳有效,13耳无效,总有效率61.8%（21/34）,A组疗效显著高于B组（P〈0.05）;在挽救治疗组中,C组23耳有效,17耳无效,总有效率57.5%（23/40）;D组9耳有效,26耳无效,总有效率25.7%（9/35）,C组疗效显著高于B组（P〈0.05）。结论鼓室灌注地塞米松作为突发性聋的初始治疗和挽救治疗方法较静脉全身给药有更好的治疗效果。     

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。     

鼓室置管灌注甲泼尼龙挽救性治疗突发性聋的疗效观察

目的探讨经鼓室置管灌注甲泼尼龙挽救性治疗突发性聋的疗效。方法选择常规治疗至少一个疗程(10天)无效的突发性聋患者,根据患者的意愿分成两组:治疗组19例(19耳),对照组20例(20耳),治疗组鼓室置管灌注甲泼尼龙20mg,每日1次,同时两组均继续常规治疗,但不再继续全身应用糖皮质激素;两组均继续治疗10天。治疗后第3个月比较两组的听力恢复情况。结果治疗组:痊愈2例,显效3例,有效4例,无效10例,总有效率47.4%,受损频率PTA平均改善14.0±16.0dB;对照组:显效1例,有效4例,无效15例,总有效率25.0%,受损频率PTA平均改善6.4±10.2dB,两组总有效率及平均PTA改善值比较,差异均无统计学意义(P=0.262,P=0.083)。治疗组发病至开始灌注的平均时间间隔50.2±55.4天;对照组发病至继续常规治疗的平均时间间隔:13.8±3.3天,治疗组长于对照组(P<0.05);治疗组内有效组和无效组的发病至开始灌注的平均时间间隔分别为23.5±14.6、13.8±3.3天,有效组短于无效组(P<0.05)。仅将发病至继续治疗的时间间隔≤60天的病例纳入分析,则实验组和对照组的受损频率平均PTA改善值分别是16.8和6.4dB,实验组优于对照组(P=0.029)。治疗组未发生永久性鼓膜穿孔、听力损失进一步加重等并发症。结论常规治疗无效后尽早选择鼓室置管灌注甲泼尼龙挽救性治疗突发性聋是安全的,可能会获得一定的有效率。     

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.     

Analysis of 101 patients with severe to profound sudden unilateral hearing loss treated with explorative tympanotomy and sealing of the round window membrane

The aim of this retrospective study was to evaluate the effect of sealing of the round window membrane in patients with severe to profound unilateral sudden sensorineural hearing loss (SSNHL). 101 Patients with unilateral SSNHL were treated with tympanotomy and sealing of the round window membrane if hearing did not improve after conservative treatment. Preoperative and postoperative pure tone audiograms after removal of the ear packing were evaluated. A 4-PTA (pure tone audiometry) was used as reference value. The improvement of 4-PTA was analysed; in addition, recovery was evaluated using Siegel’s criteria. Mean initial hearing threshold was 101.1 dB. Eighty-one patients had a hearing threshold of 80 dB or more. The average improvement at the time of ear packing was 21.7 dB and a further average recovery of 13.4 dB was recorded in the follow-up. Patients who underwent rapid tympanotomy within 5 days showed a significantly better hearing improvement than patients with delayed tympanotomy (26.9 vs. 14.0 dB, p < 0.02). Age was significantly correlated with the degree of hearing improvement. There was no significant difference of recovery between patients with detected lesions of the round window membrane and those without. Concomitant vertigo and tinnitus showed no significant effect on recovery. Tympanotomy and sealing of the round window membrane is effective in the treatment of severe to profound SSNHL. There is evidence that early surgery performed within 5 days is more effective than later surgery. The existence of a detectable lesion of the round window membrane has no significant influence on recovery.     

Intratympanic steroid therapy for refractory sudden sensory hearing loss: a 12-year experience with the Silverstein catheter

Background: Sudden sensorineural hearing loss (SSNHL) is commonly encountered in clinical practice.

Aim/Objective: Determine if local administration of corticosteroids to the inner ear can improve hearing and speech intelligibility after the failure of conventional treatment for SSNHL loss when administered for 10 days after the onset of the hearing loss in a large cohort of 77 patients.

Materials and methods: A Silverstein MicroWick? was placed under local anesthesia and endoscopic control in the round window niche, allowing self-administration of methylprednisolone twice daily for four weeks.

Results: An improvement of the pure tone average was shown in 31% of patients. Speech intelligibility improved significantly in 55% of the total cohort and in 34% of the population with a stable pure tone average. Among the 77 patients, 22% used a hearing aid. Only 14% of the patients were hearing-aid users in the group with an improvement in speech intelligibility as opposed to 31% in the failure group.

Conclusion and significance: Local administration of steroids to the inner ear through the round window route improves hearing and speech intelligibility in patients after failure of conventional therapy. The use of a hearing aid was reduced by 50% when speech intelligibility was improved.     

Topical steroid therapy using the Silverstein Microwick in sudden sensorineural hearing loss after failure of conventional treatment

CONCLUSIONS: Local administration of steroids to the inner ear through the round window route improves hearing in patients after failure of conventional therapy. OBJECTIVES: To determine if delivery of methylprednisolone to the round window can improve hearing after failure of conventional treatment for sudden sensorineural hearing loss (SSHL) administered for 10 days after the onset of the hearing loss. PATIENTS AND METHODS: A Silverstein microwick was placed in the round window niche under local anesthesia and endoscopic control, allowing self-administration of methylprednisolone twice a day for 3 weeks. Treated patients were compared to a control group composed of similar patients, treated with the same systemic regimen but who did not receive local therapy. RESULTS: Of the 12 patients enrolled in this nonrandomized prospective study, 8 patients showed an improvement of the pure tone average (PTA) and 4 remain stable. Of those who responded to perfusion, eight patients demonstrated a significant mean 24.5 +/- 12 dB improvement in PTA, and seven patients had a mean 17.5 +/- 18% improvement in discrimination, with five patients reaching 100% speech discrimination score (SDS). Patients in the control group did not show any improvement of the PTA.     

Comparison of intratympanic and intravenous dexamethasone treatment on sudden sensorineural hearing loss with diabetes.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of intratympanic administration of dexamethasone (IT-DEX) treatment on sudden sensorineural hearing loss (SSNHL) patients with diabetes by comparing the results with intravenous administration of dexamethasone (IV-DEX) treatment. STUDY DESIGN: Comparative study. SETTING: University hospital and affiliated hospital. PATIENTS: Ten sequential SSNHL patients with diabetes receiving IT-DEX and 21 sequential SSNHL patients with diabetes receiving IV-DEX. Patients with low tone hearing loss were excluded. INTERVENTION: In the IT-DEX group, two methods were applied to deliver DEX (4 mg/ml): injection through a perforation made by laser-assisted myringotomy or through a tympanostomy tube. IT-DEX administration was performed on 8 sequential days. In the IV-DEX group, DEX was administrated intravenously starting from an amount of 8 mg/d followed by taped doses for 10 days. MAIN OUTCOME MEASURES: Preprocedure and postprocedure hearing levels and complications. RESULTS: In the IT-DEX group, the average hearing level before the treatment was 79 dB. Overall, all 10 patients showed improvement of more than 10 dB in the pure-tone audiogram, with a mean improvement of 41 dB. Seven patients (70%) demonstrated successful results, and four recovered completely. In the IV-DEX group, 14 (67%) of the 21 patients showed improvement of more than 10 dB with a mean improvement of 25 dB. Thirteen patients (62%) demonstrated successful results. Free blood sugar during and after the IT-DEX treatment remained below the pretreatment levels, whereas four patients in the IV-DEX group demonstrated worsening of the hyperglycemia. CONCLUSION: IT-DEX treatment is at least as effective as IV-DEX treatment for SSNHL patients with diabetes.     

Sudden sensorineural hearing loss: does application of glucocorticoids make sense?

BACKGROUND: Treatment of sudden sensorineural hearing loss (SSNHL) consists of administration of blood flow-promoting drugs with or without the addition of glucocorticoids. General guidelines based on scientific data do not currently exist. OBJECTIVE: To investigate the effect of glucocorticoids on the treatment of SSNHL. SETTING: Academic medical center. PATIENTS AND METHODS: We retrospectively analyzed the audiograms of 603 patients with SSNHL: 301 patients (cared for between January 1, 1986, and December 31, 1991) received intravenous blood flow-promoting drugs without glucocorticoids and 302 patients (cared for between January 1, 1992, and December 31, 1998) received intravenous blood flow-promoting drugs with glucocorticoids (intravenous +/- oral application). The age distribution of patients with SSNHL in lower, middle, and higher frequencies was similar in both groups. RESULTS: Patients with SSNHL in lower and middle frequencies (250-2000 Hz) who received glucocorticoids (prednisolone-21-hydrogen-succinate) showed significantly better recovery of hearing levels compared with those who did not receive glucocorticoids (P<.05). There was no significant difference at higher frequencies between the 2 groups. Patients with SSNHL throughout all frequencies (pancochlear hearing loss) who received glucocorticoids also had significantly better recovery of hearing levels compared with those who received blood flow-promoting drugs alone (P<.05). Also, patients with elevated blood sedimentation rates had better improvement of their hearing levels after receiving glucocorticoids. CONCLUSIONS: Administration of glucocorticoids should be recommended for treatment of patients with SSNHL. In particular, patients with SSNHL in the lower and middle frequency range and pancochlear hearing loss have significantly better recovery of hearing levels.     

Therapeutic effectiveness over time of intratympanic dexamethasone as salvage treatment of sudden deafness

CONCLUSION: Intratympanic dexamethasone (ITD) within 1 month after initial treatment failure should be utilized as salvage treatment for refractory sudden sensorineural hearing loss (SSNHL). OBJECTIVE: To investigate the therapeutic efficacy over time of ITD as salvage treatment in SSNHL. MATERIALS AND METHODS: We retrospectively reviewed the medical records and audiograms of 99 SSNHL patients who were refractory to 2 weeks of oral steroid treatment, from August 2003 to October 2006. Patients were divided into those receiving no further treatment (control group) and those receiving ITD within 2 weeks (early-ITD), between 2 weeks and 1 month (mid-ITD), and between 1 and 2 months (late-ITD) after initial treatment failure. ITD was performed in the supine position on four separate occasions over the course of 2 weeks. Final assessment of hearing was carried out 3 months after outbreak of SSNHL. Hearing improvement was defined as a > 15 dB decrease in four-tone average (FTA). RESULTS: Overall hearing improvement was observed in 8 of 50 (16.0%) control patients, 7 of 16 (43.8%) early ITD patients, 6 of 20 (30.0%) mid ITD patients, and 2 of 13 (15.4%) late ITD patients.