前期治疗对地塞米松鼓室注射治疗难治性突发性聋的影响

目的观察强的松、舒血宁治疗没有痊愈的突发性聋患者应用地塞米松鼓室内注射后的疗效,以及其疗效是否与前期的不同治疗有关。方法2005年9月-2007年11月门诊突发性聋患者53例（53耳）,分成2组：第一组为激素治疗组（27耳）,第二组为舒血宁治疗组（26耳）。上述治疗后没有痊愈的患者共34耳,给予地塞米松2mg鼓室内注射,一周内注射2次。结果激素治疗组19耳有效（70．4％）,舒血宁治疗组17耳有效（65.4％）,经检验两组疗效没有显著性差异。地塞米松鼓室内注射总有效率38．2％,其中前期激素组7耳有效（41．2％）,前期舒血宁治疗组6耳（35.3％）有效,经检验两组疗效没有显著性差异。结论鼓室内注射地塞米松可以对前期治疗没有痊愈的突发性聋患者有效,疗效与之前是否用激素无关。     

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。     

鼓室内注射地塞米松治疗常规治疗无效的突发性聋

目的观察地塞米松鼓室内注射对常规治疗无效的突发性聋(sudden sensorineural hearingloss,SSNHL)的疗效,并探讨影响突发性聋预后的因素。方法将经过常规治疗无效的患者48例48耳随机分为2组,实验组37例37耳,行地塞米松3~5mg鼓室内注射,隔天注射一次,共注射3次;对照组11例11耳,给予维生素B1、B12口服,用药一周。观察治疗前后纯音听阈的变化情况,并分析性别、年龄、听力损失程度及病程对疗效的影响。结果实验组12例有效,有效率32.43%,对照组无一例有效。实验组治疗有效患者的病程平均天数是33.5±3天,无效患者的平均病程为43±10.7天,二者差异有显著性统计学意义(P<0.001)。听力损失大于90分贝的患者注射后有效率7.69%,小于或等于90分贝的患者注射后有效率为45.83%,二者差异有统计学意义(P<0.05)。结论地塞米松鼓室内给药可以改善部分常规治疗无效的突发性聋患者的听力,尤其是对病程短及听力损失程度较轻的患者有一定疗效。     

经咽鼓管鼓室内灌注地塞米松治疗突发性聋

目的 评价经咽鼓管途径鼓室内灌注地塞米松治疗突发性聋的安全性和疗效.方法 将67例(67耳)突发性聋患者随机分为A组20例(20耳).单纯经咽鼓管鼓室内灌注地塞米松(5 mg/ml)0.6毫升/次;B组23例(23耳),常规全身治疗无效后再经咽鼓管鼓室内灌注地塞米松(5mg/ml)0.6毫升/次;C组24例(24耳),单纯常规全身治疗,比较三组治疗前后受损频率平均听阈变化及咽鼓管功能变化.结果 A、B、C三组有效率分别为85.00%(17/20)、60.87%(14/23)、45.3%(11/24).三组伴随症状耳鸣、耳闷、眩晕都有一定缓解,没有出现中耳炎及耳闷、耳痛等感染症状,鼓室导抗图和咽鼓管吹张实验治疗前后没有明显变化.结论 经咽鼓管途径鼓室内灌注地塞米松治疗突发性聋是安全和有效的,可在临床推广使用.     

鼓室内注射甲强龙治疗不同类型突发性聋的临床疗效及预后影响因素分析

目的　探讨鼓室内注射甲强龙治疗不同类型突发性聋的临床疗效,分析预后影响因素。方法　收集突发性聋患者109例,分低频下降型、高频下降型、平坦下降型 及全聋型。全部用营养神经、改善循环等相同的基础治疗,所有患者从入院当日起每2天甲强龙（40 mg/ml）鼓室内注射1次,每次注射后第2天复查患耳纯音听力,痊愈则停止注射（总注射次数≤5次）。结果　不同类型突发性聋的总疗效差异有统计学意义（P =0.001）,组间两两比较：平坦型与全聋型差异无统计学意义（P＞0.05）,其余两两比较差异均有统计学意义（P＜0.05）;预后影响因素分析显示：年龄（P =0.023）、突发性聋分型（P =0.002）有统计学意义;性别、患耳、耳鸣、耳胀、眩晕、高血压、糖尿病及高压氧无统计学意义（P＞0.05）。结论　甲强龙鼓室内注射治疗低频型突发性聋效果最好,高频型效果最差;预后影响因素中年龄是突发性聋独立的负相关因素。     

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。     

糖皮质激素口服联合鼓室内注射治疗重度和极重度突发性聋

目的　观察糖皮质激素全身应用和鼓室内注射联合治疗重度和极重度突发性聋的临床疗效,以探索糖皮质激素治疗突发性聋的方法。方法　对54例重度和极重度突发性聋患者的临床资料进行回顾性分析,所有患者均给予口服激素、改善微循环、溶栓抗凝等治疗,同意加用鼓室内注射激素的患者为治疗组,其余患者为对照组,治疗2周后复查纯音测听。结果　治疗组和对照组患者平均听阈改善均具有显著统计学意义,但两组之间疗效无差异（P =0.194）。治疗组与对照组中重度突发性聋患者间疗效无差异（P =0.251）,两组中极重度突发性聋患者间疗效也无差异（P =0.380）。结论　糖皮质激素全身应用联合鼓室内注射治疗重度和极重度突发性聋有效,但并不能得到较单独全身用药更好的疗效。     

鼓室内注射地塞米松或甲泼尼龙治疗突发性聋的疗效观察

目的:观察鼓室内注射地塞米松或甲泼尼龙治疗突发性聋的疗效.方法:鼓膜穿刺注入地塞米松(5 g/L)或甲泼尼龙(40 g/L),每日注射1次,7 d为1个疗程.比较地塞米松和甲泼尼龙鼓室内注射前后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:47例突发性聋患者中,鼓室内注射地塞米松组(24例)前后PTA分别为(71.59±27.66)dB HL、(53.44±30.10)dB HL,经配对t检验差异有统计学意义(P<0.01),总有效率为67%.鼓室内注射甲泼尼龙组(23例)前后的PTA分别为(68.64±25.21)dB HL、(55.76±26.42)dB HL,经检验差异有统计学意义(P<0.01),总有效率为43%.经Fisher Exact检验,鼓室内注射地塞米松组和甲泼尼龙组的有效率差异无统计学意义(P>0.05).11例患者经过其他治疗(静脉类固醇药物、扩血管药物或高压氧治疗)后再应用鼓室内注射地塞米松治疗,仍然取得了较好的疗效(P<0.05);13例患者单纯应用鼓室内注射地塞米松治疗,PTA下降较明显,差异有统计学意义(P<0.05).17例患者经过其他治疗再应用鼓室内注射甲泼尼龙治疗,仍然取得了较好的疗效(P<0.01),6例患者单纯应用鼓室内注射甲泼尼龙治疗,PTA虽有下降,但差异无统计学意义(P>0.05).患者未出现鼓室内感染、鼓膜穿孔和听力下降.结论:鼓室内注射地塞米松或甲泼尼龙治疗突发性聋有效,两者之间的疗效比较无明显差异.推荐地塞米松作为鼓室内注射药物治疗突发性聋,并作为突发性聋的初始治疗.     

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。     

耳后注射神经节苷酯联合鼓室内注射甲泼尼龙治疗难治性突发性聋的临床研究

目的 评价鼓室内注射甲泼尼龙联合耳后注射神经节苷酯治疗难治性突发性聋的临床疗效,为难治性突发性聋的治疗提供理论依据。方法 以2019年9月～2022年1月于宜兴市人民医院和淮安市第二人民医院就诊的难治性突发性聋患者98例作为研究观察对象,随机分为观察组49例和对照组49例,观察组给予鼓室内注射甲泼尼龙联合耳后注射神经节苷脂治疗,对照组单纯行鼓室内注射甲泼尼龙治疗,通过随访调查,对两种不同治疗方法的临床效果进行对比分析。结果随访发现观察组患者治愈率明显高于对照组,差异具有显著性（P<0.05）;两组患者不良反应发生率无明显差异,差异无统计学意义（P>0.05）,对照组复发率明显高于观察组,差异显著（P<0.05）。结论 鼓室内注射甲泼尼龙联合耳后注射神经节苷酯较单纯鼓室内注射甲泼尼龙治疗难治性突发性聋效果显著、复发率低,有一定的临床推广价值。     

Effectiveness of intratympanic dexamethasone injection in sudden-deafness patients as salvage treatment

OBJECTIVE: To study the effectiveness of intratympanic dexamethasone (IT-DEX) in patients with severe or profound sudden sensorineural hearing loss (SSNHL) after treatment failure with conventional therapy. STUDY DESIGN: Randomized, controlled study. METHODS: Patients who met the criteria for SSNHL, with a severity of severe to profound, underwent 10 days of standard treatment with oral steroid and other facilitating agents. Patients showing poor response to standard treatment were assigned randomly to a control group or to a group receiving IT-DEX. IT-DEX injections were performed once a week for 3 consecutive weeks. Pure-tone audiometry was obtained before each injection. Minimum follow-up time was 1 month. Successful treatment was defined as a hearing improvement of greater than 30 dB. RESULTS: Thirty-nine patients meeting the inclusion criteria were studied. After treatment with oral steroid, 10 of 39 (26%) patients demonstrated hearing improvement, whereas the remaining 29 (74%) patients showed a hearing improvement of less than 30 dB. For those without hearing improvement, 15 received IT-DEX, and 14 received further standard treatment (except oral steroid and carbogen inhalation). Hearing improved in 8 of 15 (53.3%) compared with 1 of 14 (7.1%), with an average decrease in threshold of 28.4 dB and 13.2 dB for the IT-DEX group and the control group, respectively (P <.05). Prognostic factors such as age, treatment delay time, and sex did not significantly affect the response to therapy. CONCLUSIONS: IT-DEX injection effectively improves hearing in patients with severe or profound SSNHL after treatment failure with standard therapy and is not associated with major side effects. It is therefore a reasonable alternative as salvage treatment.     

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.     

鼓室内灌注醋酸泼尼松龙治疗主观性耳鸣的临床观察

目的探讨鼓室内灌注激素时主观性耳鸣的治疗效果。方法选择病史在1月以上已接受过口服药物治疗的耳鸣患者49例(55耳),随机分为治疗组29例(30耳),鼓室内注入醋酸泼尼松龙,同时口服扩血管药及维生素;对照组20例(25耳),仅口服扩血管药及维生素,观察两组治疗前后耳鸣的变化。结果治疗组中,耳鸣伴突发性聋14耳、老年性聋3耳、噪声性聋2耳、耳硬化症1耳,原因尚不能明确的感音性聋5耳,混合性聋2耳及传导性聋1耳,特发性耳鸣2耳。经过一个疗程的治疗后,耳鸣消失5耳,减轻11耳,有效率53.3%(16/30)。对照组中,仅6耳耳鸣响度减轻,有效率24%(6/25)。结论鼓室内应用皮质类固醇激素能改善主观性耳鸣。     

耳鸣治疗仪联合银杏叶提取物注射液治疗突聋伴耳鸣的疗效分析

目的观察耳鸣治疗仪联合银杏叶提取物注射液对突聋伴耳鸣的疗效。方法选取108例突聋伴耳鸣患者,随机数表法分为观察组与对照组,各54例。对照组应用银杏叶提取物注射液治疗,观察组联合耳鸣治疗仪。比较两组患者的听力总有效率、耳鸣总有效率、治疗前后听阈值与血液流变学指标。结果两组患者听力总有效率比较,观察组(88.89%)高于对照组(66.67%);两组患者耳鸣总有效率比较,观察组(81.48%)高于对照组(61.11%)。治疗1周、2周、4周后,观察组的听阈值均低于对照组。治疗后观察组的全血高切黏度、全血中切黏度、全血低切黏度、血浆黏度、红细胞聚集指数均低于对照组;治疗后观察组的红细胞变形指数高于对照组。结论耳鸣治疗仪联合银杏叶提取物注射液可有效改善突聋患者血液流变,缓解耳鸣症状,提高患者听力。     

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     

Chronological study of recovery of sudden deafness treated with defibrinogenation and steroid therapies.

The time courses of hearing recovery resulting from two types of treatment of sudden deafness patients, defibrinogenation (DF) therapy and betamethazone (BM) therapy, were analyzed and compared. A paired double-blind comparative study was performed on 168 patients. The average hearing level was 79.2 dBHL in the DF therapy group (n = 82) and 82.3 dBHL in the BM therapy group (n = 86). The DF group showed significantly better hearing 1 week after start of treatment at frequencies of 0.25, 0.5 and 1 kHz. After 2 weeks of treatment, the average hearing level for the frequency range of 0.25-4 kHz was 47.0 dBHL with DF therapy and 55.8 dBHL with BM therapy. Thus, the DF group still showed better hearing than the BM group (p less than 0.10, t-test), but not as significantly as after 1 week. It is concluded that therapy for increasing blood circulation is important in the early phase of sudden deafness, especially for hearing loss in the low to middle frequency range.     

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.     

巴曲酶治疗突发性聋的临床分析

目的评估巴曲酶治疗突发性聋的效果。方法180例病因不明的突发性聋患者分为3组,分别为丹参 激素组(对照组),丹参 激素 巴曲酶组,丹参 巴曲酶组(激素治疗禁忌)开展平行对照研究。在药物治疗的同时进行高压氧治疗。结果除去不良反应、治疗依从性差等病例,将剩下的164例进行最终统计,分别为巴曲酶 激素组 丹参58例,巴曲酶 丹参组53例,丹参 激素组53例。结果显示,初始听力表现为下坡型、平坦型、极重度型和全聋型的患者,治疗方式对前三种听力曲线患者预后的影响差异无显著性,而全聋组的病例巴曲酶治疗的两组与激素组之间疗效差异有显著性(巴曲酶 丹参 激素组、巴曲酶 丹参组显效率分别为75%、62.5%,丹参 激素组为28.6%,P<0.005);而巴曲酶治疗的两组之间疗效无显著性差异(P>0.05)。结论全聋型的突发性聋治疗中早期进行巴曲酶降纤治疗,可能会获得较为满意的疗效。     

耳后注射甲强龙作为补救方案在中高频听力下降型突发性聋治疗中的疗效及可行性分析

目的探析中高频听力下降型突发性聋采取耳后注射甲强龙治疗的临床效果及可行性。方法选取2019年5月~2020年7月本院耳鼻喉科就诊的中高频听力下降型突发性聋患者,共纳入病例54例,以随机法分组,即常规组(n=27)和观察组(n=27),常规组予常规治疗,观察组采取耳后注射甲强龙,比较两组效果。结果观察组有效率相比于常规组显著提高(P<0.05);治疗3周后,观察组2000~8000Hz频率听力提高值与常规组比(P<0.05)。结论中高频听力下降型突发性聋采取耳后注射甲强龙治疗效果理想,值得推广。     

巴曲酶联合常规治疗对不同类型突发性聋患者的疗效观察

目的 观察巴曲酶联合常规治疗在不同听力损失类型的突发性聋患者治疗中的临床疗效.方法 回顾性分析121例(135耳)不同听力损失类型的突发性聋患者的临床资料.按照患者病历资料中是否规范地加用巴曲酶治疗将患者分为常规治疗组69例(79耳)与巴曲酶组52例(56耳),常规治疗组应用激素、营养神经、扩血管药物;巴曲酶组在常规治...