低压脉冲发生器治疗梅尼埃病的短期临床观察

目的通过低压脉冲发生器治疗顽固性梅尼埃病的短期临床观察，评价该方法的有效性和安全性，为其长期临床治疗提供依据。方法采用自身对照方法，对18例顽固性、活动性梅尼埃病患者患侧耳鼓膜置管及低压脉冲发生器治疗8周的效果进行观察。运用症状卡和6点功能评分进行眩晕发作和活动状况的主观评分；采用纯音测听、耳蜗电图和双温试验进行听力学和前庭功能评价。结果18例患者低压脉冲治疗后较治疗前眩晕程度、发作频率、发作日及6点功能评分明显改善，差异有统计学意义（P〈0．05）；治疗后8周较治疗前耳蜗电图-SP／AP比值明显减低，差异有统计学意义（P〈0．05），双温试验水平半规管功能无明显变化；2例患者治疗后4周较治疗前纯音测听0．5、1、2．3kHz平均听阈改善≥10dB，16例患者听阈无明显变化；12例患者治疗后8周较治疗前听阈改善≥10dB，6例患者听阈无明显变化；平均6个月观察期内无明显并发症。结论低压脉冲发生器的短期治疗可以控制梅尼埃病眩晕症状、改善听力水平、无明显并发症及副作用。该方法可以安全、有效、非结构破环性地治疗梅尼埃病，可用于顽固性梅尼埃病外科手术及鼓室注药治疗前。

Clinical short-term effect of Meniett pulse generator for Meniere disease

OBJECTIVE: To investigate the short-term efficacy and safety of transtympanic pressure treatment in the management of recalcitrant vertigo in Meniere disease in order to lead to the further long-term treatment. METHODS: Using cross-sectional case study, eighteen patients with medically intractable and active Meniere disease were opted to manage with Meniett pulse generator. A standard ventilation tube was inserted in the affected ear and the treatment period with Meniett pulse generator was 8 weeks. Patients indicated on the symptom report card and six-point functional scale the maximum level of vertigo, activity and stress. Hearing was assessed by pure tone average thresholds (PTA), moreover, electrocochleogram and vestibular calorics were performed. RESULTS: Of eighteen patients, the changes of vertigo severity, vertigo frequency, sick day and six-point functional scale between after and before treatment with Meniett were statistically significant (P < 0.05), moreover, the changes of--SP/AP between after and before treatment with Meniett were statistically significant (P < 0.05). No change in vestibular function was noted. Two of 18 patients showed a significant PTA increase of 10dB or more and hearing was stable in the remainder of patients 4 weeks after treatment with Meniett. Twelve of 18 patients showed a significant PTA increase of 10dB or more and hearing was stable in the remainder of patients 8 weeks after treatment with Meniett. There were no complications during 6-month follow-up with Meniett. CONCLUSIONS: Meniett seemed to be a safe, effective and non-destructive level of therapy, which could reduce vertiginous symptoms and functional handicap and showed an improvement of hearing in patients with medically intractable Meniere disease. This method was recommended before attempting any surgical or chemical vestibular ablation procedure.