两种激素鼓室内灌注治疗主观性耳鸣的近期临床观察

目的:探讨鼓室内灌注醋酸泼尼松龙和地塞米松治疗主观性耳鸣的疗效。方法:选择病史在1个月以上已接受过口服药物治疗的主观性耳鸣患者73例(78耳),醋酸泼尼松龙组鼓室灌注醋酸泼尼松龙注射液,地塞米松组鼓室灌注地塞米松注射液,对照组口服卡马西平。3组均同时口服甲磺酸倍他司汀片、维生素B1片和甲钴胺片。所有患者在治疗前、治疗结束时再次行纯音测听和耳鸣匹配测试,随访6个月。结果:73例患者(78耳)均完成全部的治疗及随访。治疗结束时,醋酸泼尼松龙组、地塞米松组、对照组耳鸣治疗有效率分别为48.6%、33.3%、44.0%;6个月后3组的耳鸣控制率分别是45.7%、27.8%、36.0%。结论:鼓室内应用激素能改善主观性耳鸣,对口服药物无效的患者可以选用鼓室灌注类固醇激素。

A short term study on the efficacies of intratympanic prednisolone and dexamethasone injection for subjective tinnitus

Objective:To study the efficacies of intratympanic prednisolone and dexamethasone injection for the subjective tinnitus.Method:A prospective study was designed to compare the efficacies of intratympanic prednisolone injection,intratympanic dexamethasone injection and carbamazepine by oral administration for subjective tinnitus.Seventy-three cases(78 ears) with subjective tinnitus for more than one month and treated by conservative therapy(such as vasodilator agent,Vitamin B,etc.by oral intake.) were involved.The patients were randomized into 3 groups.Thirty-four cases(35 ears) were included in prednisolone group,18 cases(18 ears) in dexamethasone group with intratympanic injection of prednisolone or dexamethasone,and 21 cases(25 ears) in carbamazepine group as a control group with oral administration of carbamazepine.All of the cases in intratympanic perfusion group were injected twice in the first week,then once a week consecutively.The patients were acupunctured 4-5 times in the whole course of treatment.All of the cases accepted Betahistine Mesylate,Mecobalamine and Vitamin B1 by oral intake at the same time.Pure tone audiogram and tinnitus matching were tested before the treatment immediately after the course of treatment,and were tested again after half a year's following up.Result:All of the cases accepted the whole treatment and were followed up for half a year successfully.The effective rate of the prednisolone group,dexamethasone group and the carbamazepine group was 48.6%,33.3%,44.0%,respectively;the control rate half a year after the treatment was 45.7%,27.8%,36.0%,respectively.There was no statistically significant difference in the effective rate and control rate between intratympanic perfusion group and carbamazepine group.There is a statistically significant difference both in the effective rate and the control rate between the predisolone group and the dexamethasone group.Predisolone may be better than dexamethasone in intratympanic perfusion for subjective tinnitus.Conclusion:Intratympanic steroid injection has a positive effect on subjective tinnitus and may be considered to be an alternative treatment to subjective tinnitus.