鼓室注射糖皮质激素治疗伴持续耳鸣的难治性突发性聋疗效观察

Effects of Intratympanic Injection for Treatment of Profound Sudden Hearing Loss with Persistent Tinnitus

欧阳杰;黄永望;高晓葳;李超;

1:天津医科大学第二医院耳鼻咽喉科

摘要
目的比较鼓室注射甲泼尼龙琥珀酸钠与甲泼尼龙琥珀酸钠加利多卡因治疗伴持续耳鸣的难治性突发性聋的疗效。方法选择经常规全身用药治疗两周无效的伴持续耳鸣的难治性突发性聋患者84例84耳,随机分为治疗组和对照组,每组42例42耳。治疗组鼓室注射甲泼尼龙琥珀酸钠0.4ml和利多卡因注射液0.1ml,对照组注射甲泼尼龙琥珀酸钠0.4ml,每2天注药1次,共5次,治疗10天后比较两组患者耳鸣疗效及0.54kHz气导纯音平均听阈差异。结果治疗10天后两组气导平均听阈都较治疗前下降,治疗组由63.27±15.35dB HL下降至47.83±14.58dB HL,对照组由65.24±13.46dB HL下降至53.56±15.79dB HL,治疗组听力改善总有效率(61.90%,26/42)优于对照组(42.86%,18/42),差异有统计学意义(P<0.05);两组耳鸣程度均较治疗前减轻,治疗组有效率73.81%(31/42),对照组有效率52.38%(22/42),差异有统计学意义(P<0.05)。结论激素鼓室给药可以作为挽救性治疗应用于伴持续耳鸣的难治性突发性聋患者,且甲泼尼龙琥珀酸钠和利多卡因联合注射效果更显著。
关键词
突发性聋;耳鸣;鼓室注射;甲泼尼龙;利多卡因
基金项目(Foundation):
作者
欧阳杰;黄永望;高晓葳;李超;
参考文献

1任基浩,卢永德,殷团芳,等.地塞米松鼓室内注射治疗难治性突发性感音神经性耳聋[J].临床耳鼻咽喉科杂志,2006,20:219.

2 Banerjee A,Pames LS.Intratympanic cortieosteroid for sudden idiopathic sensorineural hearing loss[J].Otol Neurotol,2005,26:878.

3 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会突发性聋的诊断和治疗指南(2015年)[J].中华耳鼻咽喉头颈外科杂志,2015,50:443.

4 Feldmann H.Tinnitus[J].Dtsch Med Wochenschr,1992,117:480.

5 余力生,王洪田.耳鸣概述[J].听力学及言语疾病杂志,2004,12:368.

6 刘洋,余力生,俞琳琳,等.主观性耳鸣的分期治疗探讨及预后影响因素分析[J].听力学及言语疾病杂志,2012,20:231.

7 Roebuck J,Chang CY.Efficacy of steroid injection idiopathic sudden sensorineural hearing loss[J].Otolaryngol Head Neck Surg,2006,135:276.

8 施俊.杨军.吴皓,等.鼓室内注射地塞米松治疗突聋的临床研究[J].临床耳鼻咽喉科杂志,2006,20:749.

9 杨军,吴皓.鼓室内给药治疗内耳疾病的基础与临床[J].中华耳鼻咽喉科杂志,2004,39:770.

10 Lamm K,Amold W.The effect of prednisolone and nonsteroidal anti-inflammatory agents on the normal and noise-damaged guinea pig inner ear[J].Hear Res,2008,115:149.

11 Noushi F,Richardson RT,Hardman J,et al.Delivery of neurotrophin-3to the cochlea using alginate beads[J].Otology&Neurotology,2005,26:528.

12 Parnes LS,Sun AH,Freeman DJ.Corticosteroid pharmacokineties in the inner ear fluids:all animal study followed by clinical application[J].Laryngoscope,1999,109(7Pt 2):1.

13 Chandrasekhar SS,Rubinstein RY,Kwartler JA,et al.Dexamethasone pharmaeokineties in the inner ear:comparison of route of ad-ministration and use of facilitating agents[J].Otolaryngol Head Neck Surg,2000,122:521.

14 李辉,李明.利多卡因不同给药途径辅助治疗耳鸣疗效的Meta分析[J].临床耳鼻咽喉头颈外科杂志,2016,30:101.

15 刘俊秀,李学佩.利用微透析技术对利多卡因治疗耳鸣作用机制的实验研究[J].中华耳鼻咽喉科杂志,2003,38:440.