Effectiveness of Systemic High-Dose Dexamethasone Therapy for Idiopathic Sudden Sensorineural Hearing Loss
Effectiveness of Systemic High-Dose Dexamethasone Therapy for Idiopathic Sudden Sensorineural Hearing Loss
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DOI：
10.1159/000346938
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发表时间：
2013-01-01
影响因子：
1.6
通讯作者：
Hegemann, Stefan C. A.
中科院分区：
文献类型：
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作者：
Gallo, Doris Egli;Khojasteh, Elham;Hegemann, Stefan C. A.
目的：评价全身大剂量地塞米松治疗突发性感音神经性听力损失的有效性，并与既往研究中分析的既往治疗方案进行比较。方法：我们对79例特发性突发感音神经性耳聋患者的电子患者数据库进行了回顾性分析。标准治疗是在移动环境中口服地塞米松（第1至第3天：40 mg/d，第4至第6天：10 mg/d）。主要终点是听力阈值从最初的听力图到至少4周后的听力图的变化。分析的因素包括患者的年龄，症状发作和治疗开始之间的间隔，是否存在头晕和耳鸣，听力图模式，听力损失的严重程度和对侧耳朵的听力。听力增益表示为绝对或相对听力增益。功能相关听力恢复定义为最终纯音平均值（PTA）为30 dB或更低（或与对侧耳的PTA相同+/- 10 dB）。此外，我们还计算了根据美国耳鼻咽喉科学院-头颈外科基金会最近发表的临床实践指南中定义的完全、部分和无恢复的患者百分比。然后，我们将我们的结果与我们诊所以前进行的治疗方案进行了比较。结果：与未受影响耳朵的基线PTA相比，受影响耳朵的平均初始PTA听力损失为51.5 +/- 20.9 dB（平均值+/- SD）。平均绝对听力增益为44.4 +/- 18.1 dB。平均相对听力增益为86 ± 19%。其中，87%的患者听力功能恢复。我们所有的患者都表现出部分（24%）或完全恢复（76%）。在24小时内开始治疗的患者与在7天内开始治疗的患者之间未检测到恢复率差异。我们发现听力损失的严重程度与功能相关（c）恢复之间存在相关性。34%的患者出现轻度听力损失，平均相对听力增益为89%，其中96%的患者功能相关恢复; 9%的初始耳聋患者显示平均相对听力增益为69%，43%的患者功能相关恢复。低频或高频听力损失的听力图模式显示出最好的恢复率，最差的恢复率被发现在初始耳聋患者。结论：与泼尼松100 mg p.o.相比，应用大剂量口服地塞米松似乎可改善恢复结局。7天。版权所有（c）2013 S. Karger AG，巴塞尔
Objective: To evaluate the effectiveness of systemic high-dose dexamethasone therapy for sudden sensorineural hearing loss in comparison to the previous treatment regimen at our clinic with systemic prednisone 100 mg daily for 7 days analyzed in a previous study. Methods: We conducted a retrospective review of an electronic patient data base of 79 patients with idiopathic sudden sensorineural hearing loss. The standard treatment was orally applied dexamethasone (1st to 3rd day: 40 mg daily, 4th to 6th day: 10 mg daily) in an ambulant setting. The primary endpoint was change in hearing threshold from the initial audiogram to an audiogram at least 4 weeks later. Factors that were analyzed included patient's age, interval between onset of symptoms and start of treatment, presence or absence of dizziness and tinnitus, the audiogram pattern, severity of hearing loss and hearing in the opposite ear. Hearing gain was expressed either as absolute or relative hearing gain. Functionally relevant recovery of hearing was defined as the final pure-tone average (PTA) of 30 dB or less (or the same as the PTA of the opposite ear +/- 10 dB). Furthermore, we calculated the percentage of patients with complete, partial and no recovery as defined in the recently published Clinical Practice Guideline of the American Academy of Otolaryngology - Head and Neck Surgery Foundation. We then compared our results with the previous treatment regimen carried out at our clinic. Results: The average initial PTA hearing loss in the affected ear compared to baseline PTA of the unaffected ear was 51.5 +/- 20.9 dB (mean +/- SD). The mean absolute hearing gain was 44.4 +/- 18.1 dB. The mean relative hearing gain was 86 +/- 19%. Of the total, 87% had functionally relevant recovery of hearing. All of our patients showed partial (24%) or complete recovery (76%). No difference in recovery rate could be detected between patients with start of therapy within 24 h and patients with beginning of therapy within 7 days. We found a correlation between the severity of hearing loss and functionally relevant (c) recovery. A mild hearing loss was noted in 34% of patients, with an average relative hearing gain of 89% and a functionally relevant recovery in 96% of them; the 9% of patients with initial deafness showed a mean relative hearing gain of 69% and a functionally relevant recovery in 43%. The audiogram pattern with low- or high-frequency hearing loss showed the best recovery rate; the poorest recovery rate was found in patients with initial deafness. Conclusion: Application of high-dose orally applied dexamethasone seems to improve the recovery outcomes in comparison to prednisone 100 mg p.o. for 7 days. Copyright (c) 2013 S. Karger AG, Basel