Intratympanic dexamethasone injection vs methylprednisolone for the treatment of refractory sudden sensorineural hearing loss.
Intratympanic dexamethasone injection vs methylprednisolone for the treatment of refractory sudden sensorineural hearing loss.
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DOI：
10.4103/2277-9175.184277
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发表时间：
2016
影响因子：
1
通讯作者：
Hashemi SM
中科院分区：
文献类型：
--
作者：
Berjis N;Soheilipour S;Musavi A;Hashemi SM
在过去的几年中，各种药物已被用于突发性感觉神经性听力损失（SSNHL）的治疗，包括类固醇，被证明是有益的。高剂量类固醇的直接递送到内耳被建议用于其潜力，并被称为鼓室内类固醇治疗（IST）。尽管使用地塞米松和甲基强的松龙作为传统的治疗方法，但对于最佳剂量、首选药物和给药途径仍存在争议。我们进行了一项随机临床试验研究，其中50例患者患有SSNHL和耐标准治疗。每例患者沿着0.5ml甲基强的松龙（40 mg/mg）和碳酸氢钠或地塞米松（4 mg/mL）直接鼓室内注射。该方法仅在地塞米松接受组中进行，每2天进行一次，共3次。采用四频（0.5，1.0，2.0，3.0kHz）纯音平均值（PTA）和Siegel听力标准对听力进行分析。按Siegel标准，25例接受地塞米松治疗的患者中，3例（12%）痊愈，1例（16%）痊愈，9例（32%）按Siegel标准，2例（3%）痊愈，9例（32%）未痊愈。甲基强的松龙组Siegel评分1、2、3级分别有6例（24%）、8例（32%）、7例（28%）恢复，4例（16%）未恢复。甲泼尼龙组听力改善明显优于地塞米松组（P < 0.05）。接受甲泼尼龙治疗的患者的总体听力改善率为84%，明显高于地塞米松组的64%。局部鼓室内注射甲基强的松龙是一种安全有效的治疗方法，适用于那些对常规地塞米松治疗无效的SSNHL病例。
During the past years various drugs have been used for sudden sensorineural hearing loss (SSNHL) treatment including steroids that are shown to be beneficial. Directed delivery of high doses of steroids into the inner ear is suggested for its potential and known as intratympanic steroids therapy (IST). Despite the use of dexamethasone and methylprednisolone as the traditional treatments, there are still debates about the optimal dosage, preferred drug, and the route of administration. We performed a randomized clinical trial study in which 50 patients suffering from SSNHL and resistant to standard therapy were employed. Each patient took 0.5 ml methylprednisolone (40 mg/mg) along with bicarbonate or dexamethasone (4 mg/mL) through direct intratympanic injection. This method was performed and scheduled once every 2 days for three times only for the dexamethasone receiving group. Hearing test was carried out and the results were analyzed according to a four-frequency (0.5, 1.0, 2.0, 3.0 kHz) pure tone average (PTA) and Siegel's criteria. According to Siegel's criteria, three out of 25 (12%) dexamethasone receiving patients were healed in 1 and 4 (16%), 9 (32%) were respectively recovered in Siegel's criteria 2, 3, and 9 (32%) showed no recovery. In the group receiving methylprednisolone, recovery was found in 6 (24%), 8 (32%), 7 (28%) patients in the Siegel's criteria 1, 2, 3, respectively, and in 4 (16%) patients no recovery was recorded. In methylprednisolone group, hearing was significantly improved compared to the dexamethasone group (P < 0.05). The general hearing improvement rate was 84% in methylprednisolone receiving patients showing a significantly higher improvement than 64% in the dexamethasone group. Topical intratympanic treatment with methylprednisolone is safe and an effective treatment approach for those SSNHL cases that are refractory to the common therapies by Dexamethasone.