Daily Short-Term Intratympanic Dexamethasone Treatment Alone as an Initial or Salvage Treatment for Idiopathic Sudden Sensorineural Hearing Loss
Daily Short-Term Intratympanic Dexamethasone Treatment Alone as an Initial or Salvage Treatment for Idiopathic Sudden Sensorineural Hearing Loss
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DOI：
10.1159/000320269
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发表时间：
2011-01-01
影响因子：
1.6
通讯作者：
Shinkawa, Hideichi
中科院分区：
文献类型：
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作者：
Kakehata, Seiji;Sasaki, Akira;Shinkawa, Hideichi
目的：鼓室内(IT)类固醇疗法已被提出作为特发性突发性感音神经性耳聋(ISSNHL)的替代治疗方案。然而，IT治疗的数量和频率以及药物输送方式仍有待确定。本研究的目的是评估每日短期地塞米松(DEX)治疗ISSNHL患者的疗效，使用激光辅助鼓膜切开术(LAM)作为最初和/或挽救治疗的药物输送途径。研究设计：回顾性研究。单位：大学医院。患者：76例接受IT DEX治疗的ISSNHL患者。排除低音调听力损失、单侧或双侧波动性听力损失或对侧听力损失。干预：经LAM穿孔注射地塞米松(4 mg/ml)。连续给药8天。主要观察指标：术前、术后听证水平。平均听力水平由5个频率(250、500、1000、2000和4000赫兹)决定。结果：76例患者中有19例符合入选标准(I组)，24例全身治疗失败患者接受了抢救治疗(S组)。I组和S组患者年龄31~73岁，平均56.2岁；11~76岁，平均46.0岁。I组和S组从出现症状到接受IT治疗的天数分别为1~23天和6~28天，平均4.8d。I组19例患者中有18例(95%)纯音测听图改善10d B以上，平均改善40d B。12例(63%)完全恢复，16例(84%)效果良好，改善30dB值以上。S组24例患者中有14例(58%)改善超过10分贝，平均改善16分贝。7例手术成功的患者中有2例(8%)完全康复。结论：对于未同时治疗的ISSNHL患者，每日短期应用LAM的IT DEX治疗显示出高有效率和高治愈率，并被证明是替代大剂量全身类固醇作为一线和/或二线治疗的一种选择。版权所有(C)2010 S.Karger AG，巴塞尔
Objective: Intratympanic (IT) steroid therapy has been proposed as an alternative treatment option for patients with idiopathic sudden sensorineural hearing loss (ISSNHL). However, the number and frequency of IT treatments and drug delivery methods remain to be determined. The purpose of this study was to evaluate the efficacy of daily short-term IT dexamethasone (DEX) treatment alone in ISSNHL patients using laser-assisted myringotomy (LAM) for the drug delivery route as an initial and/or salvage treatment. Study Design: Retrospective study. Setting: University hospital. Patients: Seventy-six ISSNHL patients receiving IT DEX. Patients with low-tone hearing loss, unilateral or bilateral fluctuating hearing loss or contralateral hearing loss were excluded. Intervention: DEX (4 mg/ml) was injected through a perforation made by LAM. IT DEX administration was performed on 8 sequential days. Main Outcome Measures: Pre- and postprocedure hearing levels. The average hearing level was determined by 5 frequencies (250, 500, 1000, 2000 and 4000 Hz). Results: Nineteen out of 76 patients fit the criteria for initial treatment in the study (group I), while 24 patients, who had failed systemic therapy, received salvage treatment (group S). The mean age of the patients in groups I and S was 56.2 years with a range from 31 to 73 years of age and 46.0 years with a range from 11 to 76 years of age, respectively. The mean number of days from onset of symptoms to IT therapy in groups I and S was 4.8 days with a range of 1-23 days and 15.3 days with a range of 6-28 days, respectively. In group I, 18 of the 19 patients (95%) showed improvement of more than 10 dB in the pure-tone audiogram, with a mean improvement of 40 dB. Twelve patients (63%) recovered completely and 16 patients (84%) demonstrated successful results with an improvement of more than 30 dB. In group S, 14 of the 24 patients (58%) showed improvement of more than 10 dB with a mean improvement of 16 dB. Two (8%) of the 7 patients (29%) with successful results recovered completely. Conclusions: Daily short-term IT DEX administration using LAM for ISSNHL patients without concurrent therapy showed a high response rate and high cure rate and proved to be an alternative therapeutic option to high-dose systemic steroids as a first- and/or second-line treatment. Copyright (C) 2010 S. Karger AG, Basel