Inner ear perfusion: indications and applications.
Inner ear perfusion: indications and applications.
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DOI：
10.1097/00020840-200310000-00005
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发表时间：
2003-10-01
影响因子：
1.6
通讯作者：
Silverstein, Herbert
中科院分区：
文献类型：
--
作者：
Hoffmann, Karen K;Silverstein, Herbert
目的：探讨内耳灌注治疗常见耳科疾病的适应症和应用，包括梅尼埃病、突发性感音神经性听力损失和自身免疫性内耳疾病。最近发现：在20世纪90年代，包括前庭神经切除术、迷路切除术和内淋巴囊手术在内的外科手术数量有所减少。鼓室内庆大霉素治疗已成为治疗梅尼埃病最常用的侵入性方法。梅尼埃病患者成功控制眩晕的报告从71.4到100%不等。经鼓室庆大霉素治疗前庭消融程度、眩晕控制和听力损失风险之间存在相关性。前庭反应减少75%以下的患者听力损失的风险较低，但他们的持续性眩晕率高于前庭反应减少100%的患者。百分之百的前庭反应减少可能并不表明完全的前庭消融，也可能不是控制眩晕症状所必需的。在初步研究中，对于标准治疗无效的重度、深度突发性感音神经性听力损失患者，内耳灌注甲基强的松龙是有益的，其听力阈值可提高16 ~ 25 dB，言语辨别评分也有显著改善。在动物模型中，没有发现免疫抑制药物能有效抑制内耳炎症浸润或降低听力损失。摘要：内耳经鼓室化学灌注是一种安全、廉价且容易由耳科外科医生进行的手术。通过内耳灌注，可以实现较高的内耳药物浓度，并将全身副作用降至最低。
PURPOSE OF REVIEW: To examine the indications and applications of inner ear perfusion in the treatment of common otologic diseases, including Meniere disease, sudden sensorineural hearing loss, and autoimmune inner ear disease.RECENT FINDINGS: The number of surgical procedures, including vestibular neurectomy, labyrinthectomy, and endolymphatic sac surgery, decreased during the 1990s. Intratympanic gentamicin therapy has become the most frequently performed invasive procedure for treatment of Meniere disease. Reports on successful control of vertigo in patients with Meniere disease have ranged from 71.4 to 100%. There is a correlation between the degree of vestibular ablation in transtympanic gentamicin, the control of vertigo, and the risk of hearing loss. Patients with less than 75% ice-reduced vestibular response had a statistically lower risk of hearing loss, but they had a higher rate of persistent vertigo than patients with 100% reduced vestibular response. One hundred percent reduced vestibular response may not be indicative of complete vestibular ablation and may not be necessary for control of vertigo symptoms. In preliminary studies, inner ear perfusion of methylprednisolone in patients with severe, profound sudden sensorineural hearing loss who fail to respond to standard treatment is beneficial, with improvement in hearing thresholds of 16 to 25 dB and dramatic improvement in speech discrimination scores. No immunosuppressive medication has been found effective in suppressing inner ear inflammatory infiltrates or reducing hearing loss in an animal model.SUMMARY: Transtympanic chemical perfusion of the inner ear is safe, inexpensive, and easily performed by an otologic surgeon. With inner ear perfusion, high inner ear concentrations of medication can be achieved, and systemic side effects are minimized.