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目的:观察鼓室内注射地塞米松或甲泼尼龙治疗突发性聋的疗效。方法:鼓膜穿刺注入地塞米松(5 g/L)或甲泼尼龙(40 g/L),每日注射1次,7 d为1个疗程。比较地塞米松和甲泼尼龙鼓室内注射前后4个频率(500、1 000、2 000、4 000 Hz)气导纯音听阈均值(PTA),下降10 dB以上为有效。结果:47例突发性聋患者中,鼓室内注射地塞米松组(24例)前后PTA分别为(71.59±27.66)dB HL、(53.44±30.10)dB HL,经配对t检验差异有统计学意义(P<0.01),总有效率为67%。鼓室内注射甲泼尼龙组(23例)前后的PTA分别为(68.64±25.21)dB HL、(55.76±26.42)dB HL,经检验差异有统计学意义(P<0.01),总有效率为43%。经Fisher Exact检验,鼓室内注射地塞米松组和甲泼尼龙组的有效率差异无统计学意义(P>0.05)。11例患者经过其他治疗(静脉类固醇药物、扩血管药物或高压氧治疗)后再应用鼓室内注射地塞米松治疗,仍然取得了较好的疗效(P<0.05);13例患者单纯应用鼓室内注射地塞米松治疗,PTA下降较明显,差异有统计学意义(P<0.05)。17例患者经过其他治疗再应用鼓室内注射甲泼尼龙治疗,仍然取得了较好的疗效(P<0.01),6例患者单纯应用鼓室内注射甲泼尼龙治疗,PTA虽有下降,但差异无统计学意义(P>0.05)。患者未出现鼓室内感染、鼓膜穿孔和听力下降。结论:鼓室内注射地塞米松或甲泼尼龙治疗突发性聋有效,两者之间的疗效比较无明显差异。推荐地塞米松作为鼓室内注射药物治疗突发性聋,并作为突发性聋的初始治疗。
Objective: To observe the effect of intratympanic injection of dexamethasone or methylprednisolone on sudden deafness. Methods: Dexamethasone (5 g / L) or methylprednisolone (40 g / L) was injected into the tympanic membrane through the tympanic membrane. One injection was given daily and the other 7 days were treated with one course of treatment. Compared with dexamethasone and methylprednisolone, the PTA of four pure air-conduction tones (500, 1000, 2000, 4000 Hz) before and after intratympanic injection was more than 10 dB. Results: Before and after tympanic injection of dexamethasone group (n = 24), the PTA of 47 patients with sudden deafness were (71.59 ± 27.66) dB HL and (53.44 ± 30.10) dB HL, respectively. Significance (P <0.01), the total effective rate was 67%. The PTA before and after the tympanic injection of methylprednisolone group were (68.64 ± 25.21) dB HL and (55.76 ± 26.42) dB HL, respectively. The differences were statistically significant (P <0.01) and the total effective rate was 43 %. The Fisher Exact test, intratympanic injection of dexamethasone group and methylprednisolone group, the effective rate difference was not statistically significant (P> 0.05). Eleven patients were treated with intrathecal dexamethasone after other treatments (intravenous steroids, vasodilators or hyperbaric oxygen therapy), and still achieved good results (P <0.05). Thirteen patients were treated with intratympanic Injection dexamethasone treatment, PTA decreased more significantly, the difference was statistically significant (P <0.05). Seventeen patients were treated with methylprednisolone after intrathecal injection of methylprednisolone (P <0.01). Six patients were treated with intratympanic instillation of methylprednisolone, although the PTA was decreased, but no difference was found Statistical significance (P> 0.05). No tympanic infection, tympanic membrane perforation and hearing loss occurred in patients. Conclusion: Intra-tympanic injection of dexamethasone or methylprednisolone is effective in treating sudden deafness. There is no significant difference between the two methods. Dexamethasone is recommended as an intrathecal drug for sudden deafness and as an initial treatment for sudden deafness.