突發性耳聾使用類固醇作鼓室內與肌肉注射療效之比較

Comparison of Intratympanic and Intramuscular Steroid Injection in Treating Sudden Deafness

王文弘(Wen-Hung Wang) ； 吳俊良(Jiunn-Liang Wu) ； 趙文元(Wen-Yuan Chao)

《台灣耳鼻喉頭頸外科雜誌》 38卷6期 (2003/12) Pp. 263-271

https://doi.org/10.6286/2003.38.6.263

摘要

BACKGROUND: There is a need for more effective therapeutic methods associated with less side effects for the treatment of inner ear diseases such as idiopathic sudden deafness. Intratympanic steroid injection cause local infiltration and lower systemic side effect, however, the efficacy of treatment was not available. The data comparing intratympanic and intramuscular steroid injection and leading to side effects were analyzed in this study.
MATERIALS & METHODS: From June 2000 to December 2000, patients with a diagnosis of sudden deafness were grouped for a prospective, nonrandomized clinical trial according to the method of steroid administration: intratympanic or intramuscular injections. In the intratympanic group, tympanotomy over posterior-inferior quadrant was performed and then 2.5 mg dexamethasone was injected into the middle-ear daily for 5 consecutive days. In the intramuscular group, a dose of 6 mg dexamethasone was administered i.m. twice a day for 5 consecutive days. Other therapeutic medicines, including volume expansion drug and what else were the same for patients in both groups. Tinnitus and vertigo were assessed daily at the time of treatment course and pure tone audiometry was performed every other day.
RESULTS: A total of 45 patients were enrolled including 15 patients in the intratympanic group (1 patient with both ears; total 6 right ears and 10 left ears ) and 30 patients in the intramuscular group (right ear 20 and left ear 10). In the intratympanic group, hearing improvement exceeding 10 dB was noted in 11 ears (68.8%), with a mean of 31.1±22.1 dB. On average, the time interval before treatment was 5 days and the follow-up duration was 14.1 months. No serious complication occurred except for mild discomfort during injection and temporary myringitis in 3 ears. In the intramuscular group, hearing improvement was noted in 19 ears (63.3%), with a mean of 26.8±22.7 dB. On average, the time interval before treatment was 4.4 days and the follow-up duration was 13.7months. A higher improvement rate and lower post-treatment average hearing threshold were found in the intratympanic group although this difference was not significant (p=0.713 and 0.544, respectively). The prevalence/improvement rate of tinnitus was 100%/46.7% in the intratympanic group and 93.3%/41.4% in the intramuscular group. Although both prevalence rate and improvement rate for tinnitus were higher in the intratympanic group, these differences were not significant (p=0.439 for prevalence rate and 0.737 for improvement rate). No difference was found in the ratio of vertigo occurrence between the two groups.
CONCLUSION: This study found that patients with sudden hearing loss who received intratympanic injection of steroid had a higher hearing recovery rate and lower post-treated average hearing threshold than those who received intramuscular injection. Intratympanic injection of steroid had a low incidence of systemic side effects and did not result in any serious complication. We suggested that intratympanic injection may be an effective alternative if the patient was susceptive to the side effect from steroid given. A larger sample size is needed to study a significant difference in the future study.

關鍵字

突發性耳聾 ； 鼓室內注射 ； 類固醇

並列摘要

BACKGROUND: There is a need for more effective therapeutic methods associated with less side effects for the treatment of inner ear diseases such as idiopathic sudden deafness. Intratympanic steroid injection cause local infiltration and lower systemic side effect, however, the efficacy of treatment was not available. The data comparing intratympanic and intramuscular steroid injection and leading to side effects were analyzed in this study.
MATERIALS & METHODS: From June 2000 to December 2000, patients with a diagnosis of sudden deafness were grouped for a prospective, nonrandomized clinical trial according to the method of steroid administration: intratympanic or intramuscular injections. In the intratympanic group, tympanotomy over posterior-inferior quadrant was performed and then 2.5 mg dexamethasone was injected into the middle-ear daily for 5 consecutive days. In the intramuscular group, a dose of 6 mg dexamethasone was administered i.m. twice a day for 5 consecutive days. Other therapeutic medicines, including volume expansion drug and what else were the same for patients in both groups. Tinnitus and vertigo were assessed daily at the time of treatment course and pure tone audiometry was performed every other day.
RESULTS: A total of 45 patients were enrolled including 15 patients in the intratympanic group (1 patient with both ears; total 6 right ears and 10 left ears ) and 30 patients in the intramuscular group (right ear 20 and left ear 10). In the intratympanic group, hearing improvement exceeding 10 dB was noted in 11 ears (68.8%), with a mean of 31.1±22.1 dB. On average, the time interval before treatment was 5 days and the follow-up duration was 14.1 months. No serious complication occurred except for mild discomfort during injection and temporary myringitis in 3 ears. In the intramuscular group, hearing improvement was noted in 19 ears (63.3%), with a mean of 26.8±22.7 dB. On average, the time interval before treatment was 4.4 days and the follow-up duration was 13.7months. A higher improvement rate and lower post-treatment average hearing threshold were found in the intratympanic group although this difference was not significant (p=0.713 and 0.544, respectively). The prevalence/improvement rate of tinnitus was 100%/46.7% in the intratympanic group and 93.3%/41.4% in the intramuscular group. Although both prevalence rate and improvement rate for tinnitus were higher in the intratympanic group, these differences were not significant (p=0.439 for prevalence rate and 0.737 for improvement rate). No difference was found in the ratio of vertigo occurrence between the two groups.
CONCLUSION: This study found that patients with sudden hearing loss who received intratympanic injection of steroid had a higher hearing recovery rate and lower post-treated average hearing threshold than those who received intramuscular injection. Intratympanic injection of steroid had a low incidence of systemic side effects and did not result in any serious complication. We suggested that intratympanic injection may be an effective alternative if the patient was susceptive to the side effect from steroid given. A larger sample size is needed to study a significant difference in the future study.

並列關鍵字

sudden deafness ； intratympanic injection ； corticosteroid