突發性耳聾病人使用鼓室內注射類固醇作爲一線治療效果之探討

The Efficacy of Intratympanic Dexamethasone Injection as Primary Treatment in Idiopathic Sudden Sensorineural Hearing Loss Patients

羅茹筱(Ru-Hsiao Lo) ； 林明毅(Ming-Yee Lin) ； 朱繡棟(Sau-Tung Chu)

《台灣耳鼻喉頭頸外科雜誌》 46卷3期 (2011/07) Pp. 143-153

https://doi.org/10.6286/2011.46.3.143

摘要

BACKGROUND AND OBJECTIVE: Sudden hearing loss is defined as an acute onset sensorineural hearing impairment of 30 dB or more in 3 contiguous frequencies which occurred within 3 days. The etiology remained uncertain and treatment is still controversial nowadays. In clinical, high dose steroid is the only medication proved to be effective with evidence support by far in the current multi-drug regimens, however, it might cause grave systemic side effects. In recent 10 years, intratympanic steroid injection had been used as a promising alternative in regarding to reducing these severe complications, yet no many primary data in the literature could be found while treating such patients up to now. The aim of this study is to investigate the effeciveness of intratympanic steroid injection as a primary treatment compared to the traditional treatment routes.METHODS: From January 2007 to December 2009, patients who had met the criteria of unilateral sudden hearing loss diagnosed in Kaohsiung Veterans General Hospital were enrolled. Patients were assigned randomized to three treatment groups: (1) oral prednisolone (PO), (2) intravenous dexamethasone (Ⅳ), (3) intratympanic dexamethasone injection (IT). Brain CT or MRI was performed for patients who were suspected to have central lesions clinically. Audiograms were performed before and after treatment for evaluation of hearing.RESULTS: The average hearing improvement was 12.5 dB in the PO group, 24.5 dB in the Ⅳ group, and 17.8 dB in the IT group. Defining a successful treatment as complete recovery (average hearing threshold is 25 dB or lower or at least equal to opposite site) or marked recovery (average hearing threshold is 40 dB or lower or improvement more than 30 dB), 8 people in the PO group, 10 people in the Ⅳ group, and 6 people in the IT group showed successful treatment. The hearing level before and after treatment had significant improvements in all three groups, however, no statistically difference noted between these three groups.CONCLUSION: Traditional systemic steroid treatment in patients with sudden hearing loss is effective yet it might cause severe complications like poor controlled blood sugar and blood pressure, or even GI tract bleeding; which might hinder patients from having appropriate treatment in time. In our study, we found the intratympanic steroid injection could have at least the same treatment efficacy as the traditional systemic ways, thus we recommend that it could be a choice for primary treatment in patients with sudden hearing loss, especially the high risk patients.

關鍵字

鼓室內注射 ； 靜脈注射類固醇 ； 口服類固醇 ； 突發性耳聾

並列摘要

BACKGROUND AND OBJECTIVE: Sudden hearing loss is defined as an acute onset sensorineural hearing impairment of 30 dB or more in 3 contiguous frequencies which occurred within 3 days. The etiology remained uncertain and treatment is still controversial nowadays. In clinical, high dose steroid is the only medication proved to be effective with evidence support by far in the current multi-drug regimens, however, it might cause grave systemic side effects. In recent 10 years, intratympanic steroid injection had been used as a promising alternative in regarding to reducing these severe complications, yet no many primary data in the literature could be found while treating such patients up to now. The aim of this study is to investigate the effeciveness of intratympanic steroid injection as a primary treatment compared to the traditional treatment routes.METHODS: From January 2007 to December 2009, patients who had met the criteria of unilateral sudden hearing loss diagnosed in Kaohsiung Veterans General Hospital were enrolled. Patients were assigned randomized to three treatment groups: (1) oral prednisolone (PO), (2) intravenous dexamethasone (Ⅳ), (3) intratympanic dexamethasone injection (IT). Brain CT or MRI was performed for patients who were suspected to have central lesions clinically. Audiograms were performed before and after treatment for evaluation of hearing.RESULTS: The average hearing improvement was 12.5 dB in the PO group, 24.5 dB in the Ⅳ group, and 17.8 dB in the IT group. Defining a successful treatment as complete recovery (average hearing threshold is 25 dB or lower or at least equal to opposite site) or marked recovery (average hearing threshold is 40 dB or lower or improvement more than 30 dB), 8 people in the PO group, 10 people in the Ⅳ group, and 6 people in the IT group showed successful treatment. The hearing level before and after treatment had significant improvements in all three groups, however, no statistically difference noted between these three groups.CONCLUSION: Traditional systemic steroid treatment in patients with sudden hearing loss is effective yet it might cause severe complications like poor controlled blood sugar and blood pressure, or even GI tract bleeding; which might hinder patients from having appropriate treatment in time. In our study, we found the intratympanic steroid injection could have at least the same treatment efficacy as the traditional systemic ways, thus we recommend that it could be a choice for primary treatment in patients with sudden hearing loss, especially the high risk patients.

並列關鍵字

intratympanic injection ； intravenous dexamethasone ； oral prednisolone ； sudden deafness