早期類固醇治療對於槍擊急性音聲外傷之療效評估

Early Treatment with Steroid in Gun-shot Induced Acoustic Trauma

陳哲民(Che-Min Chen) ； 陳榮峰(Rong-Feng Chen) ； 謝坤衛(Kun-Wei Hsieh) ； 袁建漢(Chien-Han Yuan)

《台灣耳鼻喉頭頸外科雜誌》 48卷2期 (2013/06) Pp. 157-163

https://doi.org/10.6286/2013.48.2.157

摘要

BACKGROUND: The gunshot is the basic military training course in the armed forces of the Republic of China. However, acute acoustic trauma is relatively common without hearing protection devices. The protective effect of steroids against acute acoustic trauma (AAT) has already been demonstrated. The aim of this study was to evaluate the early intervention benefit of steroid applied to young soldiers with AAT while exposed to intense gunfire noise.METHODS: The records of 38 soldiers were reviewed; the soldiers were evaluated from January 2009 to March 2012. They presented AAT during their military training, and received steroids treatment in our hospital. They were separated into two groups. One group (group A) received treatment within 2 days after the AAT and the other (group B) was 7 days later after this catastrophe. There were 20 patients in group A and 18 patients in group B. The left ear was affected in 26 cases and both ears in 12 cases. In the cases of both ears, we chose the worst ear to compare. Pure tone audiometry was performed at presentation, second day, 1 week and 1 month after the treatment onset and was compared with each other in dB (HL) at 250, 500, 1000, 2000, 4000, 6000 and 8000 Hz. The initial dose of Prednisolone was 1 mg/kg, four times/day and then was tapered 3 days later. The steroid was stopped two weeks later.RESULTS: According to the initial audiogram configuration, 4 cases were flat, 9 cases were upsloping, 11 cases were high frequency drop, and 18 cases were high frequency notch. After steroid treatment, there were 20 cases (52.6%) whose averaged hearing recovering to the 25 dB. There were 14 cases (36.8%) whose averaged hearing improving 10 dB or even more. There were 4 cases (10.5%) whose averaged hearing improving less than 10 dB. In group A, there were 16 cases (80%) whose hearing were complete recovery and 4 cases (20%) whose hearing were partial recovery. In group A, there were 4 cases (22.2%) whose hearing were complete recovery and 10 case (55.6%) whose hearing were partial recovery. After one week treatment, the average hearing threshold in group A was better than in group B (p ＜ 0.01).CONCLUSIONS: Compared with sudden hearing loss, there are few reports about golden hours in the treatment of ATT. According to our data, the result of steroid treatment within two days after AAT is significantly better than that of seven days delay. Therefore, the early intervention of treatment in AAT is important.

關鍵字

聽性外傷 ； 聽力受損 ； 槍枝射擊噪音 ； 類固醇

並列摘要

BACKGROUND: The gunshot is the basic military training course in the armed forces of the Republic of China. However, acute acoustic trauma is relatively common without hearing protection devices. The protective effect of steroids against acute acoustic trauma (AAT) has already been demonstrated. The aim of this study was to evaluate the early intervention benefit of steroid applied to young soldiers with AAT while exposed to intense gunfire noise.METHODS: The records of 38 soldiers were reviewed; the soldiers were evaluated from January 2009 to March 2012. They presented AAT during their military training, and received steroids treatment in our hospital. They were separated into two groups. One group (group A) received treatment within 2 days after the AAT and the other (group B) was 7 days later after this catastrophe. There were 20 patients in group A and 18 patients in group B. The left ear was affected in 26 cases and both ears in 12 cases. In the cases of both ears, we chose the worst ear to compare. Pure tone audiometry was performed at presentation, second day, 1 week and 1 month after the treatment onset and was compared with each other in dB (HL) at 250, 500, 1000, 2000, 4000, 6000 and 8000 Hz. The initial dose of Prednisolone was 1 mg/kg, four times/day and then was tapered 3 days later. The steroid was stopped two weeks later.RESULTS: According to the initial audiogram configuration, 4 cases were flat, 9 cases were upsloping, 11 cases were high frequency drop, and 18 cases were high frequency notch. After steroid treatment, there were 20 cases (52.6%) whose averaged hearing recovering to the 25 dB. There were 14 cases (36.8%) whose averaged hearing improving 10 dB or even more. There were 4 cases (10.5%) whose averaged hearing improving less than 10 dB. In group A, there were 16 cases (80%) whose hearing were complete recovery and 4 cases (20%) whose hearing were partial recovery. In group A, there were 4 cases (22.2%) whose hearing were complete recovery and 10 case (55.6%) whose hearing were partial recovery. After one week treatment, the average hearing threshold in group A was better than in group B (p ＜ 0.01).CONCLUSIONS: Compared with sudden hearing loss, there are few reports about golden hours in the treatment of ATT. According to our data, the result of steroid treatment within two days after AAT is significantly better than that of seven days delay. Therefore, the early intervention of treatment in AAT is important.

並列關鍵字

acoustic trauma ； hearing loss ； gunshot noise ； steroid