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類固醇治療突發性耳聾時對非患耳聽力的影響

The Effect of Steroid Therapy on the Non-Affected Ear in Sudden Deafness

摘要


背景:高劑量靜脈注射類固醇是目前治療突發性耳聾的主流方法,由於大多數患者為單側患病,在治療期間往往忽略非患耳之聽閾變化。因此,本文比較治療前後,非患耳之聽閾變化。方法:在2003年1月至2007年10月間,共計90名(男43,女47)患者因單側突發性耳聾患者求診於桃園某區域醫院,並接受高劑量靜脈注射類固醇治療,年齡為49.4 ± 14.6(平均值 ± 標準差)歲,比較高血壓或糖尿病等系統性疾病對於非患耳治療前後聽閾變化之影響,及回溯治療前後患耳與非患耳之聽閾變化時,所有統計檢定之α值均設為.05。結果:非患耳在治療前後之平均聽閥(250~4,000 Hz)具有顯著差異(配對t檢定,p = 4.89 × 10^(-7)),各個音頻之聽閥在治療前後亦均具顯著差異(配對t檢定,p = 4.02 × 10^(-8)~5.71 × 10%^(-3))。非患耳平均聽閾改善3.20 ± 5.59 dBHL,但未達到突發性耳聾聽閾改善的標準。高血壓或糖尿病不影響非患耳治療前後平均聽閾變化(費氏精密檢定,p = .285 vs .208),患耳與非患耳各個音頻之聽閾在治療前後之變化並無相關(線性迴歸分析,相關係數p = .345~.971,迴歸係數p = .371~.952),患耳之治療預後亦不影響非患耳在治療後平均聽閾的變化(費氏精密檢定,p = .086)。結論:90%單側突發性耳聾患者,非患耳之聽閾在類固醇治療後沒有變化,10%患者改善至少10 dBHL。高血壓、糖尿病、患耳之聽閾變化或其治療預後,並不影響非患耳治療前後之聽閾變化。

並列摘要


BACKGROUND: High-dose intravenous steroid is currently recommended for sudden deafness (SD) sufferers. Because SD is mostly unilateral, the hearing threshold change of the non-affected ear is always neglected during treatment. Therefore, we try to compare the hearing threshold change of the non-affected ear before and after unilateral SD was treated.METHODS: From January 2003 to October 2007, 90 SD patients received administration of high-dose intravenous steroid at a regional hospital in Taoyuan. They were aged 49.4 ± 14.6 years (average ± standard deviation). We studied the effect of systemic diseases such as hypertension and diabetes mellitus on the hearing thresholds of the non-affected ear and retrospected the change of hearing threshold of the affected and non-affected ears before and after treatment. The α value of all statistical analysis was .05.RESULTS: There was a significant difference in the hearing threshold average (250 Hz~4,000 Hz) of the non-affected ear between pre- and post-treatment (paired t-test, p = 4.89 × 10^(-7)), so was in the hearing threshold at each frequency (paired t-test, p = 4.02 × 10^(-8) ~ 5.71 × 10^(-3)). The hearing threshold average of the non-affected ear improved 3.20 ± 5.59 dBHL. But it didn't achieve the level of improvement in sudden sensorineural hearing loss. Hypertension or diabetes mellitus had no effect on the change of hearing threshold of the non-affected ear. (Fisher's exact test, p = .285 vs .208)The hearing threshold of the non-affected ear was not related to that of the affected ear at each frequency (linear regression analysis, p of correlation coefficient = .345 ~ .971; p of regression coefficient = .371 ~ .952). The therapeutic result of the affected ear did not influence the hearing threshold average of the non-affected ear after treatment (Fisher's exact test, p = .086).CONCLUSIONS: In cases of unilateral SD, there is no significant change in the hearing thresholds of the non-affected ear of 90% of the cases after steroid therapy. The remaining 10% of the cases got improvement of hearing threshold. However, hypertension, diabetes mellitus, or the hearing threshold change or the therapeutic result of the affected ear had no effect on the change of hearing threshold of the non-affected ear.

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