Riechelmann H, Tholen M, Keck T, Rettinger G
Department of Otorhinolaryngology-Head Neck Surgery, University of Ulm Medical School, Germany.
Am J Otol. 2000 Nov;21(6):809-12.
The aim of this study was to evaluate the efficiency of prophylactic perioperative glucocorticoid treatment during stapes surgery in preventing damage to the inner ear and reducing the frequency of early postoperative complications.
A prospective, randomized, unblinded study design was selected.
The study was conducted at an academic tertiary referral center.
Ninety-five consecutive patients undergoing erbium:YAG laser-assisted stapedotomy for otosclerosis between 1996 and 1999 were included.
The preoperative minus postoperative (1-4 days and at least 6 weeks) average pure-tone bone conduction thresholds at 1, 2, and 4 kHz were compared in the prednisolone and control groups by the Mann-Whitney U Test. In addition, the occurrences of sensorineural hearing loss of >10 dB, nystagmus, vertigo, and tinnitus were counted and evaluated by use of the Freeman-Halton or Fisher's exact test, respectively.
Prophylactic perioperative prednisolone treatment was not able to improve the early postoperative average bone conduction thresholds or reduce the frequency of early sensorineural hearing loss (p > 0.5). The patients who received perioperative prednisolone treatment experienced postoperative vertigo more frequently than did the control patients (p < 0.05).
Perioperative cortisone prophylaxis for prevention of inner ear damage during stapes surgery is ineffective and is associated with increased postoperative patient discomfort.
本研究旨在评估镫骨手术围手术期预防性使用糖皮质激素治疗在预防内耳损伤及降低术后早期并发症发生率方面的效果。
选择前瞻性、随机、非盲研究设计。
研究在一家学术性三级转诊中心进行。
纳入了1996年至1999年间连续95例行铒激光辅助镫骨切除术治疗耳硬化症的患者。
通过Mann-Whitney U检验比较泼尼松龙组和对照组术前及术后（1 - 4天和至少6周）1、2和4 kHz的平均纯音骨导阈值。此外，分别使用Freeman-Halton检验或Fisher精确检验对大于10 dB的感音神经性听力损失、眼球震颤、眩晕和耳鸣的发生情况进行计数和评估。
围手术期预防性使用泼尼松龙治疗未能改善术后早期平均骨导阈值，也未降低早期感音神经性听力损失的发生率（p > 0.5）。接受围手术期泼尼松龙治疗的患者术后眩晕发生率高于对照组患者（p < 0.05）。
镫骨手术围手术期使用可的松预防内耳损伤无效，且会增加术后患者不适。
