Fattori B, De Iaco G, Nacci A, Casani A, Ursino F
Department of Neurosciences, E.N.T. Unit, Pisa University, Pisa, Italy.
Undersea Hyperb Med. 2002 Winter;29(4):260-70.
Hyperbaric oxygen therapy (HBQ) has been used for several years as a treatment for Ménière's disease, particularly in Sweden. In this study continuous variations in pressure (from 1.7 to 2.2 ATA; alternobaric oxygen therapy: ABOT) were used to decrease endolymphatic hydrops, the typical histopathological substrate of Ménière's disease by increasing hydrostatic pressure and mechanical stimulation of the endolymphatic flow toward the duct and the endolymphatic sac, which produces a consequent increase in the dissolved O2 content in the labyrinth liquid, which should contribute to recovering cell metabolism and restoring cochlear electrophysiological function to normal. An experimental group of 20 patients suffering from unilateral Ménière's disease received a total of 15 ABOT treatment sessions during the acute episodes. Treatment foresaw two days without therapy every five days of application. Maintenance treatment consisted of one session per day for five consecutive days every month for one year. Thereafter, during the second, third, and fourth years of treatment, patients were submitted to one session per day for five consecutive days every three months. A control group of 18 patients suffering from Ménière's disease was treated with 10% glycerol i.v. (during the acute episodes) and with betahistine (8 mg x 3/day) in the periods in between. Mean pure tone average (PTA in dBHL) hearing thresholds at octave frequencies from 500 to 3,000Hz, and frequency of episodes of vertigo and tinnitus, both after 15 days of treatment and at the end of a four-year follow-up, were compared for both groups according to the 1995 Committee on Hearing and Equilibrium criteria. No statistically significant differences were found between the two groups at the end of the first 15 days of treatment. However, at the end of the follow-up period, patients treated with ABOT had significantly fewer vertiginous episodes and improved PTAs and tinnitus compared to the controls. The results support the use of ABOT as a valid alternative to drugs in the long-term treatment of Ménière's disease.
高压氧疗法（HBQ）作为梅尼埃病的一种治疗方法已应用多年，在瑞典尤为如此。在本研究中，采用压力持续变化（从1.7至2.2ATA；交替气压氧疗法：ABOT）来减少内淋巴积水，这是梅尼埃病典型的组织病理学基础，通过增加静水压力以及对内淋巴流向导管和内淋巴囊的机械刺激来实现，这会使迷路液中溶解的O2含量随之增加，这应有助于恢复细胞代谢并使耳蜗电生理功能恢复正常。一组20例单侧梅尼埃病患者的实验组在急性发作期间共接受了15次ABOT治疗。治疗方案为每应用五天中有两天不进行治疗。维持治疗包括每月连续五天每天进行一次治疗，持续一年。此后，在治疗的第二、第三和第四年，患者每三个月连续五天每天接受一次治疗。一组18例梅尼埃病患者的对照组在急性发作期间接受静脉注射10%甘油治疗，在发作间歇期接受倍他司汀（8mg×3/天）治疗。根据1995年听力与平衡委员会的标准，比较了两组患者在治疗15天后以及四年随访结束时，500至3000Hz倍频程频率的平均纯音平均听阈（以dBHL为单位的PTA）、眩晕发作频率和耳鸣频率。在治疗的前15天结束时，两组之间未发现统计学上的显著差异。然而，在随访期结束时，与对照组相比，接受ABOT治疗的患者眩晕发作明显减少，PTA和耳鸣症状有所改善。这些结果支持将ABOT作为梅尼埃病长期治疗中药物的有效替代方法。
