Hong Seok Min, Park Chan Hum, Lee Jun Ho
Department of Otorhinolaryngology, Head and Neck Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea.
Otolaryngol Head Neck Surg. 2009 Nov;141(5):579-83. doi: 10.1016/j.otohns.2009.08.009.
Intratympanic (IT) dexamethasone offers a good method for avoiding systemic side effects in patients with sudden idiopathic sensorineural hearing loss (ISSHL). However, in most studies, IT was used as a salvage treatment for patients whose hearing failed to improve with the initial systemic treatment, or as an addition to conventional oral steroid protocols. Therefore, we investigated the outcomes of IT steroid administration as a primary treatment modality for ISSHL.
Randomized controlled study.
Tertiary referral center.
Two treatment methods, IT dexamethasone or oral prednisolone, were randomly assigned to 63 participants. A group of 32 patients (IT group) with ISSHL received IT dexamethasone once a day for eight days. A separate group of 31 patients (oral group), received oral prednisolone, also for eight days. We compared the hearing outcomes in the two groups.
We have found that the outcomes for patients treated with IT dexamethasone as a primary treatment modality for the management of ISSHL presented no difference in pure-tone averages or hearing recovery rate compared with patients treated with oral steroids. However, differences were noted for hearing thresholds according to frequency: the threshold improvement at low frequencies (250, 500, and 1000 Hz) was not statistically significant between groups; at high frequencies, particularly 4000 and 8000 Hz, the threshold improvement was statistically higher in the oral group than in the IT group.
IT dexamethasone might be a good primary treatment method for ISSHL; but, for the management of ISSHL, we should keep in mind the differences in hearing outcomes with regard to frequency.
鼓室内注射地塞米松为避免特发性突发性感音神经性听力损失（ISSHL）患者出现全身副作用提供了一种良好的方法。然而，在大多数研究中，鼓室内注射被用作初始全身治疗听力未改善患者的挽救治疗方法，或作为传统口服类固醇方案的补充。因此，我们研究了鼓室内注射类固醇作为ISSHL主要治疗方式的效果。
随机对照研究。
三级转诊中心。
将63名参与者随机分为两种治疗方法，即鼓室内注射地塞米松或口服泼尼松龙。一组32例ISSHL患者（鼓室内注射组）每天接受一次鼓室内注射地塞米松，共8天。另一组31例患者（口服组）接受口服泼尼松龙，同样为8天。我们比较了两组的听力结果。
我们发现，将鼓室内注射地塞米松作为ISSHL主要治疗方式的患者，与接受口服类固醇治疗的患者相比，在纯音平均值或听力恢复率方面没有差异。然而，根据频率观察听力阈值存在差异：低频（250、500和1000Hz）的阈值改善在两组之间无统计学意义；在高频，特别是4000和8000Hz，口服组的阈值改善在统计学上高于鼓室内注射组。
鼓室内注射地塞米松可能是ISSHL的一种良好的主要治疗方法；但是，对于ISSHL的治疗，我们应牢记频率方面听力结果的差异。
