Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Tuscany, Italy.
Otol Neurotol. 2010 Jan;31(1):25-30. doi: 10.1097/MAO.0b013e3181c34f18.
Treatment of sudden hearing loss is a significant matter of discussion. Lack of knowledge of the natural history of the disease and the use of different success criteria are 2 of the main reasons why it is difficult to critically evaluate the data available in the literature. To date, no therapy has proved effective according to the evidence criteria. However, there has been a trend toward the use of steroids in recent years. The management of patients who fail to respond to standard therapy is even more complex; in these cases, intratympanic steroids have been proposed as a valuable solution.
Twenty-seven patients unresponsive to traditional systemic therapy were treated with intratympanic steroids.
The mean pure-tone average before intratympanic treatment was 79.9 +/- 21.4 SD dB; at Day 30, after local steroid administration, the mean pure-tone average was 60.6 +/- 24.9 SD dB. According to our criteria, 15 (55%) of 27 patients presented a "useful" improvement in the hearing status. No serious complications have been observed.
Local application is confirmed as easy to perform and is associated with negligible complications. Our experience, although retrospective, seems to confirm the usefulness (at least in 50% of patients) of local steroids administration in cases of refractory sudden sensorineural hearing loss. Our encouraging data strongly call for further and serious evaluation through randomized studies.
突发性听力损失的治疗是一个备受关注的问题。缺乏对疾病自然史的了解以及使用不同的成功标准是导致难以对文献中现有数据进行严格评估的两个主要原因。迄今为止，根据证据标准，没有任何治疗方法被证明有效。然而，近年来类固醇的使用呈上升趋势。对于那些对标准治疗无反应的患者的管理更加复杂；在这些情况下，鼓室内类固醇已被提出作为一种有价值的解决方案。
对 27 名对传统全身治疗无反应的患者采用鼓室内类固醇治疗。
接受鼓室内治疗前的平均纯音平均听力值为 79.9 ± 21.4 SD dB；局部类固醇给药 30 天后，平均纯音平均听力值为 60.6 ± 24.9 SD dB。根据我们的标准，27 名患者中有 15 名（55%）听力状况“有所改善”。未观察到严重并发症。
局部应用被证实易于实施，且并发症可忽略不计。我们的经验虽然是回顾性的，但似乎证实了局部类固醇给药在难治性突发性感觉神经性听力损失中的有效性（至少在 50%的患者中）。我们令人鼓舞的数据强烈呼吁通过随机研究进行进一步和更严格的评估。
