Hato Naohito, Hyodo Jun, Takeda Shoichiro, Takagi Daiki, Okada Masahiro, Hakuba Nobuhiro, Gyo Kiyofumi
Department of Otolaryngology, Ehime University School of Medicine, Shitsukawa Toon City, Ehime 791-0295, Japan.
Auris Nasus Larynx. 2010 Oct;37(5):626-30. doi: 10.1016/j.anl.2010.01.008. Epub 2010 Feb 18.
The additive effects of local hypothermia and restricted activity in the treatment of idiopathic sudden sensorineural hearing loss (ISSHL) were investigated by case-matched study as a multicenter (13 hospitals) pilot trial.
In a preliminary experiment, we evaluated the effects of cooled water pillow (15 degrees C). Cooling the neck and mastoid with the pillow decreased the tympanic membrane temperature for 1.4 degrees C in 2h without causing uncomfortable sensation or frostbite. In this study, 86 patients with ISSHL were enrolled in the hypothermic group, which received hypothermic treatment with restricted activity in addition to medication, and 86 ISSHL patients constituted the control group, which received the same medication but without cooling and rest. Control patients were selected retrospectively from case records by matching the experimental patients with respect to age, gender, days until the start of treatment, hearing loss, shape of the audiogram, and accompanying vertigo. The patients in the hypothermic group were admitted and treated with a cooled water pillow for 48h, in addition to conventional drug treatment (e.g., 60 mg of prednisone) for 7 days. The water pillow was cooled to 15 degrees C and was changed 4-5 times per day. The patients used the water pillow for the first 48 h after admission, with restricted activity. The control patients received only the medications.
Hearing results were evaluated using criteria proposed by the Sudden Sensorineural Hearing Loss Research Group of the Japanese Ministry of Health and Welfare. The recovery rates were judged 6 months after onset. The recovery rate in the hypothermic group was significantly (p<0.05) better than that in the control group. When the comparison was limited to younger patients, the use of the cooled water pillow was effective in facilitating the recovery of hearing.
Hearing restoration in ISSHL may be improved by adding mild hypothermia and restricted activity to the conventional treatment.
通过病例匹配研究进行多中心（13家医院）的初步试验，调查局部低温和限制活动对特发性突发性感音神经性听力损失（ISSHL）治疗的附加效果。
在一项初步实验中，我们评估了冷水枕（15摄氏度）的效果。使用该枕头冷却颈部和乳突，2小时内可使鼓膜温度降低1.4摄氏度，且不会引起不适感或冻伤。在本研究中，86例ISSHL患者被纳入低温治疗组，该组除药物治疗外还接受低温治疗并限制活动；86例ISSHL患者构成对照组，接受相同药物治疗但不进行冷却和休息。通过回顾病例记录，根据年龄、性别、治疗开始天数、听力损失、听力图形状和伴随的眩晕情况，将对照组患者与试验组患者进行匹配。低温治疗组患者入院后除接受7天的常规药物治疗（如60毫克泼尼松）外，还使用冷水枕治疗48小时。冷水枕冷却至15摄氏度，每天更换4 - 5次。患者入院后的前48小时使用冷水枕，并限制活动。对照组患者仅接受药物治疗。
使用日本厚生省突发性感音神经性听力损失研究组提出的标准评估听力结果。在发病6个月后判断恢复率。低温治疗组的恢复率显著高于对照组（p<0.05）。当仅对年轻患者进行比较时，使用冷水枕有助于听力恢复。
在常规治疗中添加轻度低温和限制活动可能会改善ISSHL的听力恢复情况。
