Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
J Otolaryngol Head Neck Surg. 2010 Dec;39(6):640-5.
to evaluate the effectiveness of transtympanic methylprednisolone injection in patients with refractory sudden sensorineural hearing loss via endoscopic diode laser myringotomy.
thirty-six sudden sensorineural hearing loss patients who failed routine oral steroid therapy and two patients with a contraindication to systemic steroid received intratympanic methylprednisolone injections at the round window by endoscopic diode laser myringotomy once every other day with a maximum of four injections. One of the two patients with a contraindication to oral steroid was a normal pregnant woman, whereas the other was an active digestive ulcer patient. Hearing level, dizziness, and tinnitus were evaluated before the first procedure and 20 days after the last injection.
thirteen of 38 patients (34.2%) showed an improvement in hearing levels. The average improvement 20 days after treatment was 54 dB in the hearing thresholds of 125 to 8000 Hz. The complete recovery rate of intratympanic methylprednisolone injection (mean 2.6 times) was 21% (8 of 38). There were no serious unexpected adverse events in the 38 patients except one aggravation of hearing loss occurred after intratympanic injection. Temporary dizziness in seven subjects and otalgia in six subjects occurred after injection, which was relieved after 0.5 to 2 hours without special treatment. No perforation of tympanic membrane or infection occurred 20 days after the last injection.
topical intratympanic injection may be considered a substitute for the systemic administration in patients with refractory sudden hearing loss, especially those who have contraindications to systemic steroid administration. The endoscope is helpful for ensuring the effective delivery of drugs into the round window. Prospective randomized controlled trials should be designed for further investigation.
通过内镜下二极管激光鼓膜切开术评估鼓室内注射甲泼尼龙治疗难治性突发性聋的疗效。
36 例常规全身应用激素治疗无效的突发性聋患者和 2 例不能使用全身激素的患者接受鼓室内注射甲泼尼龙治疗，每周 2 次，最多 4 次，每次注射均于内镜下经圆窗膜进行。2 例不能全身使用激素的患者中，1 例为正常孕妇，1 例为活动性消化性溃疡患者。所有患者均于第 1 次治疗前及末次治疗后 20 天评估听力水平、眩晕和耳鸣情况。
38 例患者中 13 例（34.2%）听力提高。治疗后 20 天平均听阈在 125～8000Hz 频率各频率点提高 54dB。鼓室内注射甲泼尼龙完全缓解率（平均注射 2.6 次）为 21%（8/38）。38 例患者中除 1 例鼓室内注射后听力下降加重外，无严重意外不良事件发生。7 例患者注射后出现短暂眩晕，6 例患者出现耳痛，均于 0.5～2 小时内自行缓解，无需特殊处理。末次治疗后 20 天无鼓膜穿孔或感染发生。
对于难治性突发性聋患者，尤其是不能全身应用激素的患者，鼓室内注射甲泼尼龙可能替代全身用药。内镜有助于确保药物有效送达圆窗。需要设计前瞻性随机对照试验进一步研究。
