Department of Otorhinolaryngology - Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Otol Neurotol. 2011 Dec;32(9):1432-6. doi: 10.1097/MAO.0b013e318238fc43.
This study aimed to investigate the therapeutic efficacy of intratympanic dexamethasone (ITD) as a salvage treatment in sudden hearing loss (SHL) patients who had no response to initial systemic combination steroid therapy.
From May 2007 to June 2010, 415 SHL patients visited 3 tertiary referral centers within 7 days of disease onset. They were all treated with an identical protocol, a 10-day scheduled hospitalization and oral steroid treatment. Of these, 151 patients were totally unresponsive 2 weeks after treatment initiation according to Siegel's criteria. We divided these 151 refractory patients into 3 groups: those receiving no further treatment (control group, n = 59), those receiving one more 10-day cycle of oral steroids (systemic reapplication group, n = 26), and those receiving ITD therapy (ITD group, n = 66). Final assessment of hearing was conducted approximately 3 months after the onset of SHL. Hearing improvement was defined as demonstrating "any" improvement according to Siegel's criteria.
The initial average hearing thresholds of all groups were similar. Overall hearing improvement was observed in 10 of 59 patients in the control group, in 4 of 26 in the systemic reapplication group, and in 32 of 66 in the ITD group. No serious complications were observed. Analyzing by frequency, paradoxically, hearing of the low and mid frequencies was more significantly improved than high frequencies in the ITD group.
Intratympanic dexamethasone administration after failure of an initial treatment is effective, and this should be used as a salvage treatment in cases of refractory SHL.
本研究旨在探讨鼓室内地塞米松（ITD）治疗作为初始全身联合类固醇治疗无效的突发性聋（SHL）患者的挽救治疗的疗效。
2007 年 5 月至 2010 年 6 月，415 例 SHL 患者在发病后 7 天内到 3 个三级转诊中心就诊。他们均采用相同的方案治疗，即 10 天的住院治疗和口服类固醇治疗。其中，根据 Siegel 的标准，有 151 例患者在治疗开始后 2 周完全无反应。我们将这 151 例难治性患者分为 3 组：未接受进一步治疗的患者（对照组，n=59）、接受另一个 10 天周期的口服类固醇治疗的患者（全身再应用组，n=26）和接受 ITD 治疗的患者（ITD 组，n=66）。大约在 SHL 发病后 3 个月进行最终听力评估。听力改善定义为根据 Siegel 的标准表现出“任何”改善。
所有组的初始平均听力阈值相似。在对照组中，59 例患者中有 10 例，全身再应用组中 26 例中有 4 例，ITD 组中 66 例中有 32 例观察到总体听力改善。未观察到严重并发症。按频率分析，令人惊讶的是，在 ITD 组中，低频和中频的听力比高频更显著改善。
在初始治疗失败后，鼓室内给予地塞米松是有效的，在难治性 SHL 病例中，应将其作为挽救治疗。
