UO Otorinolaringoiatria, Azienda Sanitaria Provinciale 1 Agrigento, Ospedale S. Giovanni di Dio, Italia.
Am J Otolaryngol. 2013 Jul-Aug;34(4):296-300. doi: 10.1016/j.amjoto.2012.12.010. Epub 2013 Jan 26.
The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone to treat sudden sensorineural hearing loss as salvage therapy.
A prospective study was conducted on patients affected by idiopathic sudden hearing loss who were treated before with some systemic therapy, but without recovery of the hearing The patients able to undergo the study, but who refused salvage treatment were considered as control group. A solution of Dexamethasone 4 mg/ml was then injected through the posterior-inferior quadrant filling completely the middle ear. The follow-up in the following 6 months included an audiogram every month.
The number of patients treated with salvage therapy was 36. The patients who refused treatment were further 10. The salvage treatment was done with a mean delay of 24.3 days from the onset of symptoms. Mean hearing threshold after the onset of sudden hearing loss at PTA was 66.5 dB. After the failed treatment the mean PTA was 59.6 dB. The mean PTA after the intratympanic steroid administration was 46.8 dB, with a mean improvement of 12.8 dB. No hearing change was noted in the 10 patients who refused salvage therapy. The patients that assumed systemic steroid as first therapy showed a better PTA threshold after the salvage intratympanic treatment (p<0.01). A significant difference (p<0.05) of hearing recovery was evidenced between non-smoker patients and those with smoking habit.
Our data showed that a salvage treatment with intratympanic dexamethasone should be suggested to all patients who failed the first systemic treatment. The systemic steroid therapy done before the salvage treatment seems to exert a protective role for the inner ear, as shown by our series. On the contrary the smoke habit is a negative prognostic factor in the hearing recovery.
本研究旨在验证鼓室内注射地塞米松治疗特发性突发性聋作为挽救性治疗的疗效和安全性。
对接受过全身治疗但听力未恢复的特发性突发性聋患者进行前瞻性研究。能够接受但拒绝挽救性治疗的患者被视为对照组。然后通过后下象限填充将 4mg/ml 的地塞米松溶液注入中耳。在接下来的 6 个月中，每月进行一次听力测试。
接受挽救性治疗的患者有 36 例，拒绝治疗的患者进一步有 10 例。挽救性治疗从症状发作开始平均延迟 24.3 天。纯音听阈平均值（PTA）在突发性聋发病时为 66.5dB。在失败治疗后，PTA 平均值为 59.6dB。鼓室内类固醇给药后 PTA 平均值为 46.8dB，平均听力提高 12.8dB。拒绝挽救性治疗的 10 例患者听力无变化。首次接受全身类固醇治疗的患者在接受挽救性鼓室内治疗后 PTA 阈值更好（p<0.01）。非吸烟者和吸烟者之间的听力恢复差异有统计学意义（p<0.05）。
我们的数据表明，所有首次全身治疗失败的患者都应接受鼓室内注射地塞米松的挽救性治疗。我们的研究表明，在挽救性治疗前进行全身类固醇治疗似乎对内耳起到保护作用。相反，吸烟习惯是听力恢复的负面预后因素。
