Paksoy Mustafa, Altin Gokhan, Eken Mehmet, Hardal Umit
2nd ENT Department, Kartal Training and Research Hospital, Istanbul, Turkey ; Kayısdagı cd. Yamac Apt. No: 154 D:12, Goztepe, 34731 Istanbul, Turkey.
2nd ENT Department, Kartal Training and Research Hospital, Istanbul, Turkey.
Indian J Otolaryngol Head Neck Surg. 2013 Dec;65(Suppl 3):461-7. doi: 10.1007/s12070-011-0281-z. Epub 2011 Jun 29.
The aim of this study was to determine the efficiency of intratympanic dexamethasone (ITD) injections as a new treatment modality in otitis media with effusion resistant to conventional therapy. We planned a nonrandomized prospective study to determine the safety and effectiveness of the direct administration of dexamethasone into middle ear cavity with chronic eustachian tube dysfunction. This study was applied on 75 ears of 64 patients aged from 12 to 60 years. ITD received 47 ears of 41 patients who had previously been treated by medical or surgical therapy middle ear effusion without resolution classified as study group. They were taken conventional medical therapy again 28 ears of 23 patients classified as a control group. ITDs were administered 0.5 ml/4 mg per mm directly in antero-superior quadrant of tympanic membrane. These injections were repeated once a week for 4 weeks. Results were evaluated by using audiometric and tympanometric measurements 1 and 3 months after the treatments. Audiometric measurement shows that 9.91 dB improvement in the mean air-bone gap 15.17 dB in air conduction (AC) pure-tone averages (PTA) and 5.25 dB bone conduction (BC) PTA. But the control group data showed only 2 dB improvement in the mean air-bone gap, 3 dB AC-PTA and 1.36 dB BC-PTA. Tympanometric improvement was found. In 28 ears of patients (59.6%) like type B or C converted to type A in study group without complication but only in three ears (10.7%) of control group. ITD administration to the middle ear is safe and effective for the treatment of otitis media with effusion or chronic eustachian tube dysfunction. No complications like tympanic membrane perforation and/or sensorineural hearing loss have occurred.
本研究的目的是确定鼓室内注射地塞米松（ITD）作为一种新的治疗方式，用于治疗对传统疗法耐药的分泌性中耳炎的疗效。我们计划进行一项非随机前瞻性研究，以确定在慢性咽鼓管功能障碍患者中，将地塞米松直接注入中耳腔的安全性和有效性。本研究应用于64例年龄在12至60岁之间患者的75只耳朵。41例曾接受过药物或手术治疗但中耳积液仍未消退的患者的47只耳朵接受ITD治疗，分为研究组。23例患者的28只耳朵再次接受传统药物治疗，分为对照组。将0.5毫升/4毫克/毫米的ITD直接注射到鼓膜的前上象限。这些注射每周重复一次，共进行4周。在治疗后1个月和3个月，通过听力测定和鼓室图测量来评估结果。听力测定显示，平均气骨导差改善了9.91分贝，气导（AC）纯音平均听阈（PTA）改善了15.17分贝，骨导（BC）PTA改善了5.25分贝。但对照组数据显示，平均气骨导差仅改善了2分贝，AC-PTA改善了3分贝，BC-PTA改善了1.36分贝。发现鼓室图有改善。研究组中28只耳朵（59.6%）的B型或C型患者转变为A型，且无并发症，而对照组仅3只耳朵（10.7%）出现这种情况。向中耳注射ITD治疗分泌性中耳炎或慢性咽鼓管功能障碍是安全有效的。未发生鼓膜穿孔和/或感音神经性听力损失等并发症。
