Sevil Ergun, Bercin Sami, Muderris Togay, Gul Fatih, Kiris Muzaffer
Department of Otorhinolaryngology, Head and Neck Surgery, Karaman State Hospital, 70100, Karaman, Turkey.
Department of Otorhinolaryngology, Head and Neck Surgery, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey.
Eur Arch Otorhinolaryngol. 2016 Sep;273(9):2419-26. doi: 10.1007/s00405-015-3791-6. Epub 2015 Nov 4.
The purpose of the study was to assess the efficacy of the association of intratympanic (IT) steroid and hyperbaric oxygen (HBO) therapy in patients presenting with idiopathic sudden sensorineural hearing loss (ISSNHL), and to compare this protocol with another consisting of intravenous (IV) steroid administration and HBO therapy. A total of 80 patients diagnosed with ISSNHL were included in this prospective trial. Patients were divided into three categories: a mild-to-moderate ISSNHL group with a pure-tone average (PTA) ≤60 decibels (dB), a severe ISSNHL group with a PTA of 60-80 dB, and a profound ISSNHL group with a PTA ≥81 dB. The first protocol consisted of 20 sessions of HBO therapy together with IV methylprednisolone 1 mg/kg body weight and a 10 mg taper every 3 days for 10 days. The second protocol consisted of HBO therapy for 20 sessions, together with an IT injection of dexamethasone at a dose of 4 mg/mL, 0.5-0.7 mL once a day for 7 consecutive days, performed 3 h before the HBO therapy. In the mild-to-moderate ISSNHL patients, the mean hearing gain and successful treatment rate was 19 (0-27) dB and 78.9 %, respectively in the IT + HBO treatment group, and 18 (3-44) dB and 70.5 % in the IV + HBO therapy group. In the severe ISSNHL patients, the mean hearing gain and successful treatment rate was 33 (1-54) dB and 81.8 %, respectively in the IT + HBO treatment group and 33.5 (7-57) dB and 58.2 % in the IV + HBO group. In the profound ISSNHL patients, the mean hearing gain and successful treatment rate was 36 (4-69) dB and 40 %, respectively in the IT + HBO therapy group, and 39.5 (0-92) dB and 72.7 % in the IV + HBO treatment group. The results demonstrated that patients with severe hearing loss success rate was superior in the group submitted to IT + HBO treatment, conversely IV + HBO therapy may be benefit for patients with profound hearing loss. Nevertheless, these clinical results were not statistically significant.
本研究的目的是评估鼓室内（IT）注射类固醇与高压氧（HBO）联合治疗特发性突发性感音神经性听力损失（ISSNHL）患者的疗效，并将该方案与另一种由静脉内（IV）注射类固醇和HBO治疗组成的方案进行比较。共有80例被诊断为ISSNHL的患者纳入了这项前瞻性试验。患者被分为三类：纯音平均听阈（PTA）≤60分贝（dB）的轻度至中度ISSNHL组、PTA为60 - 80 dB的重度ISSNHL组和PTA≥81 dB的极重度ISSNHL组。第一个方案包括20次HBO治疗，同时静脉注射甲泼尼龙1毫克/千克体重，每3天减量10毫克，共10天。第二个方案包括20次HBO治疗，同时在HBO治疗前3小时进行鼓室内注射地塞米松，剂量为4毫克/毫升，每天0.5 - 0.7毫升，连续7天。在轻度至中度ISSNHL患者中，IT + HBO治疗组的平均听力增益和成功治疗率分别为19（0 - 27）dB和78.9%，IV + HBO治疗组为18（3 - 44）dB和70.5%。在重度ISSNHL患者中，IT + HBO治疗组的平均听力增益和成功治疗率分别为33（1 - 54）dB和81.8%，IV + HBO组为33.5（7 - 57）dB和58.2%。在极重度ISSNHL患者中，IT + HBO治疗组的平均听力增益和成功治疗率分别为36（4 - 69）dB和40%，IV + HBO治疗组为39.5（0 - 92）dB和72.7%。结果表明，重度听力损失患者在接受IT + HBO治疗组的成功率更高，相反，IV + HBO治疗可能对极重度听力损失患者有益。然而，这些临床结果无统计学意义。
