Topf Michael C, Hsu David W, Adams Douglas R, Zhan Tingting, Pelosi Stanley, Willcox Thomas O, McGettigan Brian, Fisher Kyle W
Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA.
Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA.
Am J Otolaryngol. 2017 Jan-Feb;38(1):21-25. doi: 10.1016/j.amjoto.2016.09.004. Epub 2016 Sep 28.
To determine the rate of persistent tympanic membrane perforation after intratympanic steroid injection. To determine which comorbid conditions and risk factors are associated with prolonged time to perforation closure following intratympanic steroid injection.
Clinical data were gathered for patients who had undergone intratympanic steroid injection to treat sudden sensorineural hearing loss or Ménière's disease. Primary outcomes analysis included rate of persistent tympanic membrane perforation, defined as perforation at least 90days following last injection, and time to perforation healing. Age, sex, number of injections, smoking status, diabetes mellitus, previous head and neck irradiation, and concurrent oral steroids, were analyzed as potential predictors of persistent perforation.
One hundred ninety two patients were included in this study. Three patients (1.6%) had persistent tympanic membrane perforations. All three patients received multiple injections. One patient underwent tympanoplasty for repair of persistent perforation. The median time to perforation healing was 18days. There was no statistically significant variable associated with time to perforation healing. However, patients with prior history of head and neck radiation averaged 36.5days for perforation healing compared to 17.5days with no prior history of radiation and this approached statistical significance (p=0.078).
The rate of persistent tympanic membrane perforation following intratympanic steroid injection is low. Patients with a history of radiation to the head and neck may be at increased risk for prolonged time for closure of perforation.
确定鼓室内注射类固醇后鼓膜持续穿孔的发生率。确定哪些合并症和危险因素与鼓室内注射类固醇后穿孔闭合时间延长相关。
收集接受鼓室内注射类固醇治疗突发性感音神经性听力损失或梅尼埃病患者的临床资料。主要结局分析包括鼓膜持续穿孔的发生率（定义为最后一次注射后至少90天存在穿孔）以及穿孔愈合时间。分析年龄、性别、注射次数、吸烟状况、糖尿病、既往头颈部放疗史以及同时使用口服类固醇作为持续性穿孔的潜在预测因素。
本研究纳入了192例患者。3例患者（1.6%）出现鼓膜持续穿孔。所有3例患者均接受了多次注射。1例患者接受了鼓膜成形术以修复持续性穿孔。穿孔愈合的中位时间为18天。与穿孔愈合时间相关的变量无统计学意义。然而，有头颈部放疗史的患者穿孔愈合平均时间为36.5天，而无放疗史的患者为17.5天，这接近统计学意义（p=0.078）。
鼓室内注射类固醇后鼓膜持续穿孔的发生率较低。有头颈部放疗史的患者穿孔闭合时间延长的风险可能增加。
