Si Yu, Jiang Huai Li, Chen Yu Bin, Chu Yu Guo, Chen Sui Jun, Chen Xi Ming, He Wu Hui, Zheng Yi Qing, Zhang Zhi Gang
Department of Otolaryngology, Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China.
Audiol Neurootol. 2018;23(6):309-315. doi: 10.1159/000493086. Epub 2019 Jan 10.
To explore the effectiveness and safety of round window niche drilling combined with intratympanic methylprednisolone injection for the salvage treatment of sudden sensorineural hearing loss (SSNHL) and its associated tinnitus after failed primary treatment.
SSNHL patients who showed a less than 10-dB improvement of pure-tone average after receiving standard systemic treatment and intratympanic steroid injection were enrolled. All included patients were randomly divided into two groups (control and study). Patients in the study group received round window niche drilling combined with daily intratympanic methylprednisolone for 7 times; the control group received only daily intratympanic methylprednisolone for 7 times. One month after treatment, the improvements of PTA, speech discrimination score (SDS), tinnitus and the incidence of adverse events were analyzed.
20 patients (10 for each group) were included in this study. The baseline between two groups showed no statistical significance. Patients in the study group experienced an average hearing improvement of 20.38 dB, SDS 19.3 compared with 2.1 dB and SDS 2.0 in the control group. None (0%) in the control group and 4 patients (40%) showed marked recovery, 5 patients (50%) showed slight improvement of hearing in the study group after 1 month. All patients in the study group showed significant recovery of tinnitus. Both tinnitus handicap inventory and a symptom visual analogue scale between two groups revealed statistical differences (p < 0.001, p = 0.002, respectively). None in the control and study groups experienced vertigo, infection and facial paralysis.
Round window niche drilling increases the contact area and time of methylprednisolone. It is an effective and safe salvage therapy of idiopathic SSNHL and its induced tinnitus.
探讨圆窗龛钻孔联合鼓室内注射甲泼尼龙对突发性感音神经性听力损失（SSNHL）初次治疗失败后的挽救治疗效果及安全性，以及对相关耳鸣的治疗效果。
纳入标准全身治疗和鼓室内注射类固醇后纯音平均听阈改善不足10dB的SSNHL患者。所有纳入患者随机分为两组（对照组和研究组）。研究组患者接受圆窗龛钻孔并每日鼓室内注射甲泼尼龙，共7次；对照组仅每日鼓室内注射甲泼尼龙7次。治疗1个月后，分析纯音听阈（PTA）、言语识别率（SDS）、耳鸣的改善情况及不良事件发生率。
本研究共纳入20例患者（每组10例）。两组间基线无统计学差异。研究组患者平均听力改善20.38dB，言语识别率改善19.3，而对照组分别为2.1dB和2.0。1个月后，对照组无一例（0%）、研究组4例（40%）听力显著恢复，研究组5例（50%）听力稍有改善。研究组所有患者耳鸣均有显著恢复。两组间耳鸣 handicap 量表和症状视觉模拟量表均有统计学差异（分别为p < 0.001，p = 0.002）。对照组和研究组均无眩晕、感染及面瘫发生。
圆窗龛钻孔增加了甲泼尼龙的接触面积和时间。它是特发性SSNHL及其所致耳鸣的一种有效且安全的挽救治疗方法。
