Georgetown University School of Medicine, Washington, DC, USA.
Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC, USA.
Ann Otol Rhinol Laryngol. 2023 Aug;132(8):879-887. doi: 10.1177/00034894221120125. Epub 2022 Aug 21.
To investigate how dexamethasone dosage impacts intratympanic steroid therapy (IST) for treatment of sudden sensorineural hearing loss (SSNHL).
Retrospective review.
Inclusion criteria identified subjects who received IST between January 1, 2010 and June 1, 2020 for iSSNHL. Subjects with Meniere's disease, autoimmune inner ear disease, subjects who received injections of non-dexamethasone steroid formulations, and subjects with missing audiogram data were excluded. Subjects were stratified by dexamethasone dosage: low-dose (10 mg/ml) versus high-dose (24 mg/ml), time-to-treatment and oral corticosteroid use. Outcome measures included post-treatment improvement in 4-frequency pure tone average (4F-PTA [500, 1000, 2000,4000 Hz]), low- and high-frequency PTA (250-1000 Hz and 2000-8000 Hz, respectively).
Of the 55 included subjects (50.9% male, mean age 48.9 ± 16.4 years), 31 received high-dose while 24 received low-dose injections. 90.9% of subjects were treated with oral steroids prior to or during IST. No significant differences in hearing outcomes were observed between low- and high-dose cohorts or when stratifying by oral steroid use. Time-to-treatment analysis comparing ≤1 month (67.3%) versus >1 month (32.7%) groups demonstrated a significant improvement in post-treatment 4F-PTA ( = .01) in the ≤1 month group.
Hearing recovery was not significantly different between the 10 mg/ml versus 24 mg/ml doses of intratympanic dexamethasone, suggesting that steroid dose may not impact the efficacy of IST. A shorter time-to-treatment was observed to be favorable for hearing improvement.
研究地塞米松剂量对鼓室内类固醇治疗（IST）治疗突发性聋（SSNHL）的影响。
回顾性研究。
纳入标准为 2010 年 1 月 1 日至 2020 年 6 月 1 日期间因 iSSNHL 接受 IST 的患者。排除梅尼埃病、自身免疫性内耳疾病、接受非地塞米松类固醇制剂注射的患者以及听力图数据缺失的患者。根据地塞米松剂量将患者分为低剂量（10mg/ml）和高剂量（24mg/ml）组、治疗时间和口服皮质类固醇使用情况。主要结局为治疗后 4 个频率纯音平均听阈（4F-PTA[500、1000、2000、4000Hz]）、低频和高频 PTA（250-1000Hz 和 2000-8000Hz）的改善情况。
55 例患者（50.9%为男性，平均年龄 48.9±16.4 岁）中，31 例接受高剂量，24 例接受低剂量注射。90.9%的患者在 IST 前或期间接受了口服皮质类固醇治疗。低剂量和高剂量组或口服皮质类固醇使用分层时，听力结果无显著差异。比较≤1 个月（67.3%）和＞1 个月（32.7%）治疗时间的分析显示，≤1 个月组治疗后 4F-PTA 显著改善（ = .01）。
鼓室内地塞米松 10mg/ml 与 24mg/ml 剂量之间的听力恢复无显著差异，提示类固醇剂量可能不会影响 IST 的疗效。治疗时间越短，听力改善越有利。
