Wang Shi-Yi, Fu Wen-Ting, Yu Meng, Sun Aidong, Sun Jingwu, Li Guang
Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Yangzhou University, No. 368 Hanjiang Middle Road, Yangzhou, Jiangsu Province 225001, PR China.
Yangzhou Hospital of Traditional Chinese Medicine, No. 577 Wenchang Middle Road, Yangzhou, Jiangsu Province 225001, PR China.
Am J Otolaryngol. 2025 Mar-Apr;46(2):104603. doi: 10.1016/j.amjoto.2025.104603. Epub 2025 Jan 17.
Our study tried to evaluate and compare the therapeutic efficacy of intratympanic injection of dexamethasone (DEX) at different concentrations for the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL).
A prospective randomized controlled study was conducted on 203 patients with unilateral ISSNHL. Patients were divided into four groups: the control group (n = 47, systemic treatment only), the high-concentration group (n = 51, intratympanic injection of DEX 20 mg/ml), the medium-concentration group (n = 55, 10 mg/ml), and the low-concentration group (n = 50, 5 mg/ml). Pure tone audiometry (PTA) thresholds were measured before treatment and on the 10th day post-treatment, with a follow-up period of 2 months. Hearing gains and efficacy rates were compared among the groups.
Significant differences were observed in PTA thresholds before and after treatment in all four groups (P < 0.05), indicating that both systemic therapy and intratympanic injection were effective. The overall efficacy rate and hearing gain were higher in the intratympanic injection groups compared to the control group, but the differences were not statistically significant. Specifically, the control group achieved an efficacy rate of 57.4 % with a hearing gain of 11.25 ± 10.00 dB HL. The intratympanic injection groups showed an overall efficacy rate of 67.3 % and a hearing gain of 12.50 ± 10.94 dB HL, with subgroup results as follows: low-concentration group (62.0 %, 12.50 ± 11.56 dB HL), medium-concentration group (69.1 %, 11.25 ± 13.75 dB HL), and high-concentration group (70.6 %, 12.50 ± 8.75 dB HL). Among patients with severe or profound hearing loss, the high-concentration group exhibited significantly greater hearing gains compared to the control group, while no significant differences were observed in efficacy rates.
Combined intratympanic injection of DEX with systemic treatment for SSNHL provides higher hearing gains and efficacy rates compared to systemic treatment alone, though the differences were not statistically significant. In patients with severe or profound hearing loss, intratympanic injection of high-concentration DEX resulted in significantly greater hearing improvement, suggesting a potential therapeutic advantage in this subgroup.
本研究旨在评估和比较不同浓度地塞米松（DEX）鼓室内注射治疗特发性突发性感音神经性听力损失（ISSNHL）的疗效。
对203例单侧ISSNHL患者进行前瞻性随机对照研究。患者分为四组：对照组（n = 47，仅全身治疗）、高浓度组（n = 51，鼓室内注射20 mg/ml DEX）、中浓度组（n = 55，10 mg/ml）和低浓度组（n = 50，5 mg/ml）。在治疗前及治疗后第10天测量纯音听力计（PTA）阈值，随访期为2个月。比较各组的听力改善情况和有效率。
四组治疗前后PTA阈值均有显著差异（P < 0.05），表明全身治疗和鼓室内注射均有效。鼓室内注射组的总体有效率和听力改善程度高于对照组，但差异无统计学意义。具体而言，对照组有效率为57.4%，听力改善11.25 ± 10.00 dB HL。鼓室内注射组总体有效率为67.3%，听力改善12.50 ± 10.94 dB HL，各亚组结果如下：低浓度组（62.0%，12.50 ± 11.56 dB HL）、中浓度组（69.1%，11.25 ± 13.75 dB HL）和高浓度组（70.6%，12.50 ± 8.75 dB HL）。在重度或极重度听力损失患者中，高浓度组的听力改善明显大于对照组，而有效率无显著差异。
与单纯全身治疗相比，鼓室内注射DEX联合全身治疗SSNHL可提供更高的听力改善程度和有效率，尽管差异无统计学意义。在重度或极重度听力损失患者中，鼓室内注射高浓度DEX可显著改善听力，提示该亚组可能具有潜在的治疗优势。
