Redleaf M I, Bauer C A, Gantz B J, Hoffman H T, McCabe B F
Department of Otolaryngology--Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Am J Otol. 1995 May;16(3):295-303.
Many treatments have been proposed to manage sudden sensorineural hearing loss. The University of Iowa has used a protocol of intravenous radiopaque contrast and volume expander for the last 10 years in the treatment of sudden sensorineural hearing loss. A retrospective analysis of these cases was performed to review the efficacy of this treatment with respect to the natural history of the disease, as reported in previous studies. Sixty-four percent of 39 cases showed audiometric improvement in their pure-tone averages, speech reception thresholds, and speech discriminations while receiving treatment. Forty-eight percent of these showed improvement after their first treatment doses. Eighty percent of patients who presented more than 7 days after the onset of their hearing loss showed audiometric improvement with treatment, whereas 71 percent of patients presenting before 7 days showed audiometric improvement. However, the patients who presented earlier showed more marked improvement. Speech discrimination with the W-22 word list was a predictor of early recovery. Patients with measurable speech discrimination scores on presentation uniformly improved with treatment, even if their pure-tone average was profound. Our findings were suggestive of a pathophysiologic mechanism for some cases of sensorineural hearing loss for which intravenous contrast is efficacious. Although our findings were far from conclusive in this uncontrolled study, these initial results support the use of these agents in a rigorous clinical trial.
针对突发性感音神经性听力损失，人们提出了许多治疗方法。在过去10年里，爱荷华大学采用了静脉注射不透射线造影剂和扩容剂的方案来治疗突发性感音神经性听力损失。对这些病例进行了回顾性分析，以根据既往研究报告的疾病自然史来评估这种治疗方法的疗效。在接受治疗的39例病例中，64%的患者在纯音平均听阈、言语接受阈和言语辨别力方面有听力改善。其中48%的患者在首次治疗剂量后即有改善。听力损失发作后7天以上就诊的患者中，80%经治疗后有听力改善，而7天内就诊的患者中，71%有听力改善。然而，就诊较早的患者改善更为明显。使用W-22单词表进行的言语辨别是早期恢复的一个预测指标。就诊时言语辨别分数可测的患者，即使其纯音平均听阈严重，经治疗后也均有改善。我们的研究结果提示，对于某些静脉注射造影剂有效的感音神经性听力损失病例，存在一种病理生理机制。尽管在这项非对照研究中我们的结果远非结论性的，但这些初步结果支持在严格的临床试验中使用这些药物。
