Sismanis A, Wise C M, Johnson G D
Department of Otolaryngology-Head and Neck Surgery, Medical College of Virginia/Virginia Commonwealth University, USA.
Otolaryngol Head Neck Surg. 1997 Feb;116(2):146-52. doi: 10.1016/S0194-59989770316-4.
Immune-mediated cochleovestibular disorders continue to present a management challenge to the otolaryngologist. The traditional treatment of these disorders, corticosteroids and/or cyclophosphamide (Cytoxan), has been associated with serious and occasionally life-threatening complications. In this study we report our experience in treating 25 patients with immune-mediated cochleovestibular disorders with methotrexate, a less toxic immunosuppressive agent that has been used extensively in patients with rheumatoid arthritis. Mean duration of treatment was 12.9 months, and adverse reactions were acceptable and reversible. Hearing improved in 69.6% of patients, and vestibular symptoms subsided or improved in 80% of patients. The results of this study suggest that methotrexate treatment is effective in a substantial number of patients with immune-mediated cochleovestibular disorders and has acceptable adverse reactions. A prospective, randomized study is needed to compare the efficacy of methotrexate with that of other immunosuppressive agents.
免疫介导的耳蜗前庭疾病仍然给耳鼻喉科医生带来治疗挑战。这些疾病的传统治疗方法，即使用皮质类固醇和/或环磷酰胺（癌得星），会引发严重且偶尔危及生命的并发症。在本研究中，我们报告了使用甲氨蝶呤治疗25例免疫介导的耳蜗前庭疾病患者的经验，甲氨蝶呤是一种毒性较小的免疫抑制剂，已广泛应用于类风湿关节炎患者。平均治疗时间为12.9个月，不良反应可接受且可逆。69.6%的患者听力得到改善，80%的患者前庭症状减轻或改善。本研究结果表明，甲氨蝶呤治疗对大量免疫介导的耳蜗前庭疾病患者有效，且不良反应可接受。需要进行一项前瞻性随机研究，以比较甲氨蝶呤与其他免疫抑制剂的疗效。
