| Objective:To compare the therapeutic effect of intramural injection and retroauricular injection of dexamethasone in the treatment of all frequency sudden senesineural deafness with full-frequency decline（SSNHL at all frequencies）,find a more effective,safe and simple way to treat SSNHL at all frequencies,in order to better application in clinical.Materials and Methods:Patient selection and grouping:56 patients（60 ears）meet the diagnostic criterial of SSNHL at all frequencies,and were in the second affiliated hospital Universityof South China in March 2019 to November 2020.According to the clinic time,all the affected ears were numbered 1 to 60.According to the principle of random grouping,the affected ears numbered odd were divided into the intratympanic group,and the affected ears numbered even were divided into the retroauricular group.There was no statistical significance in the general data（including gender,type of affected ear side,course of disease,age,tinnitus,vertigo and other associated symptoms,initial threshold of speech hearing,initial threshold of hearing,type of hearing curve,etc.）of the intratympanic group and the retroauricular group,indicating that the data of the two groups were well balanced and comparable.The onset time of all the patients in this study was different,so they were divided into two groups according to the course of disease within one week and exceed one week,to compare the curative effect of different course of disease.There were no significant differences in the general information（such as age,gender,affected side of ear,tinnitus,vertigo and other associated symptoms,initial threshold of speech hearing,initial threshold of hearing,type of hearing curve,etc.）of the two groups,indicating that the data of the two groups were well balanced and comparable.Methods:In the intratympanic group,the surface of the tympanic membrane was anesthetized for 10 minutes and disinfected with alcohol for 3 times,then 1ml of dexamethasone was injected into the tympanic cavity.In the retroauricular group,disinfecting skin of cribriform area,1ml of dexamethasone was injected into the subperiosteum of cribriform area.Two group were injected once every other day for five time.In addition,two groups were given systemic adjuvant drug therapy and hyperbaric oxygen therapy for a course of treatment.Date collection:Mean values of 250Hz,500Hz,1000Hz,2000Hz,4000Hz and 8000Hz were obtained for 3 times before treatment,the 7th day of treatment,and the day after the end of a course of treatment.The efficacy of the two groups was compared,and the adverse reactions and improvement of tinnitus and vertigo in the two groups were recorded.Efficacy evaluation:Refer to the standards of the guidelines for diagnosis and treatment of sudden deafness issued by Chinese Medical Association in 2015.Results:1、At the end of treatment,the average speech hearing threshold of the intratympanic group before treatment was 84.5±22.6 d B,the average speech hearing threshold after treatment was 62.8±27.1 d B,the average speech hearing threshold of the retroauricular group was 80.8±19.4 d B before treatment and 57.1±25.6 d B after treatment.The comparison of mean threshold of speech hearing before and after treatment in the two groups was analyzed by t-test（P<0.05）,indicating that the difference was statistically significant.In the intratympanic group,the average speech hearing threshold was 84.9±21.4d B before treatment and was 65.2±25.0d B after treatment.In the retroauricular group,the average speech hearing threshold was 82.1±17.7d B before treatment and was 60.0±24.9d B after treatment.The comparison of the mean threshold of hearing before and after treatment in the two groups was analyzed by t-test（P<0.05）,indicating that the difference was statistically significant.The results indicated that intratympanic injection and retroauricular injection of dexamethasone were both effective in the initial treatment of SSNHL at all frequencies.After treatment,the mean threshold of speech hearing in the intratympanic group was 21.8±14.5d B,and the mean threshold of speech hearing in the retroauricular group was 23.9±17.1d B.The comparison of the mean threshold of speech hearing after treatment between the two groups showed no statistical significance by t-test analysis（P>0.05）.After treatment,the reduction of mean hearing threshold was19.8±13.6d B in the intratympanic group,and the reduction of mean hearing threshold was 22.1±17.0d B in the retroauricular group.There was no significant difference between the two groups in the mean reduction of speech hearing threshold（P>0.05）by t-test,showing that the efficacy of the two methods in the treatment of SSNHL at all frequencies was not statistically significant.2、After 1 period of treatment,the recovery rate and the effective rate were 6.7%and 66.67%according to the speech hearing threshold of 4frequencies in the intratympanic group,the recovery rate and the effective rate were 10.0%and 66.67%in the retroauricular group.The recovery rate and effective rate of the two groups were calculated according to 6frequencies.The recovery rate of tympanum group was 6.7%and the effective rate was 53.33%.The recovery rate and effective rate were 6.7%and 46.67%in the retroauricular group.The difference fell short of statistical significance between the two groups,indicating that the effective rate and recovery rate of intratympanic injection and retroauricular injection of dexamethasone in the treatment of SSNHL at all frequencies were not statistically significant.3、On the 7th day of treatment,the decline of average speech threshold was 15.0±8.8d B in the intratympanic group and was 15.5±12.9d B in the retroauricular group.T-test analysis showed that there was no statistically significant difference in the decline of average speech threshold between the two groups（P>0.05）,indicating that the onset time of the two treatment methods was not statistically significant.The the decline of average threshold was 12.9±8.7d B in the intratympanic group,and was14.4±12.0d B in the retroauricular group.The t-test showed no statistical significance in the decline of average threshold between the two groups（P>0.05）,indicating that different frequencies in the two groups had similar onset speed in the process.4、In the cases of initial PTA≤70d B,there are 9 cases in the intratympanic group and 10 cases in the retroauricular group,and the general information between the two groups showed no statistical significance and the data could be compared.The decline of PTA was18.6±12.0 d B in the intratympanic group and 19.6±15.5 d B in the retroauricular group after treatment.The t-test analysis showed that there was no statistical significance in the decline of PTA between two groups after treatment（P>0.05）.In the cases of initial PTA>70 d B,there are 21cases in the intratympanic group and 20cases in the retroauricular groupthe,and the general information between the two groups showed no statistical significance and the data could be compared.The decline of PTA was 23.3±15.5 d B in the intratympanic group and 26.0±17.8 d B in the retroauricular group after treatment.The t-test analysis showed that there was no statistical significance in the decline of PTA between two groups after treatment（P>0.05）.The results showed that the two methods had similar effect on the SSNHL at all frequencies with different degree of hearing loss.5、One end of the course,42 cases had a course of disease within 1week.The decline of average speech hearing was 25.5±16.2 d B and the decline of average speech hearing was 23.5±16.0 d B.18 cases had a course of disease exceed 1 week.The decline of average speech hearing was 15.9±12.3 d B and the decline of average speech hearing was 14.4±11.4 d B.The general data is not significant in two groupsand the data was comparable.Comparison of the decline of average speech hearing and average hearing between the two groups,showed that the different fell short of statistical significance by t-test analysis（P<0.05）.It shows that the shorter the time from onset to treatment,the better the treatment effect.6、After treatment,the decline of PTA at frequencies of 250Hz,500Hz,1000Hz,2000Hz,4000Hz and 8000Hz were 18.3±20.9d B,24.8±17.2d B,23.7±20.0d B,22.3±17.4d B,16.2±15.8d B,13.2±15.8d B in the intratympanic group.The decline of PTA at frequencies of 250Hz,500Hz,1000Hz,2000Hz,4000Hz and 8000Hz were 21.2±24.3d B,26.3±22.5d B,25.3±19.9d B,22.8±17.8d B,21.0±19.4d B and 16.0±17.4d B in the retroauricular group.The comparison of the decline of PTA at different frequencies was no statistical significance in the different group（P>0.05）.At the same frequencies,the comparison of the decline of PTA was no statistical significance in two groups（P>0.05）.The results indicated that there was no statistical difference in the decline of PTA of different frequencies between intrapertamellar injection and retroauricular injection in the treatment of SSNHL at all frequencies.7、After the treatment,the effective rate of tinnitus treatment in the intratympanic group was 92.9%,and the effective rate of tinnitus treatment in the retroauricular group was 88.7%.It showed no statistical significance（P>0.05）,indicating that the remission of tinnitus with SSNHL at all frequencies was not statistically different between intratympanic injection and retroauricular injection of dexamethasone.8、Compared with the adverse reactions of treatment,there were no adverse reactions in the retroauricular group.In the intratympanic group,2patients had transient vertigo and 1 patient had transient aggravation of vertigo.No tympanic membrane perforation,otorrhea and other adverse reactions occurred,and the incidence of adverse reactions was 10.0%（3/30）in the intratympanic group.The incidence of adverse reactions was higher in the intratympanic group than in the retroauricular group,and the operation requirements were higher.The operation in the retroauricular group was simple and easy,indicating that retroauricular injection was simpler and safer than intratympanic injection.Conclusion:1、Intratympanic injection and retroauricular injection were all effective in the initial treatment of SSNHL at all frequencies.The recovery rate,the effective rate,the level of hearing improvement and onset time of the two groups were roughly similar,and there was no significant difference in hearing improvement at each frequency.2、The shorter the time from onset to therapeutic intervention,the better the efficacy.3、The operation requirement of tympanum injection is higher than that of retroauricular injection,and can lead to dizziness.The adverse reactions of retroauricular injection are less,and the operation is simple and feasible. |
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