Intratympanic Dexamethasone Injection Combined Drug Therapy For The Sensorial Deafness Patients Of Sudden Sensorineural Hearing Loss: Clinical Evaluation

Objective:To evaluate the efficacy of intratympanic dexamethasone injectioncombined drug therapy as initial treatment for the sensorial deafnesspatients of sudden sensorineural hearing loss.Materials and methods:Patient selection and grouping:69patients meet the diagnostic criteriamade by the Chinese Otolaryngology Head Neck Surgery Association in2005,also meet the criteria as follows:1.Less than2weeks to see adoctor;2.Ages less than sixty years old;3.Didn’t receive any treatmentbefore;4.The suggestive diagnosis was sensorial deafness by pure toneaudiometry, acoustic immittance measurement and auditory brainstemresponse audiometry(ABR).Patients were divided into three groupsaccording to their wishes:20cases, local hormone therapy group(localtreatment group);22cases, systemic hormone therapy group(systemictreatment group);27cases, local and systemic hormone combined therapygroup(combined therapy group).Treatment: Local treatment group received dexamethasone1ml onceevery other day for six times by intratympanic injection. Systemic treatment group received dexamethasone20mg every day for3days byintravenous drip and reduced dexamethasone5mg every3days for12days together. Combined treatment group used the above two methods atthe same time. In addition, routine drugs were used to all patients. Allpatients take1~2courses, and the interval between courses are2days.Data collection: Pure tone threshold audiometry was conductedrepeatedly on the very next day after one course. The hearing gains at500,1000,2000,4000Hz before treatment, on14th day,28th day and the meanvalues were compared among three groups.Outcomes were analyzed based on the criteria made by the ChineseOtolaryngology Head Neck Surgery Association in2005.Statistical analysis: All values are expressed as mean±SD (χ±S), andSPSS18.0is used for statistical with α=0.05.Results:1. After treatment, the difference between the rate of significantimprovement in local treatment group and combined therapy group wasnot statistically significant（P＞0.05），but the difference between theabove two groups and systemic treatment group was statisticallysignificant(P<0.05). It shows that the rate of significant improvement inlocal treatment group(60%) and combined treatment group(51.9%) wassignificantly higher than systemic treatment group(22.7%).The totaleffective rate of local treatment group, systemic treatment group and combined therapy group was85.0%、68.2%、85.2%respectively，andthere is no statistically significant difference among3groups.2. After1course, the effective rate in local treatment group and combinedtherapy group was75.0%and74.1%respectively, with no statisticallysignificant（P＞0.05）,but the difference of the effective rate between theabove two groups and systemic treatment group(40.9%) was statisticallysignificant(P<0.05). It shows that the effective rate in local treatmentgroup and combined treatment group was significantly higher thansystemic treatment group. After2course the total effective rates in thethree groups were higher than those after1course.3. In patients with PTA≤70dB,the decline of PTA had no obviousdifference (P>0.05) among three groups. In patients with PTA>70dB,the decline of PTA in systemic treatment group was17.8dB,more lowerthan local treatment group(29.8dB) and combined therapy group（28.7dB）(P <0.05).Conclusion:1. Intratympanic hormone injection as initial treatment for sensorialdeafness patients of sudden sensorineural hearing loss should get greaterhearing improvement than systemic treatment, and two kinds of treatmentcombined did not increase the curative effect.2. For the sensorial deafness patients of sudden sensorineural hearing loss,intratympanic hormone injection did work faster than systemic treatment. The effective rate after two courses was higher than those after onecourse, but the difference was not statistically significant, so we can makea general judgment about the effective rate after one course.3. Severe to profound patients(PTA>70dB) should take intratympanichormone injection in early days.