| Objective: To explore the difference of clinical effects in three different glucocorticoid delivery routes,including tympanum injection combined with systemic administration,retroauricular injection combined with systemic administration and single systemic administration,on hearing,vertigo and,tinnitus and ear stuffy in SSNHL(Sudden sensorineural hearing loss).Methods: This paper was a retrospective study.138 patients who met the inclusion criteria were selected from the Otolaryngology Head and Neck Surgery Department of Qingdao Municipal Hospital from April 2021 to December 2022.According to different treatment methods,patients were divided into three groups: tympanic injection group(44 cases),retroauricular injection group(50 cases),and control group(44 cases).All three groups of patients were routinely treated with Ginaton,Mecobalamin,and Batroxobin according to the guidelines.Patients with SSNHL accompanied by tinnitus were treated with lidocaine,while patients with SSNHL accompanied by dizziness were treated with Minazolam and Promethazine as symptomatic treatments.The control group received intravenous injection of 40 mg of methylprednisolone sodium succinate on the basis of routine medication,once a day,for 3 consecutive days.If it was effective,it was added for 2 more days without gradually reducing the dosage.If it was ineffective,the medication was stopped directly.The tympanic injection group received 5 mg dexamethasone sodium phosphate injection into the tympanic cavity on the basis of the control group,once every other day,2-4 times.On the basis of the control group,the retroauricular injection group was injected with 5 mg of dexamethasone sodium phosphate once every other day,2-4 times.The above treatment process lasts for 7-10 days.If the hearing loss and other accompanying symptoms disappear during the treatment process and reach the recovery standard,the treatment can be stopped.Patients with full frequency decline type SSNHL were further divided into flat decline type SSNHL patients and total deafness type SSNHL patients based on the average hearing threshold of hearing loss frequency,and the efficacy of different treatment methods was evaluated.The evaluation results include the last pure tone audiometry,THI(Tinnitus Handicap Inventory)score,improvement of conscious dizziness in patients with dizziness,and VAS(Visual Analog Scale)score for ear stuffy before the end of the treatment course.The efficacy evaluation indicators include the improvement of average hearing threshold of damaged frequency,improvement of tinnitus,improvement of dizziness,and improvement of ear stuffy.The safety assessment mainly includes the assessment of adverse events(such as ear pain,infection,dizziness,elevated blood pressure,non healing of tympanic membrane perforation,abnormal tympanic bleeding,etc.).The statistical processing of data adopts spss25.0 statistical software.The measurement data is expressed as mean ± standard deviation,and the counting data is expressed as use case(percentage).The comparison of independent samples uses the normal test.If it conforms to the normal distribution,the t-test or one-way anova is performed,but it does not conform to the normal distribution rank sum test.For those with a small number of cases,the Fisher exact probability test is used to calculate the p-value at a=0.05 test level.If p<0.05,the difference is statistically significant.Result: 1.On the baseline data,three groups of patients with flat descent SSNHL and total deafness SSNHL were compared in terms of gender,age,hearing loss side,course of disease,accompanying symptoms,average hearing threshold of pre treatment damage frequency,presence or absence of accompanying symptoms,THI score of patients with concomitant tinnitus before treatment,and VAS score of patients with concomitant ear stuffy before treatment.There was no significant difference between the groups(P>0.05).2.Efficacy evaluation:(1)Among the three groups of patients with flat descent type SSNHL and total deafness type SSNHL,The total effective rate(cure rate+significant rate+effective rate)of the tympanic injection group was the highest,higher than that of the retroauricular injection group and the control group,but there was no statistically difference in the distribution of efficacy between the groups(P>0.05).(2)The improvement of symptoms in patients with dizziness: In patients with flat descent SSNHL accompanied by dizziness and those with total deafness SSNHL accompanied by dizziness,the effective rates in the tympanic injection group and the retroauricular injection group were higher than those in the control group,but there was no significant statistical difference in the effective rates among the three groups(P>0.05).THI score: In patients with flat descent type SSNHL accompanied by tinnitus,the effectiveness rate of the retroauricular injection group on tinnitus was higher than that of the tympanic injection group and control group.However,there was no difference in THI score before and after treatment among the three groups of patients(P>0.05),and there was no statistically difference in effectiveness rate between the three groups(P>0.05).And those with total deafness type SSNHL accompanied by tinnitus,the effectiveness rate of the tympanic injection group on tinnitus was higher than two others.However,there was no difference in THI score before and after treatment among the three groups of patients(P>0.05),and there was no statistically difference in effectiveness rate between the three groups(P>0.05).Ear stuffiness VAS score: In patients with flat and declining SSNHL accompanied by ear stuffiness,there was a statistical difference in the VAS score of ear stuffiness after treatment(P<0.05).The effective rate of the tympanic injection group was higher than that of the retroauricular injection group and the control group,and the difference was statistically significant(P<0.05).In total deafness type SSNHL patients with accompanying ear stuffy,there was no significant difference in VAS scores before and after treatment among the three groups of patients(P>0.05),and there was no statistically significant difference in effective rate between the three groups(P>0.05).3.Safety evaluation: After treatment,2 patients in the tympanic injection group experienced ear pain(4.5%),15 patients experienced transient dizziness after injection(34.1%),and 3 patients experienced transient autonomic nervous system dysfunction symptoms after injection(6.8%).The other two groups of patients had no adverse reactions.Conclusion: 1.Retroauricular injection combined with systemic corticosteroids,tympanic injection combined with systemic corticosteroids,and systemic corticosteroids alone have similar efficacy in improving hearing,tinnitus,and dizziness in patients with flat and completely deaf SSNHL divided into full frequency hearing loss SSNHL.2.For patients with total deafness type SSNHL,the three treatment methods have similar therapeutic effects,while for patients with flat type SSNHL,the combination of tympanic injection and systemic corticosteroids is superior to the other two groups in improving the symptoms of ear stuffy.3.Due to different intervention methods,there are differences in adverse events among the three groups.The combination of tympanic injection and systemic application of glucocorticoids has a higher short-term adverse reaction rate. |
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