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目的:探讨不同途径给地塞米松治疗对突发性聋(SD)疗效的影响。方法:将84例SD患者随机分为4个治疗组,每组21例,第1组采用常规疗法加口服地塞米松治疗;第2组常规疗法加静脉注射地塞米松治疗;第3组常规疗法加鼓室注射地塞米松治疗;第4组常规疗法加耳咽鼓管鼓室注射地塞米松治疗。比较治疗后各组在0.5、1.0、2.0、4.0kHz听力提高的平均值。结果:治疗后4组在4个频率的平均听阈提高分别为21.3、27.5、43.2、48.1dB,组3、组4和组1、组2比较,听力提高均差异有统计学意义(均P<0.05);组1与组2及组3与组4比较,听力提高均差异无统计学意义(均P>0.05)。在PTA≤70dB患者中,治疗后4组在0.5、1.0、2.0、4.0kHz4个频率的平均听阈提高均差异无统计学意义(均P>0.05),而在PTA>70dB患者中,治疗后4组在0.5、1.0、2.0、4.0kHz的平均听阈提高的比较,组1与组2之间比较及组3与组4之间比较听阈提高均差异无统计学意义(均P>0.05),组3、组4平均听阈提高明显高于组1和组2(P<0.05)。结论:常规疗法加全身给地塞米松治疗对PTA>70dB的SD患者的治疗效果提高不明显,而常规疗法加鼓室内注射地塞米治疗能提高SD的治疗效果;和全身给药相比,鼓室给药使用方便,禁忌证和并发症较少,对PTA>70dB的患者,更应早期用鼓室注射地塞米松治疗。
Objective: To investigate the effects of different routes of dexamethasone treatment on the efficacy of sudden deafness (SD). Methods: Eighty-four SD patients were randomly divided into four treatment groups, 21 cases in each group. The first group received conventional therapy plus oral dexamethasone. The second group received conventional therapy plus intravenous dexamethasone. The third group Therapy plus intratympanic injection of dexamethasone treatment; Group 4 conventional therapy plus eustachian tube tympanic catheter dexamethasone treatment. The mean hearing improvement of each group at 0.5,1.0,2.0,4.0kHz after treatment was compared. Results: After the treatment, the average hearing thresholds of the four groups were increased by 21.3, 27.5, 43.2 and 48.1 dB at 4 frequencies respectively. There were significant differences in hearing improvement between group 3, group 4 and group 1 (all P < 0.05). There was no significant difference in hearing improvement between group 1 and group 2 and group 3 and group 4 (all P> 0.05). In patients with PTA≤70dB, there was no significant difference in mean hearing thresholds at 4 frequencies of 0.5,1.0,2.0,4.0kHz after treatment (all P> 0.05), while in patients with PTA> 70dB, 4 The average hearing threshold increased at 0.5, 1.0, 2.0 and 4.0 kHz in groups 1 and 2 and no significant difference in hearing threshold between groups 3 and 4 (all P> 0.05) The mean hearing threshold of group 4 was significantly higher than that of group 1 and group 2 (P <0.05). CONCLUSION: Conventional therapy combined with systemic dexamethasone treatment has no significant improvement on the treatment of SD patients with PTA> 70dB, while conventional therapy plus intravenous dexamethasone treatment can improve the therapeutic effect of SD. Compared with systemic administration, Tympanic administration easy to use, contraindications and complications less PTA> 70dB of patients, should be early use of tympanic injection of dexamethasone.