摘要
目的探讨突发性聋分型治疗的必要性。方法采用国际通用的标准化临床研究方法，统一设计、统一方案进行前瞻性临床多中心研究。收集年龄在18～65周岁之间，病程在2周以内，未经任何相关医疗处理的突发性聋患者，按照听力曲线分为低中频下降型，中高频下降型；平坦型和全聋型四种类型。每种类型有四种不同治疗方案，根据统一设计的随机表，随机选取其中一种方案进行治疗。其中低中频下降型为银杏叶提取物（金纳多）、泼尼松、巴曲酶（东菱迪芙）及其组合；中高频下降型为利多卡因、泼尼松、金纳多及其组合；平坦型或全聋型为东菱迪芙、金纳多、泼尼松及其组合。结果2007年8月至2011年10月全国33家医院共收集符合入组条件的单侧突发性聋患者1024例，其中男性492例（48．05％），女性532例（51．95％）。年龄为19—65岁，平均（41．2±12．8）岁。按照听力曲线分型，低中频下降型205例（20．02％），高频下降型141例（13．77％），平坦型402例（39．26％），全聋型276例（26．95％）。各种类型的总有效率：低中频下降型最高，为90．73％；平坦型次之，为82．59％；全聋型为70．29％；中高频下降型为65．96％；各型之间总有效率比较，差异具有统计学意义（X2=231．58，P=0．000）。1024病例中，痊愈378例（36．91％），显效229例（22．36％），有效198例（19．34％），无效219例（21．39％）；总有效率为78．61％。糖皮质激素对各型突聋均有效，联合用药优于单独用药。结论不同听力曲线类型的突发性聋患者预后差异很大，根据听力曲线进行分型选择不同的治疗方案具有重要意义。低中频下降型疗效最好，平坦型次之，中高频下降型和全聋型效果不佳。
Objective To investigate the necessity of subtyping for the treatment of sudden deafness. Methods The international standardized clinical research methods, the unified design and program were used in the study. The sudden deafness patients between 18 to 65 years old were recruited, whose duration was less than two weeks with no medication. The patients were divided into four types according to the hearing curve： type A was acute sensorineural hearing loss in low tone frequencies, type B was acute sensorineural hearing loss in high tone frequencies, type C was acute sensorineural hearing loss in all frequencies and type D was total deafness. Each type had four different treatment programs, based on the unified designed randomized table. Results Total of 1024 cases with single side sudden deafness were recruited in the study by 33 hospitals in China from August 2007 to October 2011, including 492 male cases （48.05%） , and 532 females（51.95% ）. The average age was （41.2±12.8） years old. By classification of audiogram, among the1024 cases, 205 cases were type A（20.20% ）, 141 cases were type B（ 13.77% ）, 402 cases were type C（39.26% ） , 276 cases were type D（26.95% ）. The curative effects of different types were analyzed, type A had the highest rate of 90.73% , type C was 82.59% , type D was 70.29% and type B had the lowst rate of 65.96%. Significant difference of curative rate between different types was detected （X2 = 231.58, P = 0. 000）. Regarding the curative results of the 1024 cases, 378 cases were recovery （36. 91% ）, 229 cases were excellent better （22.36%）, 198 cases were better（ 19.34% ） and 219 cases were poor（21.39% ）. Glucocorticoid was effective for each type and the combined treatment was better than any single medication. Conclusions Different types of the hearing curves of sudden deafness have different curing effect, it indicates that different types should use different treatments. It＇ is important that sudden deafness should be treated according
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2013年第5期355-361,共7页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
中华医学会临床医学科研专项资金（07030480056）
国家自然科学基金（81070780）
首都医学发展科研基金（20091015）
关键词
听觉丧失
突发性
测听法
纯音
随机对照试验
药物疗法
Hearing loss, sudden
Audiometry, pure-tone
Randomized controlled trial
Drug therapy
