A Study On The Therapeutic Effectiveness And Prognosis Related Factors Of Sudden Hearing Loss: Systemic Or Intratympanic Steroids

Object：To observe the the therapeutic effectiveness of systemic or intratympanic steroids for suddenhearing loss（SHL）. Compare primary initial treatment with the therapeutic effectiveness of the systemicsteroids first and then intratympanic steroids. To discuss and analyse the relevant factors related withprognosis of sudden hearing loss.Methods：One hundred and fifty-six patients diagnosed as having SHL, were randomized into a initialtranstympanic treatment and a the systemic steroids first and then intratympanic steroids. Seven-eightpatients received intratympanic steroids as primary initial treatment. Intratympanic steroid injectiontreatment was administered once erery day,a week was a schedule, one to four schedule. Seven-eightpatients received systemic steroids treatment for ten days,then intratympanic steroids. Meanwhile everygroup was treated with intravenous Dansheng(16ml／d) and hyperbaric oxygen. The follow-up in thefollowing3months included an audiogram every week.Results： In the primary transtympanic treatment73.1%of the patients showed at least15dBHLimprovement in pure tone average compared with53.8%of the patients in the the systemic steroids firstand then intratympanic steroids. By means of χ2analysis,the differences between the2groups werestatistically significantly（P＜0.05）. In the primary transtympanic treatment group76.9%of the patientsshowed at least10dBHL improvement in pure tone average compared with64.1%of the patients in the thesystemic steroids first and then intratympanic steroids. By means of χ2analysis,the differences between the2groups were not statistically significantly（P﹥0.05）. The results of the analysis about the prognosticcorrelated factors showed that from the aspect of patient age,sex, pre-treatment audiometric evaluationsand treatment method of steroids was not significant（P﹥0.05）. Beginning to treatment time, accompaniedwith tinnitus, vertigo,hearing audiogram patterns, hyperbaric oxygen treatment were connected with theprognosis（P＜0.05）.From the aspect of beginning to treatment time, the efficiency of <3d was73.0％,theefficiency of3-7d was69.4％, the efficiency of7-14d was44.4％, the efficiency of>14d was36.4％.Thedifferences between <3d and3-7d were not statistically significantly（P﹥0.05）. The differences between7-14d and>14d were not statistically significantly（P﹥0.05）.The differences between≤7d and>7d werestatistically significantly（P＜0.05）. From the aspect of tinnitus, the efficiency of the patients with tinnituswas44．4％, the efficiency of the patients without tinnitus was71．2％, the effective rates of treatment wassignificant（P＜0.05）. From the aspect of vertigo, the efficiency of the patients with vertigo was49．3％,the efficiency of the patients without vertigo was74．2％, the effective rates of treatment was ignificant（P＜0.05）. From the aspect of audiogram patterns, the efficiency of upgrade audiogram was64.9%,theefficiency of flat audiogram was56.6%, the efficiency of downgrade audiogram was55.6%, the efficiencyof total deafness was50.0%.Good prognosis was demonstrated in the upgrade audiogram. The hyperbaric oxygen(effective rates74．2％)efficacy is higher than drug treatment(effective rates55.0％) lonely.Conclusion：Both systemic and transtympanic steroids treatment of sudden hearing loss is effective.Theefficiency of intratympanic steroids as primary initial treatment is similar or more than of systemic steroids.Intratympanic steroid injection is an safe and well-tolerated office-based procedure for the treatment of SHL.We can consider transtympanic administration as a first line treatment. The initial treatment beyond1weekshad negative impact on the prognosis. The audiogram patterns was significant factors on the prognosis. Theefficiency of upgrade audiogram was better.The companying such as tinnitus, vertigo had negative impacton the prognosis of SHL．Hyperbaric oxygen treatment can improve the therapeutic effect.