| Objective:To evaluate the clinical efficacy and analyze the prognostic factors of intratympanic injection of methylprednisolone in different types of sudden hearing loss(SHL),and provide a reference for clinical research of sudden hearing loss.Methods:In this retrospective study,a total of 109 sudden hearing loss patients,hospitalization of Otolaryngology-Head and Neck Surgery in Affiliated People’s Hospital of Jiangsu University from 2016.11 to 2017.07 and meet the inclusion criteria,were divided into four types such as low frequency declining type,high frequency declining type,flat type and total deafness type according to the latest clinical practice guidelines for SHL of China in 2015 and the hearing curves of patients when they were admitted to hospital.Each type was given with the same basic therapy as nutritional nerve and improve circulation.Patients undergo hyperbaric oxygen therapy according to their wishes.At the same time,all patients signed the informed consent for intratympanic injection and were treated by methylprednisolone sodium succinate(methylprednisolone)40 mg/ml intratympanic injection on the first day,then checked the pure tone audiometry of affected ear on the second day,and the treatment would stop if audiometry indicated recovery.Patients would continue to be intratympanic injection on the third day if their audiometry indicated significant recovery,partial recovery and no recovery.Then reviewed pure tone audiometry of affected ear on the fourth day to evaluate the efficacy,with the above analogy(total≤5times).Results:R × C table chi-square test showed that there were significant differences in the overall efficacy of different types of sudden hearing loss(P=0.001).Pairwise comparison between types: flat type versus total deafness was no significant difference(P=0.911),low frequency declining type versus high frequency declining type was statistically significant(P<0.001),low frequency declining type versus flat type was statistically significant(P=0.007),low frequency declining type versus total deafness type was statistically significant(P=0.022),high frequency declining type versus flat type was statistically significant(P=0.047),high frequency declining type versus total deafness type was statistically significant(P=0.029).Logistic regression analysis of prognostic factors showed that age(OR=0.959,95% CI=0.926-0.994,P=0.023)and types of sudden hearing loss(OR=3.314,0.132,0.728,95% CI=0.706-15.548,0.027-0.639,0.209-2.537,P=0.002)related to the prognosis of sudden hearing loss.While there was no statistically significant(P>0.05)in gender,defeated ear,tinnitus,ear fullness,dizziness,hypertension,diabetes and hyperbaric oxygen and explain that these factors have no significant correlation with the prognosis of sudden hearing loss.Conclusion:The clinical efficacy of intratympanic injection of methylprednisolone was different among different types of SHL.The effect of low frequency declining type is best and there is no obvious difference between flat type and full deafness type,whereas there exists worse efficacy in high frequency type.Prognostic factors analysis shows that age is an independent factor to negatively related to the patients’ prognosis.The younger the age,the better the prognosis of SHL,the older the age,the worse the prognosis.However,the prognosis was not significantly associated with gender,affected ear,tinnitus,ear swelling,dizziness,hypertension,diabetes,and hyperbaric oxygen therapy.This study is likely to help clinicians choose the appropriate treatment for different types of sudden hearing loss,judge the efficacy and estimate the prognosis,as well as provide certain evidence for improving the guidelines of sudden hearing loss. |
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