Initial Experience Of Intra-arterial Intermittent Pulse-spray Urokinase For Sudden Sensorineural Hearing Loss Of Vascular Etiology

Objective:A retrospective study of intra-arterial intermittent pulse-spray urokinase in the treatment of vascular sudden sensorineural hearing loss in our center,and to analyze the clinical safety and effectiveness of this treatment,so as to provide a new clinical treatment reference for vascular sudden sensorineural hearing loss.Methods:Sixty-five patients with vascular SSNHL in HIS system of our hospital from September 2016 to December 2018 were retrieved.According to the treatment plan,35 cases were divided into intravascular therapy(IAU)group,30 cases into conventional therapy(IV)group.IV group received routine drug intravenous infusion and hyperbaric oxygen treatment.IAU group was invalid in routine treatment(3-34days,average 8.37 days),On the basis of IV group,intermittent pulse-spray urokinase was performed in vertebral artery and external carotid artery.Pure tone audiometry,Tinnitus Handicap Inventory(THI)and clinical evaluation with vertigo symptoms were performed on the 1st,3rd,6th and 10th day after treatment in both groups.SPSS20.0 was used for statistical analysis,t-test andχ~2-test were used for measuring and counting data,and rank sum test was used for rank data.Results:(1)pure tone audiometry:the total effective rate of IAU group was higher than that of IV group(82.86%VS 60.00%,P<0.05),and the starting time of IAU group was longer than that of IV group(8.37 6.78d VS 5.50 3.20d,P<0.05).The results of IAU group comparison showed that the curative effect showed a decreasing trend(91.67%VS 63.63%,P<0.05)when compared between groups at 7 d and above.(2)THI scale:patients with mild tinnitus(THI I~III),THI score decreased more in IAU group than in IV group(13.50 4.83 VS 8.00 2.58,P<0.05).In patients with moderate to severe tinnitus(THI IV~V),the decrease of THI score in IAU group was greater than that in IV group(32.20 11.79 VS 18.40 3.29,P<0.05).The total effective rate of IAU group was significantly higher than that of IV group(77.27%VS 38.89%,P<0.05).(3)symptoms associated with vertigo:in patients with vertigo(37/65),the total effective rate of IAU(n=20)group was higher than that of IV(n=17)group(70.00%vs.29.41%,P<0.05).In the IAU group,the total effective rate of patients with vertigo was significantly lower than that of patients without vertigo(80.00%vs.86.67%,P<0.05).The total effective rate of patients with vertigo in group IV was significantly lower than that of patients without vertigo(47.06%VS 76.92%,P<0.05).Conclusion:The effect of intra-arterial intermittent pulse-spray urokinase for vascular SSNHL is better than that of conventional therapy,especially for some patients who fail to respond to conventional treatment,it can be used as one of the options for clinical remedial treatment.The application of this therapy in the early stage of disease can achieve a better clinical prognosis,but whether it can be used as a conventional treatment in the early stage of disease still needs the safety evaluation of a large multi-center sample.