Mingming Wang1, Zhaomin Fan1, Zhiqiang Hou1, Daogong Zhang1, Haibo Wang2. 1. Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital affiliated to Shandong University, Jinan 250021, China. 2. Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital affiliated to Shandong University, Jinan 250021, China. Email: whbotologic797@163.com.
Abstract
OBJECTIVE: To investigate the therapeutic effect of topical corticosteroids injection and systemic application in the treatment of typing idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: Total of 438 patients with ISSNHL, including 76 with hearing loss in low-middle frequencies, 43 in middle-high frequencies, 162 in all frequencies and 157 in total deafness, were randomly divided into two groups, the systemic application group: dexamethasone (DEX) was applied by intravenous injection in dose of 10 mg×3 d followed by 5 mg×4 d, and the topical injection group: methylprednisolone sodium succinate of 40 mg was injected into cortical bone of mastoid region every three days. According to the results of pure-tone threshold audiometry, the curative effect among ISSNHL with low-middle frequencies, middle-high frequencies, all frequencies hearing loss, and total deafness were evaluated. SPSS 18.0 software was used to analyze the data. RESULTS: Among 220 patients with systemic application of DEX, 66 subjects (30.0%) cases were recovery, 51 (23.2%) were excellent better, 39 (17.7%) better, 64 (29.1%) were poor, and the total effective rate was 70.9% (156/220) . There was no statistical difference in total effective rate of four typing subgroups (χ(2) = 1.60, P > 0.05). And the recovery rate in total deafness subgroup was significant lower than that in low-middle and all frequencies subgroups (χ(2) = 10.63 and 15.94 respectively, both P < 0.05). In the topical injection group, the recovery rate was 30.3% (66 cases), excellent better 18.8% (41), better 15.6% (34), poor 35.3% (77), and the total effective rate was 64.7% (141/220) . There were statistical differences of total effective rate in low-middle frequencies in comparison with that in all frequencies (χ(2) = 8.38) and total deafness (χ(2) = 7.28) subgroups (both P < 0.05). Regarding recovery rate, there were significant differences between each two typing subgroups, except middle-high frequencies subgroup vs. all frequencies (χ(2) = 1.60) and total deafness (χ(2) = 2.29) subgroups (both P < 0.05). In 76 ISSNHL with hearing loss in low-middle frequencies, the recovery rate in cases with local corticosteroids injection(65.0%) was significantly increased in comparison with that with systemic application (41.7%), χ(2) = 4.15, P < 0.05. There were increasing tendencies of curative effect in other three typing groups by systemic corticosteroids application when compared with local injection, but no statistical significances (all P > 0.05). CONCLUSIONS: For low-middle frequencies ISSNHL, the corticosteroids administration of local injection should be the optimization. Systemic application would be applied for middle-high frequencies, all frequencies and total deafness.
RCT Entities:
OBJECTIVE: To investigate the therapeutic effect of topical corticosteroids injection and systemic application in the treatment of typing idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: Total of 438 patients with ISSNHL, including 76 with hearing loss in low-middle frequencies, 43 in middle-high frequencies, 162 in all frequencies and 157 in total deafness, were randomly divided into two groups, the systemic application group: dexamethasone (DEX) was applied by intravenous injection in dose of 10 mg×3 d followed by 5 mg×4 d, and the topical injection group: methylprednisolone sodium succinate of 40 mg was injected into cortical bone of mastoid region every three days. According to the results of pure-tone threshold audiometry, the curative effect among ISSNHL with low-middle frequencies, middle-high frequencies, all frequencies hearing loss, and total deafness were evaluated. SPSS 18.0 software was used to analyze the data. RESULTS: Among 220 patients with systemic application of DEX, 66 subjects (30.0%) cases were recovery, 51 (23.2%) were excellent better, 39 (17.7%) better, 64 (29.1%) were poor, and the total effective rate was 70.9% (156/220) . There was no statistical difference in total effective rate of four typing subgroups (χ(2) = 1.60, P > 0.05). And the recovery rate in total deafness subgroup was significant lower than that in low-middle and all frequencies subgroups (χ(2) = 10.63 and 15.94 respectively, both P < 0.05). In the topical injection group, the recovery rate was 30.3% (66 cases), excellent better 18.8% (41), better 15.6% (34), poor 35.3% (77), and the total effective rate was 64.7% (141/220) . There were statistical differences of total effective rate in low-middle frequencies in comparison with that in all frequencies (χ(2) = 8.38) and total deafness (χ(2) = 7.28) subgroups (both P < 0.05). Regarding recovery rate, there were significant differences between each two typing subgroups, except middle-high frequencies subgroup vs. all frequencies (χ(2) = 1.60) and total deafness (χ(2) = 2.29) subgroups (both P < 0.05). In 76 ISSNHL with hearing loss in low-middle frequencies, the recovery rate in cases with local corticosteroids injection(65.0%) was significantly increased in comparison with that with systemic application (41.7%), χ(2) = 4.15, P < 0.05. There were increasing tendencies of curative effect in other three typing groups by systemic corticosteroids application when compared with local injection, but no statistical significances (all P > 0.05). CONCLUSIONS: For low-middle frequencies ISSNHL, the corticosteroids administration of local injection should be the optimization. Systemic application would be applied for middle-high frequencies, all frequencies and total deafness.