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*For medical professionals
only, although high-dose, long-term hormone therapy may bring good results, the associated risks cannot be ignored
.
First, the choice
of variety In the treatment of SD, the intermediate-acting hormone methylprednisolone or the long-acting hormone dexamethasone
is usually selected.
There was no significant difference in efficacy between systemic and topical administration [2-3].
Prednisone acetate tablets are available for oral administration [4].
2.
Mode of administration: GC administration mode is divided into systemic administration and local administration
。 Systemic administration is divided into intravenous and oral, and local administration is commonly used by tympanic injection and retroauricular injection
.
Third, the timing of administration Although some studies have proposed that delayed treatment does not affect the results of SD treatment, many studies [8] believe that the shorter the time from onset to intervention in SD patients, the
better their prognosis, and timely treatment can prevent irreversible auditory lesions
。 Although early GC treatment is more effective, GC is still meaningful in patients with a long course of disease, and some hearing may be restored with GC therapy in patients with a disease duration of more than one year [9].
4.
Dosage and course of
SD treatment in the whole body, There is no uniform standard
for GC dose and duration of topical drugs.
The recommended dose and duration of SD guidelines in Europe in 2010, China in 2015 and the United States in 2019 were inconsistent
.
The density of GC receptors in parts such as the cochlear spiral ganglion gradually decreases, and the use of large doses of GC can improve the efficiency
of treatment.
However, blood glucose levels also increase with increasing GC doses, and for non-diabetic patients, short-term hyperglycemia may also induce diabetes
.
Although high-dose, long-course hormone therapy may bring good efficacy, the associated risks cannot be ignored
.
V.
Research and exploration
of the combination of GC and certain drugs In order to improve the therapeutic effect of GC, many clinical explorations
have been carried out in recent years.
It was found that the combination of GC and some drugs was more
effective than GC alone.
However, due to the low quality of research, few observation cases, and unclear synergistic mechanisms, it is only for clinical reference and needs to be further studied and verified
as a therapeutic idea.
Guidelines for the diagnosis and treatment of sudden deafness(2015)[J].
Chinese Journal of Otorhinolaryngology-Head and Neck Surgery,2015,50(6):443-447.
) [2] YANG Jun, HUANG Li, SHI Jun, et al.
Efficacy of intratympanic injection of dexamethasone or methylprednisolone in the treatment of sudden deafness[J].
Journal of Clinical Otorhinolaryngology-Head and Neck Surgery,2010,24(13):594-597.
) [3] Jing Yuanyuan, Wang Dayong, Fan Zhaomin, et al.
A multicenter controlled study of the efficacy of methylprednisolone and dexamethasone on full-frequency descending sudden deafness[J].
Chinese Journal of Otorhinolaryngology-Head and Neck Surgery,2015,50(7):536-539.
) [4] XIAO Yong, RUAN Zijuan.
Clinical effect of prednisone acetate tablets combined with hyperbaric oxygen adjuvant in the treatment of patients with high-frequency descending sudden deafness[J].
Medical Equipment,2022,35(8):100-102.
) [5] ZHANG Zhijian, WANG Xinchun, LIAO Hua, et al.
Effects of different routes of glucocorticoid administration and timing on the efficacy of severe and very severe sudden deafness[J].
Journal of Audiology and Speech Disorders,2011,19(6):529-531.
)
Where to see more neurological clinical knowledge?
Come to the "doctor's station" and take a look 👇
only, although high-dose, long-term hormone therapy may bring good results, the associated risks cannot be ignored
.
Sudden deafness (SD) refers to sudden, unexplained sensorineural hearing loss
that occurs suddenly, within minutes to 72 hours.
The etiology and pathogenesis of SD are still unclear and may be related to
viral infections, autoimmune diseases, and inner ear blood supply disorders.
Although there is no uniform regimen for the treatment of SD, it is currently accepted that glucocorticoids (GC) are used as the basic drug [1].
This article summarizes the specific medication details of GC in the treatment of SD for clinical reference
.
First, the choice
of variety In the treatment of SD, the intermediate-acting hormone methylprednisolone or the long-acting hormone dexamethasone
is usually selected.
There was no significant difference in efficacy between systemic and topical administration [2-3].
Prednisone acetate tablets are available for oral administration [4].
2.
Mode of administration: GC administration mode is divided into systemic administration and local administration
。 Systemic administration is divided into intravenous and oral, and local administration is commonly used by tympanic injection and retroauricular injection
.
■ 1.
Systemic administration
After systemic administration, the drug reaches the inner ear through the labyrinth barrier, and the body's absorption of the drug is affected
by its bioavailability and ability to pass through cell membranes.
It was found that there was no significant difference
in efficacy between intravenous and oral administration[5].
The two modes of administration have their own advantages and disadvantages, intravenous administration has a fast onset of action and stable effect, but there is a risk of phlebitis; Oral administration is convenient and economical, but drug absorption is easily affected by gastrointestinal factors and other factors, and the effect is unstable
.
Therefore, it can be flexibly selected according to the patient's situation.
■ 2.
Topical administration
Tympanic injection can avoid the blood-brain barrier and the blood-labyrinth barrier, and is beneficial to increase the drug concentration in the perilymph fluid
.
Tympanic administration usually does not affect the structure and function of the cochlea, and the safety is high [6], but there are still shortcomings, on the one hand, it may lead to adverse reactions such as tympanic membrane perforation, middle ear infection, and increased vertigo, on the other hand, the drug is easy to lose through the eustachian tube, degraded quickly, and the number of drugs needs to be increased number
.
Retro-auricular injection administration mainly enters the inner ear through two routes: one is the circulatory route, which is absorbed into the blood through the capillaries and lymphatic vessels behind the ear, and enters the inner ear through the blood-labyrinth barrier; The second is the penetration pathway, which enters the inner ear
through the round window membrane, oval window, tissue space, etc.
Although the injection behind the ear is safe and effective, its effective dose needs further study
.
There was no significant difference in efficacy between retroauricular and tympanic injections [7], and retroauricular injections
are generally preferred.
Third, the timing of administration Although some studies have proposed that delayed treatment does not affect the results of SD treatment, many studies [8] believe that the shorter the time from onset to intervention in SD patients, the
better their prognosis, and timely treatment can prevent irreversible auditory lesions
。 Although early GC treatment is more effective, GC is still meaningful in patients with a long course of disease, and some hearing may be restored with GC therapy in patients with a disease duration of more than one year [9].
4.
Dosage and course of
SD treatment in the whole body, There is no uniform standard
for GC dose and duration of topical drugs.
The recommended dose and duration of SD guidelines in Europe in 2010, China in 2015 and the United States in 2019 were inconsistent
.
The density of GC receptors in parts such as the cochlear spiral ganglion gradually decreases, and the use of large doses of GC can improve the efficiency
of treatment.
However, blood glucose levels also increase with increasing GC doses, and for non-diabetic patients, short-term hyperglycemia may also induce diabetes
.
Although high-dose, long-course hormone therapy may bring good efficacy, the associated risks cannot be ignored
.
■1.
Dosage and course of tympanic injection
The higher the concentration of dexamethasone injected into the tympanic cavity, the longer the duration and the better
the effect.
High-dose GC is recommended for treatment-naïve patients with poor response to treatment, but low-dose may be used in treatment-naïve patients with mild to moderate SD [10].
By comparing the efficacy of tympanic injection at different frequencies, it was found that tympanic injection once a day and every other day not only had better patient compliance, but also had better effect [11].
Although the application of tympanic injection of hormones has been widely used, the frequency and course of tympanic injection are not standardized, and there are few
related studies.
Therefore, the frequency and course of tympanic injection need to be further studied and determined
.
■2.
Dosage and course of systemic administration
If the pulse dose does not significantly improve the efficacy, the lower incidence of adverse effects is the reason
for choosing the usual dose.
However, very high doses of hydrocortisone have been clinically found to rapidly improve hearing levels without increasing complications [12].
Reasonable increase in hormone course with systemic medication can improve the therapeutic effect, but the side reactions and complications of GC are mostly related to drug dose and course of treatment, so the minimum dose and shortest course of treatment
should be selected clinically.
Although many studies believe that the efficacy of large doses of GC is certain, SD has a certain natural recovery rate, and no blank control has been set in various studies, so whether the benefits and risks of using large doses and long courses of GC are worth further exploration
.
V.
Research and exploration
of the combination of GC and certain drugs In order to improve the therapeutic effect of GC, many clinical explorations
have been carried out in recent years.
It was found that the combination of GC and some drugs was more
effective than GC alone.
However, due to the low quality of research, few observation cases, and unclear synergistic mechanisms, it is only for clinical reference and needs to be further studied and verified
as a therapeutic idea.
■1.
GC+ alprostadil
The synergistic mechanism of alprostadil may be that the drug acts as a vasodilator, which relieves intravascular smooth muscle tension, inhibits platelet aggregation, and improves blood circulation in the inner ear by increasing the cyclic amptonylate production of vascular smooth muscle cells.
The clinical treatment results showed [13], GC+ alprostadil had a better effect on the improvement of blood rheology and blood lipids in SD patients, and had a certain safety.
The usage is 10μg of alprostadil dry emulsion (5μg/branch) for injection, dissolved in 100mL of normal saline, intravenous drip once a day, for 10 days
.
GC usage is the same as above (the same below, not described separately).
■2.
GC+ Ginkgo biloba extract injection
Ginkgo biloba extract injection can produce arteriodilating effect by inhibiting cell membrane peroxidation reaction, stimulating the release of catecholamines, thereby stimulating the production of prostacyclin and endothelial diastolic factor, and promoting ear blood flow to improve symptoms such as hearing loss [14].
In addition, Ginkgo biloba extract injection can enhance the plasticity of red blood cells and white blood cells, promote blood circulation in the cochlea, thereby reducing the symptoms of capillary edema, so it is effective in the treatment of SD [15].
Clinical treatment results showed [16], GC+ Ginkgo biloba extract injection can shorten the improvement time of patients' symptoms, effectively reduce the effect of serum endothelin (ET), soluble vascular intercellular adhesion factor-1 (sVCAM-1) and anti-endothelial cell antibody (AECA) levels, and have a good
safety profile.
The usage is 15ml of Ginkgo biloba extract injection (5 ml: 17.
5mg) dissolved in 250ml of 0.
9% sodium chloride solution intravenous drip, once / d, maintenance administration for 1 week after the evaluation of efficacy
.
■ 3.
GC+ murine nerve growth factor (NGF).
NGF has the effect of stabilizing calcium ions, resisting oxygen free radicals, slowing down nerve cell death, etc.
, and can repair damaged blood vessels in the cochlea, enhance the body's metabolism, remove harmful substances, reduce hair cell damage, promote repair, and improve cochlear microcirculation
.
The clinical treatment results showed [17], GC+NGF had a better effect on SD, and the total efficiency and hearing improvement of low-frequency SD were more significant
.
The usage is NGF [18 μg (9 000 U)/bottle] intramuscularly for injection, 18 μg/time, 1 time/d, treatment for 7 days
.
■ 4.
GC+ pentoxifylline
Pentoxifylline has the effect
of dilating blood vessels and improving peripheral microcirculation.
Red blood cells treated with pentoxifylline have a greatly improved deformability
.
Its application in the treatment of patients with SD can improve blood flow in the cochlear microcirculation and reduce fibrinogen levels, inhibit thrombosis, improve blood supply to ischemic areas, and do not cause blood theft in the brain
.
The clinical treatment results showed [18], GC+ pentoxifylline had good efficacy and safety in the treatment of SD
.
The usage is pentoxifylline 0.
1g dissolved in 0.
9% sodium chloride or 0.
5% glucose 250ml, intravenous drip, qd, continuous treatment for 14 days
.
It can be combined with vitamin B1, methylcobalamin and other treatments
.
Guidelines for the diagnosis and treatment of sudden deafness(2015)[J].
Chinese Journal of Otorhinolaryngology-Head and Neck Surgery,2015,50(6):443-447.
) [2] YANG Jun, HUANG Li, SHI Jun, et al.
Efficacy of intratympanic injection of dexamethasone or methylprednisolone in the treatment of sudden deafness[J].
Journal of Clinical Otorhinolaryngology-Head and Neck Surgery,2010,24(13):594-597.
) [3] Jing Yuanyuan, Wang Dayong, Fan Zhaomin, et al.
A multicenter controlled study of the efficacy of methylprednisolone and dexamethasone on full-frequency descending sudden deafness[J].
Chinese Journal of Otorhinolaryngology-Head and Neck Surgery,2015,50(7):536-539.
) [4] XIAO Yong, RUAN Zijuan.
Clinical effect of prednisone acetate tablets combined with hyperbaric oxygen adjuvant in the treatment of patients with high-frequency descending sudden deafness[J].
Medical Equipment,2022,35(8):100-102.
) [5] ZHANG Zhijian, WANG Xinchun, LIAO Hua, et al.
Effects of different routes of glucocorticoid administration and timing on the efficacy of severe and very severe sudden deafness[J].
Journal of Audiology and Speech Disorders,2011,19(6):529-531.
)
[6] LIU Hongjian,DONG Mingmin,CHI Fanglu.
Effect of dexamethasone transtympanic administration on the structure and function of guinea pig cochlea[J].
Chinese Journal of Otorhinolaryngology-Head and Neck Surgery,2005,40(6):440-443.
)
[7] JIA Hongguang, YU Zhan, LI Xiping, et al.
Comparative study of retroauricular and tympanic injection of methylprednisolone sodium succinate in the treatment of sudden deafness with type 2 diabetes[J].
Chinese Journal of Otological Science,2018,16(3):319-324.
)
[8] ZHAO Hui, ZHANG Tianyu, JING Jianghua, et al.
Clinical study on prognostic factors affecting sudden deafness[J].
Chinese Journal of Otorhinolaryngology-Head and Neck Surgery,2008,43(9):660-664.
)
[9] CHEN Xi,YU Lisheng,XIA Ruiming.
Clinical efficacy analysis of patients with sudden deafness with a course of more than 3 weeks[J].
Chinese Journal of Otorhinolaryngology-Head and Neck Surgery,2011, 46(7):539-542.
)
[10] Gunel C, Basal Y, Toka A, et al.
, Efficacy of low-dose intratympanic dexamethasone for sudden hearing loss[J].
Auris Nasus Larynx,2015.
42(4): 284-287.
[11] YANG Pingli, ZHANG Zhiping.
Clinical study of dexamethasone intratympanic perfusion at different intervals in the treatment of sudden deafness[J].
Journal of Clinical Otorhinolaryngology-Head and Neck Surgery,2017(11):11-13.
)
[12] Egli Gallo D, Khojasteh E, Gloor M, et al.
Effectiveness of Systemic High-Dose Dexamethasone Therapy for Idiopathic Sudden Sensorineural Hearing Loss[J].
Audiology and Neurotology,2013, 18(3):161-170.
[13] ZHANG Min, GUO Shijie, et al.
Effect of alprostadil in the treatment of sudden deafness[J].
China Rural Medicine,2022,29(9):25-26.
)
[14] Nishad RK，Jain AK，Singh M，et al.
Randomised Con trolled Clinical Study of Injection Caroverine and Ginkgo Biloba Extract in Cochlear Synaptic Tinnitus
[J].
Indian J Otolaryngol Head Neck Surg，2019，71（2）：1523-1528.
[15] Mehta N，Mehta S.
Comparative Evaluation of Injection Dexamethasone and Oral Glycerol Versus Injection Dexamethasone Alone in the Treatment of Sudden Onset Sensorineural Deafness [J].
Ear Nose Throat J，2021，100（3）：317S-324S.
[16] ZHU Liping, TAN Xiaoye.
Effect of Ginkgo biloba extract injection combined with dexamethasone in the treatment of sudden deafness and its effect on serum ET, sVCAM-1 and AECA levels[J].
China Medical Herald,2022,19(6):106-109.
)
[17] Zeng Zhijiang.
Efficacy of murine nerve growth factor combined with glucocorticoids in the treatment of sudden deafness of different types[J].
Dr,2022,7(1):37-40.
)
[18] SUN Pu,ZHANG Jianxin.
Efficacy of pentoxifylline combined with Ginkgo biloba extract in the treatment of sudden deafness[J].
Capital Food and Medicine, 2022,29(11):69-71.
)
Where to see more neurological clinical knowledge?
Come to the "doctor's station" and take a look 👇
