突発性難聴に対する高気圧酸素併用療法の比較 Hyperbaric Oxygen in Combination with Other Therapies for Idiopathic Sudden Sensorineural Hearing Loss
Hyperbaric oxygen (HBO) therapy combined with steroid administration is an effective treatment for idiopathic sudden sensorineural hearing loss (ISSNHL), but is sometimes unfeasible for patients with underlying diseases, particularly for those with steroid-intolerance. We conducted a controlled retrospective analysis of patients with ISSNHL who received HBO in combination with stellate ganglion block (SGB), prostaglandin (PG) E<sub>1</sub>, or steroid therapy in order to identify possible alternative regimens.<br>Three hundred and six consecutive patients with ISSNHL (average hearing levels of 5 frequencies (250-4000Hz)≥40dB; time from the onset of hearing loss to the start of treatment ≤30 days) were enrolled. One hundred and ten, 95, and 101 patients underwent SGB+HBO (SGB group), PGE<sub>1</sub>+HBO (PG group), and steroid+HBO therapy (steroid group), respectively. Hearing recovery was evaluated by grade assessment, by hearing gain, and by hearing improvement rate compared to the unaffected contralateral ear.<br>The overall hearing outcome did not differ among the three groups. In patients with initial hearing levels <80dB, the PG group tended to show a higher cure rate, recovery rate, hearing gain, and hearing improvement rate compared to those of the other groups. In contrast, in patients with initial hearing levels ≥80dB, the SGB group tended to show a higher recovery rate, hearing gain, and hearing improvement rate compared to those of the other groups, and the hearing improvement rate was significantly higher in the SGB group than in the PG group (53.0±5.0% vs. 35.3±6.8%; p<0.05).<br>We concluded that both SGB+HBO and PGE<sub>1</sub>+HBO are promising alternative regimens for ISSNHL, and that SGB+HBO and PGE<sub>1</sub>+HBO are recommended for patients with initial hearing levels≥80dB and <80dB, respectively.
耳鼻咽喉科臨床 101(9), 663-667, 2008-09-01
The Society of Practical Otolaryngology