突发性耳聋的临床治疗新进展-现代临床医学.docVIP

突发性耳聋的临床治疗新进展 易 旺，白 忠 （昆明医科大学附属第二人民医院 耳鼻咽喉科，云南 昆明 650000） [摘要]突发性耳聋的发病率在我国近年来呈渐升高的趋势,但是因为病因及发病机理的研究不明，治疗无法获得突破性进展。内耳微循环障碍、病毒感染、膜迷路积水、代谢障碍及植物神经功能紊乱等病因均认为与突发性耳聋有关。本文将目前主要的治疗突发性耳聋方法归为2大类：第一类为药物治疗：如糖皮质激素、改善耳蜗循环药物、神经营养类药物、 降低血液粘稠度药物、抗凝药物以及抗病毒药物等，第二大类为非药物治疗：如高压氧治疗、针灸（包括耳穴治疗、火罐治疗等）等。有些学者研究认为低能量冲击波因可以改善内耳微循环、促进细胞氧代谢、诱导NO生成等作用，被用于突聋的治疗。 [关键词]突发性耳聋；药物治疗；非药物治疗 [中图分类号]R764.43+7 [文献标识码]A New progress in clinical treatment of sudden deafness YI Wang, BAI Zhong (The second peoples hospital affiliated to kunming medical university otolaryngology department China) [Abstract] the incidence of sudden deafness gradually rising trend in recent years in our country,however,because of unknown etiology and pathogenesis of research, treatment cannot get breakthrough.The inner ear microcirculation, virus infection, membranous labyrinth water, metabolic disorders and plant nerve function disorder, cause that is associated with sudden deafness.This article will be the main methods which treat sudden deafness fall into two broad categories: the first, there is drug treatment, such as corticosteroids, improve cochlear circulation drugs, neurotrophic drugs, reduce blood viscosity, anticoagulation drugs and antiviral drugs, the second major categories for non-drug therapy, hyperbaric oxygen therapy, acupuncture treatment (including ear, cupping therapy, etc.), etc.Some scholars suggest that low-energy shock wave for oxygen can improve inner ear microcirculation, promote cells metabolism, induced NO generated etc, can be used in the treatment of sudden deafness. [Key words] Sudden deafness；Drug therapy；Non-drug therpy 突发性耳聋,又称特发性突聋。指72小时以内忽然发生的、原因不清楚的感音神经性听力丧失，至少在相邻的两个频率听力下降≥20 dBHL。常伴有耳鸣、耳闷胀感或眩晕，患者可同时伴有其中一个或多个症状。目前分为高频下降、低频下降、平坦下降和全聋（包括极重度耳聋）四种类型 [1] 。突聋发病至治疗的最佳时间是7 d 内，所以在治疗上要尽早。对于病程较长的患者，虽仍有希望提高听力，但应告知患者合理的期望值。陈嘉等[2]报告说，病程超过3周甚至大于1年的突发性耳聋患者，经过积极治疗，仍可能提高听力。本文将目前突聋的治疗进展归纳如下。 药物治疗 1.1 糖皮质激素 糖皮质激素被认为是目前治疗突发性耳聋实际有效的治疗方法之一。它能抗炎、抗病毒和免疫抑制；能消除血管痉挛从而增加内耳血供，改善微循环。它也可减轻血管内皮水肿、抑止毛细血管扩张、较少炎性渗出。多数的研究证明糖皮