Abdulkadir İMRE, İbrahim ALADAĞ, Ercan PINAR, Hale ASLAN, Rıdvan DURAN, Mustafa YAZIR

Steroidlerin başarısız kalmasından sonraki ani sensörinöral iflitme kaybında hiperbarik oksijen kurtarma tedavisinin terapötik etkinliğii

Steroidlerin başarısız kalmasından sonraki ani sensörinöral işitme kaybında hiperbarik oksijen kurtarma tedavisinin terapötik etkinliği Amaç: Bu çalışmanın amacı sistemik tedavi başarısızlığından sonra aniidiyopatik sensörinöral işitme kaybı (ISSNHL) olan hastalarda kurtarma tedavisi olarak hiperbarik oksijen (HBO) tedavisinin etkinliğini değerlendirmekti.Yöntem:Dirençli ISSNHL'li 48 ardışık hasta retrospektif çalışmayadahil edilmiştir. Hastaların hepsine giderek azalan dozlarda sistemiksteroid tedavisi, 41 hastaya intratimpanik deksametazon enjeksiyonuverilmiştir. Siegel kriterlerine göre işitme sonuçları iyileşme oranınave HBO tedavisi öncesi ve sonrasında odyometriyle ölçülen saf ton ortalamasına (PTA) göre işitme kazançları belirlenmiştir. Prognostikfaktörlerin işitme duyusundaki iyileşme üzerine etkisi de değerlendirilmiştir. Bulgular:On üç (%27) hasta HBO tedavisine yanıt vermiştir. Geri kalan 35 (%73) hasta herhangi bir iyileşme göstermemiştir. HBO tedavisinden sonra her frekanstaki ortalama işitme eşiğinde anlamlı iyileşmesaptanmıştır. Yalnızca başlangıçtaki PTA düzeyi ve cinsiyet iyileşme ileanlamlı derecede iyileşmişti. Ağır işitme kaybı (>=70 dM) olan hastalarda anlamlı derecede daha iyi sonuçlar elde edilmişti. Sonuç:Birincil kombine steroid tedavisinin başarısız olduğu ISSNHLhastalarında kurtarma HBO tedavisi yararlı olabilir. Özellikle PTA'sı70 dB'den daha yüksek olan hastalarda kurtarma HBO tedavisinin işitme duyusunda daha fazla iyileşme sağlaması beklenebilir.

Therapeutic efficacy of salvage hyperbaric oxygen therapy in sudden sensorineural hearing loss after failure of steroids

Objective:The aim of this study was to evaluate the efficacy of hyperbaric oxygen (HBO) therapy as salvage therapy in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) after failure of systemic therapy. Methods:Forty-eight consecutive patients with refractory ISSNHLwere enrolled retrospectively. All patients were given systemic steroidtherapy by tapered doses. In addition, forty-one patients receivedintratympanic dexamethasone injection. Hearing outcomes were determined by recovery rate according to Siegel's criteria and hearing gainsin pure-tone average (PTA) measured by audiometry before and afterHBO therapy. The effects of prognostic factors on hearing recoverywere also evaluated. Results: Thirteen (27%) patients responded to HBO therapy. Theremaining 35 (73%) patients did not show any improvement. After HBOtherapy, significant improvement was found in mean hearing thresholdsat all frequencies. Only the level of initial PTA level and gender were significantly associated with recovery. Patients with severe hearing loss (>=70dB) had significantly better results. Conclusion:Salvage HBO therapy may be beneficial in patients withISSNHL who failed to recover by primary combined steroid therapy.Further hearing recovery with salvage HBO therapy can be expected,particularly in patients with PTA greater than 70 dB.

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