[Analysis of prognostic factors in patients with refractory sudden sensorineural hearing loss].

Objective:To explore the relationships between glucocorticoid (GC) sensitivity and the prognosis of refractory sudden sensorineural hearing loss (SSNHL), and to analyze the related factors being affected the prognosis of SSNHL. Method:Ninety-one refractory SSNHL patients were enrolled in the present investigation. Peripheral blood mononuclear cells (PBMCs) from the refractory SSNHL were extracted to conduct GC proliferation dexamethasone (DEX) inhibition experiments. All patients accepted comprehensive treatment with methylprednisolone. Result:Total effective rate was 40.66% in refractory SSNHL patients. Gender, number of affected ear, age, accompanying with vertigo, tinnitus or not and the procedure of methylprednisolone treatment were irrelevant to the efficacy. Only the inhibitory rate of DEX and the time from onset to visit were related to GC treatment effect, especially for inhibitory rate of DEX. The DEX inhibition rate of the effective group was higher than that of the ineffective group. Conclusion:DEX inhibition rate can predict GC sensitivity and prognosis of SSNHL. GC sensitivity and the time from onset to treatment are two important factors affecting the prognosis of refractory SSNHL patients..

[Clinical observation on the effect of glucocorticoid insensitivity on sudden sensorineural hearing loss patients].

Objective: To investigate the correlation between the proliferation inhibition effect of glucocorticoid (GC) on peripheral blood mononuclear cell (PBMC) and the pure tone average (PTA) improvement in SSNHL patients. Methods: Sixty inpatients with SSNHL were included from July 2013 to October 2015 in Nanjing Drum Tower Hospital, Medical School of Nanjing University. Peripheral venous blood was collected before receiving treatment, then the PBMC was isolated for GC proliferation inhibition. PBMCs of each patient were cultivated into 4 groups: Group A: PBMCs+ Medium; Group B: PBMCs+ Medium+ lipopolysaccharide (LPS, 1 µmol/L); Group C: PBMCs+ Medium+ LPS+ Dexamethasone; Group D: Medium. PBMCs were maintained in a humidified 5% CO(2) atmosphere at 37°C and were observed after 24 hours. 5-diphenyltetrazolium bromide (MTT) was used to measure PBMC proliferation inhibition rate. The PBMC proliferation inhibition rates were calculated according to the absorbance at 490 nm wavelength under a microtiter plate reader. Independent sample t tests of PBMC proliferation inhibition rate were performed between different groups. χ(2) tests were performed between gender, affected ear side, accompanied by vertigo or not, audiometric curve, time period from onset to treatment, PBMC proliferation inhibition rate and the improvement of pure tone average (PTA). Linear correlation analyses were performed between PBMC proliferation inhibition rate, the time period from onset to treatment and the hearing improvement. Results: The proliferation inhibition effect of GC on PBMC varied significantly among patients. The PBMC proliferation inhibition rate in GC insensitive group was lower than that in GC sensitive group (26.72%±21.82% vs 64.44%±25.48%, t=6.113, P<0.05). The PBMC proliferation inhibition rate in refractory group was lower than that in initial group (40.93%±28.57% vs 57.04%±31.19%, t=2.035, P=0.046). There was no statistical significance between gender, affected ear side, accompanied by vertigo or not, audiometric curve and the hearing improvement (χ(2) value was 2.320, 0.031, 2.143, 0.106, respectively, all P>0.05). Both in initial group and refractory group, the linear correlation analyses showed a significant positive correlation between PBMC proliferation inhibition rate and the PTA improvement (r value was 0.615, 0.657, respectively, all P<0.05), as well as a significant negative correlation between time period from onset to treatment and the PTA improvement(r value was -0.542, 0.370, respectively, all P<0.05). Conclusions: The proliferation inhibition rate of PBMC in vitro by GC is correlated with patients' hearing improvement. The proliferation inhibition test might be used to predict the sensitivity to GC treatment and be helpful for individualized treatment of SSNHLin clinical practice.

[Intratympanic methylprednisolone perfusion remedy refractory sudden sensorineural hearing loss].

Objective:To observe the clinical efficacy and characteristics of intratympanic methylprednisolone perfusion (IMP) as a salvage treatment in sudden sensorineural hearing loss（SSNHL） patients who failed in conventional treatments.Method:One hundred and ten SSNHL patients who failed to respond to conventional therapies were recruited. And a 10-day IMP was adopted as a salvage treatment to improve their hearing. Twenty five SSNHL patients who failed to respond to conventional therapies and without any other treatment were recruited as control group. The pure tone average(PTA) before and after IMP treatment was observed by pure tone audiometry. Data analysis was performed using SPSS13.0 and test level was set α=0.05. Result:The total effective rate of IMP was 49.09%, significantly higher than control group 16.00%. Significant hearing improvement was observed at all frequencies after IMP treatment. Especially PTA gain at the low frequencies was (13.45±18.10) dB, obviously higher than high frequency. An obvious improvement of PTA were detected in profound group(15.62±13.95)dB compared with in moderate group(7.97±14.90) dB and in severe groupï¼»PTA gain(5.59±13.88) dBï¼½. However, there was no significant difference between the two latter groups. PTA gain was(12.26±14.69) dB,(13.37±17.11) dB and (3.21±10.51) dB respectively in patients who suffer from SSNHL within 2 weeks, >2-4 weeks and over 4 weeks. Whether accompanied with vertigo or tinnitus had no significant influence on the efficacy of IMP treatment in SSNHL patients who failed investigated. Conclusion:IMP treatment could improve the hearing in SSNHL patients who failed to respond to conventional therapies. The gain was closely related to the onset time and the severity of hearing loss before IMP treatment.

[Effect of ligustrazine on kanamycin ototoxicity].

By measuring cochlear superoxide dismutase (SOD) activity, malondialdehyde (MDA) and electrocochleogram (ECoG) in guinea pigs, the antioxidation of Ligustrazine on Kanamycin (KM) was studied. The results showed that SOD activity, MDA content and threshold value of ECoG were significantly increased after KM was administered, while it markedly reduced after Ligustrazine was given. It was considered that lipid hyperoxidative reaction was correlated with KM ototoxicity, Ligustrazine could prevent and treat KM ototoxicity by antioxidation.