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*Only for medical professionals to read for reference comprehensive treatment, early treatment, typed treatment.
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Sudden deafness (abbreviated as sudden deafness) refers to the sensorineural hearing loss of unknown cause that occurs suddenly within 72 hours , Usually in a few minutes, a few hours or a day, the patient’s hearing drops to the lowest point (a small part of it drops to the lowest point on the 3rd day), at least in two adjacent frequencies, the hearing loss is ≥20dBHL, and it may be accompanied by tinnitus or dizziness.
Some patients tend to heal themselves.
Pathogenesis and clinical manifestations The etiology and pathophysiological mechanism of sudden deafness have not been fully clarified.
Both local and systemic factors can cause deafness.
Common causes include: vascular diseases, viral infections, autoimmune diseases, infectious diseases, Tumors and so on.
It is generally believed that excessive fatigue, mental stress, high pressure, mood swings, irregular life, sleep disorders, seasonal factors, etc.
may be the main inducements for sudden deafness.
At present, the more recognized possible pathogenesis include: inner ear vasospasm, stria vascularis dysfunction, vascular embolism or thrombosis, membrane labyrinth hydrops and hair cell injury.
The main clinical manifestations of sudden deafness have the following 4 points.
1.
Deafness: Most of them are unilateral deafness, and there is no aura before the onset.
A few patients have a history of mild cold, fatigue or emotional agitation.
Deafness occurs suddenly, and the patient's hearing generally drops to its lowest point within a few minutes or hours, and a small number of patients can reach the lowest point with hearing loss within 3 days.
2.
Tinnitus: It can be the initial symptom.
Most patients can experience tinnitus when they are deaf, but tinnitus can also occur after deafness.
After treatment, most patients can improve their hearing, but tinnitus can persist for a long time.
3.
Dizziness: Some patients may have different degrees of dizziness, mostly rotational dizziness, accompanied by nausea and vomiting.
It can occur at the same time as the deafness, or before and after the deafness occurs.
4.
Others: A small number of patients may have ear stuffiness, oppression or numbness.
Therapeutic drug introduction At present, the treatment of sudden deafness mostly adopts comprehensive treatment (drug therapy and hyperbaric oxygen therapy, etc.
), and the early treatment is effective.
Therefore, the treatment of sudden deafness should be "race against time" to avoid damage to the cochlear nerve, resulting in permanent Hearing impairment, miss the golden treatment period.
Commonly used therapeutic drugs are introduced as follows.
01 Glucocorticoid hormone therapy is recommended for systemic oral administration, taking it in the morning; if it is effective for 3 days, it can be stopped after another 2 days.
There is no need to gradually reduce the dose.
If it is ineffective, the drug can be stopped directly.
Hormone can also be administered by intravenous injection.
According to the analogy of prednisone dose, methylprednisolone 40mg or dexamethasone 10mg, the course of treatment is the same as oral hormone.
Local administration can be used as a salvage treatment, including intratympanic injection or post-auricular injection.
Intratympanic injection can be dexamethasone 5mg or methylprednisolone 20mg, once every other day for 4 to 5 times.
Behind the ear injection can use 20-40mg of methylprednisolone, or 5-10mg of dexamethasone, once every other day, 4 to 5 times in a row.
If it is difficult for the patient to follow-up, you can use compound betamethasone 2mg, which can be injected once behind the ear.
In terms of hormone side effects, topical use of hormones has better safety than oral systemic drugs.
02 Improved microcirculation drugs Ginkgo biloba extract can regulate blood vessel function, improve organ blood circulation and peripheral microcirculation, improve local microcirculation in the ear, etc.
, and relieve hearing damage caused by hypoxia and insufficient blood supply.
Naoshuantong Capsules are composed of Puhuang, Red Peony Root, Turmeric, Gastrodia, and Leu Lu.
It has the effects of activating blood and dredging collaterals, expelling wind and phlegm, and can improve the symptoms of vertigo and tinnitus caused by sudden deafness.
03 The ion channel blocker lidocaine can enter the inner ear through the blood-ear barrier, improve the microcirculation of the vestibule and inner ear, reduce inner ear lymphedema, and inhibit Na+ channels, block the afferent impulse, thereby attenuating or eliminating the cochlea and vestibule Pathological irritation reduces or disappears tinnitus and dizziness.
Flunarizine is a calcium ion channel antagonist, which can block excessive calcium ions from transmembrane into cells, prevent excessive intracellular calcium load, and can also prevent large amounts of calcium from entering neurons during ischemia and hypoxia, improving brain microcirculation and Neuronal metabolism, inhibition of cerebral vasospasm, platelet aggregation and increased blood viscosity, in addition to cell membrane stabilization, can improve the symptoms of vertigo and tinnitus caused by sudden deafness.
04 Betahistine mesylate can improve inner ear circulation, increase cochlear blood flow, and reduce inner ear hydrops.
05 Nutritional nerve drugs, methylcobalamin, vitamin B1, neurotrophic factors, etc.
Classification treatment recommendations Sudden deafness is divided into: high frequency drop type, low frequency drop type, flat drop type and total deafness (including extremely severe deafness) according to the frequency and degree of hearing loss.
According to different types, different treatment options are recommended.
01 Low-frequency drop type ①Because there may be membrane labyrinth water, it is necessary to limit salt, the infusion volume should not be too large, it is best not to use 0.
9% sodium chloride solution.
②Patients with average hearing loss less than 30dB have a higher self-healing rate and can be administered orally, including glucocorticoids, betahistine mesylate, drugs to improve venous return, etc.
, and glucocorticoid injections into the tympanic cavity or behind the ear can also be considered ; For those with hearing loss ≥30dB, ginkgo biloba extract + glucocorticoid can be administered intravenously.
③A small number of patients using the program of ② are ineffective and (or) ear fullness increases.
They can be treated with drugs that reduce fibrinogen and improve venous return.
02 High-frequency descending type ①Improving microcirculation drugs + glucocorticoids; ②Ion channel blockers are better for reducing high-profile tinnitus; ③Nutrition neurological drugs can be considered.
03 People with full-frequency hearing loss (including flat-decline and total deafness) ① drugs for reducing fibrinogen; ② glucocorticoids; ③ drugs for improving inner ear microcirculation.
It is recommended to combine medication as soon as possible.
Source of this article: Yixian Pharmacy V Editor: Mr.
Lu Li Copyright Statement This reprint is welcome to forward to the circle of friends-End-
.
.
Sudden deafness (abbreviated as sudden deafness) refers to the sensorineural hearing loss of unknown cause that occurs suddenly within 72 hours , Usually in a few minutes, a few hours or a day, the patient’s hearing drops to the lowest point (a small part of it drops to the lowest point on the 3rd day), at least in two adjacent frequencies, the hearing loss is ≥20dBHL, and it may be accompanied by tinnitus or dizziness.
Some patients tend to heal themselves.
Pathogenesis and clinical manifestations The etiology and pathophysiological mechanism of sudden deafness have not been fully clarified.
Both local and systemic factors can cause deafness.
Common causes include: vascular diseases, viral infections, autoimmune diseases, infectious diseases, Tumors and so on.
It is generally believed that excessive fatigue, mental stress, high pressure, mood swings, irregular life, sleep disorders, seasonal factors, etc.
may be the main inducements for sudden deafness.
At present, the more recognized possible pathogenesis include: inner ear vasospasm, stria vascularis dysfunction, vascular embolism or thrombosis, membrane labyrinth hydrops and hair cell injury.
The main clinical manifestations of sudden deafness have the following 4 points.
1.
Deafness: Most of them are unilateral deafness, and there is no aura before the onset.
A few patients have a history of mild cold, fatigue or emotional agitation.
Deafness occurs suddenly, and the patient's hearing generally drops to its lowest point within a few minutes or hours, and a small number of patients can reach the lowest point with hearing loss within 3 days.
2.
Tinnitus: It can be the initial symptom.
Most patients can experience tinnitus when they are deaf, but tinnitus can also occur after deafness.
After treatment, most patients can improve their hearing, but tinnitus can persist for a long time.
3.
Dizziness: Some patients may have different degrees of dizziness, mostly rotational dizziness, accompanied by nausea and vomiting.
It can occur at the same time as the deafness, or before and after the deafness occurs.
4.
Others: A small number of patients may have ear stuffiness, oppression or numbness.
Therapeutic drug introduction At present, the treatment of sudden deafness mostly adopts comprehensive treatment (drug therapy and hyperbaric oxygen therapy, etc.
), and the early treatment is effective.
Therefore, the treatment of sudden deafness should be "race against time" to avoid damage to the cochlear nerve, resulting in permanent Hearing impairment, miss the golden treatment period.
Commonly used therapeutic drugs are introduced as follows.
01 Glucocorticoid hormone therapy is recommended for systemic oral administration, taking it in the morning; if it is effective for 3 days, it can be stopped after another 2 days.
There is no need to gradually reduce the dose.
If it is ineffective, the drug can be stopped directly.
Hormone can also be administered by intravenous injection.
According to the analogy of prednisone dose, methylprednisolone 40mg or dexamethasone 10mg, the course of treatment is the same as oral hormone.
Local administration can be used as a salvage treatment, including intratympanic injection or post-auricular injection.
Intratympanic injection can be dexamethasone 5mg or methylprednisolone 20mg, once every other day for 4 to 5 times.
Behind the ear injection can use 20-40mg of methylprednisolone, or 5-10mg of dexamethasone, once every other day, 4 to 5 times in a row.
If it is difficult for the patient to follow-up, you can use compound betamethasone 2mg, which can be injected once behind the ear.
In terms of hormone side effects, topical use of hormones has better safety than oral systemic drugs.
02 Improved microcirculation drugs Ginkgo biloba extract can regulate blood vessel function, improve organ blood circulation and peripheral microcirculation, improve local microcirculation in the ear, etc.
, and relieve hearing damage caused by hypoxia and insufficient blood supply.
Naoshuantong Capsules are composed of Puhuang, Red Peony Root, Turmeric, Gastrodia, and Leu Lu.
It has the effects of activating blood and dredging collaterals, expelling wind and phlegm, and can improve the symptoms of vertigo and tinnitus caused by sudden deafness.
03 The ion channel blocker lidocaine can enter the inner ear through the blood-ear barrier, improve the microcirculation of the vestibule and inner ear, reduce inner ear lymphedema, and inhibit Na+ channels, block the afferent impulse, thereby attenuating or eliminating the cochlea and vestibule Pathological irritation reduces or disappears tinnitus and dizziness.
Flunarizine is a calcium ion channel antagonist, which can block excessive calcium ions from transmembrane into cells, prevent excessive intracellular calcium load, and can also prevent large amounts of calcium from entering neurons during ischemia and hypoxia, improving brain microcirculation and Neuronal metabolism, inhibition of cerebral vasospasm, platelet aggregation and increased blood viscosity, in addition to cell membrane stabilization, can improve the symptoms of vertigo and tinnitus caused by sudden deafness.
04 Betahistine mesylate can improve inner ear circulation, increase cochlear blood flow, and reduce inner ear hydrops.
05 Nutritional nerve drugs, methylcobalamin, vitamin B1, neurotrophic factors, etc.
Classification treatment recommendations Sudden deafness is divided into: high frequency drop type, low frequency drop type, flat drop type and total deafness (including extremely severe deafness) according to the frequency and degree of hearing loss.
According to different types, different treatment options are recommended.
01 Low-frequency drop type ①Because there may be membrane labyrinth water, it is necessary to limit salt, the infusion volume should not be too large, it is best not to use 0.
9% sodium chloride solution.
②Patients with average hearing loss less than 30dB have a higher self-healing rate and can be administered orally, including glucocorticoids, betahistine mesylate, drugs to improve venous return, etc.
, and glucocorticoid injections into the tympanic cavity or behind the ear can also be considered ; For those with hearing loss ≥30dB, ginkgo biloba extract + glucocorticoid can be administered intravenously.
③A small number of patients using the program of ② are ineffective and (or) ear fullness increases.
They can be treated with drugs that reduce fibrinogen and improve venous return.
02 High-frequency descending type ①Improving microcirculation drugs + glucocorticoids; ②Ion channel blockers are better for reducing high-profile tinnitus; ③Nutrition neurological drugs can be considered.
03 People with full-frequency hearing loss (including flat-decline and total deafness) ① drugs for reducing fibrinogen; ② glucocorticoids; ③ drugs for improving inner ear microcirculation.
It is recommended to combine medication as soon as possible.
Source of this article: Yixian Pharmacy V Editor: Mr.
Lu Li Copyright Statement This reprint is welcome to forward to the circle of friends-End-
