十年经验：高压氧联合类固醇治疗特发性突发性感音神经性听力损失的回顾性队列研究（332例患者）

文献信息

中文摘要

背景： 评估高压氧治疗（HBOT）联合全身性皮质类固醇治疗特发性突发性感音神经性听力损失（ISSNHL）患者的临床疗效和安全性，特别关注治疗时机、听力恢复的预测因素以及合并症的影响。
方法： 这项回顾性观察性队列研究在一家三级转诊中心（意大利萨莱诺的AOU "San Giovanni di Dio e Ruggi d'Aragona"）进行。共纳入2014年至2024年间接受治疗的332例成人ISSNHL患者。所有患者均接受全身性皮质类固醇（口服泼尼松1 mg/kg/天，在10-15天内逐渐减量）和HBOT（2.4个绝对大气压，每次90分钟；中位10次）的联合治疗。听力结局采用纯音平均听阈（PTA）评估。治疗反应定义为PTA较基线改善≥30%。进行多变量逻辑回归分析以确定听力改善的独立预测因素。同时记录安全性结局。
结果： 平均基线PTA为61.3 ± 21.5 dB HL，治疗后改善至44.6 ± 22.7 dB HL，平均听力增益为16.7 ± 14.2 dB HL（P < .001）。总体而言，151例患者（43.5%）符合反应标准。与无反应者相比，有反应者的基线PTA显著更高（67.6 vs. 56.8 dB HL，P < .001），且更常报告耳鸣（64.2% vs. 51.5%，P = .014）。治疗开始的中位时间为15天（四分位距：7-30）。多变量分析确定较短的治疗时间（比值比[OR]：0.95，95% CI：0.92-0.98）、存在耳鸣（OR：1.79，95% CI：1.15-2.80）和较高的基线PTA（OR：1.03，95% CI：1.01-1.05）是听力改善的独立预测因素。常见合并症，包括高血压、糖尿病和心血管疾病，与治疗反应无显著关联。未观察到与HBOT相关的严重不良事件。
结论： 高压氧治疗联合全身性皮质类固醇与ISSNHL患者听力结局改善相关，尤其是在早期开始治疗时。较短的治疗时间、较大的基线听力损失和存在耳鸣成为听力恢复的独立预测因素。总体而言，这些发现表明早期使用HBOT与听力结局改善之间存在关联，并支持将其视为ISSNHL多模式治疗策略的辅助组成部分。

英文摘要

BACKGROUND: To evaluate the clinical efficacy and safety of hyperbaric oxygen therapy (HBOT) combined with systemic corticosteroids in patients with idiopathic sudden sensorineural hearing loss (ISSNHL), with particular focus on treatment timing, predictors of hearing recovery, and the impact of comorbidities.
METHODS: This retrospective observational cohort study was conducted at a tertiary referral center (AOU "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy). A total of 332 adult patients with ISSNHL treated between 2014 and 2024 were included. All patients received combined therapy with systemic corticosteroids (oral prednisone 1 mg/kg/day, tapered over 10-15 days) and HBOT (2.4 atmospheres absolute, 90 minutes per session; median of 10 sessions). Audiometric outcomes were assessed using pure-tone average (PTA). Treatment response was defined as a ≥30% improvement in PTA compared with baseline. Multivariate logistic regression was performed to identify independent predictors of hearing improvement. Safety outcomes were also recorded.
RESULTS: Mean baseline PTA was 61.3 ± 21.5 dB HL, improving to 44.6 ± 22.7 dB HL after treatment, with a mean hearing gain of 16.7 ± 14.2 dB HL (P < .001). Overall, 151 patients (43.5%) met the response criteria. Responders presented with significantly higher baseline PTA compared with nonresponders (67.6 vs. 56.8 dB HL, P < .001) and more frequently reported tinnitus (64.2% vs. 51.5%, P = .014). Median time to treatment initiation was 15 days (interquartile range: 7-30). Multivariate analysis identified shorter time to treatment (odds ratio [OR]: 0.95, 95% CI: 0.92-0.98), presence of tinnitus (OR: 1.79, 95% CI: 1.15-2.80), and higher baseline PTA (OR: 1.03, 95% CI: 1.01-1.05) as independent predictors of hearing improvement. Common comorbidities, including hypertension, diabetes, and cardiovascular disease, were not significantly associated with treatment response. No serious adverse events related to HBOT were observed.
CONCLUSION: Hyperbaric oxygen therapy combined with systemic corticosteroids was associated with improved audiometric outcomes in patients with ISSNHL, particularly when initiated early. Shorter time to treatment, greater baseline hearing loss, and the presence of tinnitus emerged as independent predictors of hearing recovery. Overall, these findings suggest an association between early HBOT use and improved audiometric outcomes and support its consideration as an adjunctive component of multimodal treatment strategies for ISSNHL.