耳内镜鼓室注射地塞米松治疗顽固性前庭性眩晕的临床研究分析

Clinical Study on the Treatment of Refractory Vestibular Vertigo by Otoscopic Intratympanic Injection of Dexamethasone

摘要: 目的：探讨鼓室注射地塞米松治疗顽固性前庭性眩晕的临床疗效及对前庭功能改善作用，为临床顽固性前庭性眩晕的治疗提供新的有效治疗方案。方法：选取我院2024年1月~2025年12月诊治的72例顽固性前庭性眩晕患者为研究对象，采用随机数字表法分为研究组(36例)与对照组(36例)，对照组给予常规静滴地塞米松及改善内耳前庭微循环药物及前庭康复对症治疗，研究组在对照组基础上联合耳内镜下鼓室注射地塞米松药物治疗。对比两组治疗前及治疗后1个月、3个月、6个月眩晕发作频率、眩晕残疾量表(DHI)评分、前庭功能指标等评估临床疗效，并观察治疗期间不良反应发生情况。结果：治疗后1、3、6个月两组眩晕发作频率、DHI评分均较治疗前下降，且研究组同期评分明显低于对照组，差异有统计学意义(P < 0.05)；治疗6个月后两组前庭功能指标均有有效改善，研究组前庭眼反射增益更高、半规管功能不对称值更低，组间对比差异有统计学意义(P < 0.05)。研究组治疗有效率83.33%，高于对照组61.11%，差异有统计学意义(P < 0.05)。两组不良反应发生情况对比，差异无统计学意义(P > 0.05)。结论：内镜下鼓室注射地塞米松治疗顽固性前庭性眩晕可有效减少眩晕发作频率，改善前庭功能及提高患者生活质量，临床疗效明显且安全性高，值得临床推广应用。

Abstract: Objective: To explore the clinical efficacy of intratympanic dexamethasone injection in the treatment of refractory vestibular vertigo and its effect on improving vestibular function, and to provide a new and effective treatment plan for the clinical treatment of refractory vestibular vertigo. Methods: A total of 72 patients with refractory vestibular vertigo admitted to our hospital from January 2024 to December 2025 were enrolled and randomly divided into study group (n = 36) and control group (n = 36) using random number table method. The control group received conventional treatment with intravenous dexamethasone, vestibular microcirculation-improving agents, and vestibular rehabilitation therapy. On this basis, the study group was additionally treated with otoscope-guided intratympanic dexamethasone injection. The frequency of vertigo attacks, Dizziness Handicap Inventory (DHI) scores, vestibular function indicators, and clinical efficacy were compared between the two groups before treatment and at 1, 3, and 6 months after treatment. Adverse reactions during treatment were also observed. Results: At 1, 3, and 6 months post-treatment, both groups demonstrated significant reductions in vertigo attack frequency and Dizziness Handicap Inventory (DHI) scores compared with baseline. Notably, the study group exhibited significantly lower scores than the control group at all follow-up time points, with statistically significant differences (P < 0.05). After 6 months of treatment, vestibular function indicators improved effectively in both groups. The study group showed higher vestibulo-ocular reflex (VOR) gain and lower canal paresis (CP) value, with statistically significant differences between the two groups (P < 0.05). The total effective rate of treatment in the study group was 83.33%, which was significantly higher than that in the control group (61.11%), with a statistically significant difference (P < 0.05). No statistically significant difference was observed in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion: Endoscopic intratympanic dexamethasone injection for refractory vestibular vertigo can effectively reduce the frequency of vertigo attacks, improve vestibular function, and enhance patients’ quality of life. It has significant clinical efficacy and high safety, making it worthy of clinical promotion and application.