内耳置管治疗突聋、耳鸣和梅尼埃

2022-01-02

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内耳疾病，比如突发性耳聋、梅尼埃病(美尼尔)、耳鸣和免疫性耳聋，其治疗的难点就是药物很难从血液里直达内耳。即便是通过鼓膜穿刺注射药物进入中耳腔，也难以确保药物能够进入内耳。美国医生 Herbert Silverstein 在20年前就发明了通过鼓膜置管经过中耳，再通过圆窗进入中耳。

患者自己可以每天滴药三次(比如皮质激素或庆大霉素等)。有效后，一个月再将管子取出。操作简单，患者也很少痛苦。管子的名字叫：Silverstein Microwick，我翻译成“内耳微芯”。以下是原文，供同行们参考：

THIS NEW TECHNIQUE developed by Dr. Herbert Silverstein was designed to deliver medication to the inner ear using a Micro Wick™.The first drug used was dilute gentamicin, an antibiotic solution that the patient places in their ear three times a day for two to three weeks. This method is similar to treating eye diseases with eye drops. Thus far the results have been excellent in relieving vertigo attacks in 80% of the patients and preserving hearing in most patients. In 60% of patients, the pressure and tinnitus have been reduced.

Dexamethasone is used to treat certain cases of Meniere's disease where the complaints are mostly hearing loss, pressure and tinnitus in the ear. The MicroWick™ has also been used to deliver steroids directly to the inner ear thus avoiding subjecting the body to the side effects of steroids. The results are excellent and work best early in the disease when there is little damage to th e inner ear from the disease.

SUDDEN DEAFNESS-Certain patients suddenly lose their hearing, usually due to a viral infection, a tiny blood clot in the innel ear, or Meniere's disease. This can usually be treated with prednisone for 2 weeks. Some patients respond to this treatment, however, when the steroid is given directly into the inner ear, it gets into the fluids in higher concentration than taken by mouth and there are no systemic side effects. lf the patient responds to the systemic drug. perfusion the inner ear with Dexamethasone for one month can result in further improvement. If the patient can not tolerate the systemic steroids (i.e., diabetes, stomach ulcersor hypertension) then the MicroWick™ procedure can be used to deliver the drug to the inner directly. Usually, the earlier the treatment, the better the result. About 50% of patients will get some hearing back, especially if they are treated early in the disease. lt appears the higher the concentration is obtained in the inner ear the better the result.

MicroWick™ Procedure

This minimally invasive office procedure is done using local anesthesia. The ESC Lumenis CO2 laser is used to create a bloodless opening in the eardrum through which a tiny endoscope is inserted. Any obstructing membranes near the round window membrane are easily removed with an instrument before the MicroWick™ is inserted. Next, a tiny tube is placed in the tympanosto my opening. Now the round window membrane is clearly seen and the Silverstein Inner Ear MicroWick™ is inserted. This allows the medication to reach the round window membrane and diffuse into the inner ear fluids, which willtreat the inner ear disease.

The treatment is far less expensive than hospitalization for surgery. lt is also painless and well tolerated by patients. Most insurances cover the procedure. After the treatment. the tube and the MicroWick™ are easily removed in the office. The opening in the eardrum heals rapidly. There have been few complications and excellent results.

来源：张华听力师

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