中西医协同干预突发性耳聋的分期干预策略

Staged integrated traditional Chinese and Western medicine intervention strategies for sudden sensorineural hearing loss

摘要

突发性耳聋（SSNHL）是耳鼻喉科常见的急症之一。单纯西医治疗 SSNHL 存在局限性，现有研究表明，西医治疗基础上联合中药注射剂、口服辨证汤剂及针灸等中医综合疗法，可发挥协同增效的优势，中西医协同干预模式可实现优势互补，为临床诊疗提供新思路。本文系统归纳了近年中西医协同干预 SSNHL 的相关研究，从作用路径阐述中西医在抗炎免疫、改善微循环、抗氧化应激及促进神经修复等方面的互补作用，探讨分期分型干预路径在临床中的可行性。文章提出急性期西医主导治疗、恢复期中医整体调理巩固的分期干预策略，有利于提高治疗有效率、改善耳鸣等后遗症并提高患者生活质量。当前，中西医协同干预 SSNHL 已初步形成分期诊疗模式，未来仍需要更多高质量临床研究，借助前沿技术推动该诊疗模式的标准化发展。

Abstract

Sudden sensorineural hearing loss (SSNHL) is one of the common emergencies in otorhinolaryngology. Western medical treatment alone has certain limitations in the management of SSNHL. Existing studies have shown that, on the basis of Western medical treatment, combined use of comprehensive traditional Chinese medicine therapies, such as Chinese herbal injections, oral decoctions based on syndrome differentiation, and acupuncture, can produce synergistic and efficacy-enhancing effects. A integrated traditional Chinese and Western medicine intervention model can realize complementary advantages and provide new ideas for clinical diagnosis and treatment. This article systematically summarizes recent studies on integrated Chinese and Western medicine interventions for SSNHL. From the perspective of mechanisms of action, it elaborates on the complementary roles of Chinese and Western medicine in anti-inflammatory and immune regulation, improvement of microcirculation, antioxidative stress, and promotion of neural repair, and explores the clinical feasibility of staged and classification-based intervention pathways. This article proposes a staged intervention strategy in which Western medicine plays the leading role in the acute phase, while traditional Chinese medicine provides holistic regulation and consolidation in the recovery phase. This strategy may help improve the treatment response rate, alleviate sequelae such as tinnitus, and enhance patients’ quality of life. At present, integrated Chinese and Western medicine interventions for SSNHL have initially formed a staged intervention model. In the future, more high-quality clinical studies are still needed, and advanced technologies should be used to promote the standardized development of this intervention model.

关键词

突发性耳聋 / 中西医协同 / 分期干预 / 整合医学

Key words

Sudden sensorineural hearing loss / Integrated traditional Chinese and Western medicine / Staged intervention / Integrative medicine

参考文献

[1] Chandrasekhar S S, Tsai Do B S, Schwartz S R, et al. Clinical practice guideline: sudden hearing loss (update)[J]. Otolaryngol, 2019, 161(S1): S1-S45. DOI: 10.1177/0194599819859885.

[2] Prince A D P, Stucken E Z . Sudden sensorineural hearing loss: a diagnostic and therapeutic emergency[J]. J Am Board FamMed, 2021, 34(1): 216-223. DOI: 10.3122/jabfm.2021.01.200199.

[3] Tripathi P, Deshmukh P . Sudden sensorineural hearing loss: a review[J]. Cureus, 2022: e29458. DOI: 10.7759/cureus.29458.

[4] Frosolini A, Franz L, Daloiso A, et al. Digging into the role of inflammatory biomarkers in sudden sensorineural hearing loss diagnosis and prognosis: a systematic review and meta-analysis[J]. Medicina (Kaunas), 2022, 58(7): 963. DOI: 10.3390/medicina58070963.

[5] 林育珊, 卢标清. 从心脾论治突发性耳聋的疗效观察[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 6-11. DOI: 10.6040/j.issn.1673-3770.0.2019.584.

[6] Lin Y S, Lu B Q. Treatment of sudden seafness by heart and spleen[J]. J Otolaryngol Ophthalmol Shandong Univ, 2020, 34(6): 6-11. DOI: 10.6040/j.issn.1673-3770.0.2019.584.

[7] Hoch S, Kremper L, Rudhart S A, et al. Stellenwert der intratympanalen glukokortikoidtherapie in der behandlung des Hörsturzes[J]. HNO, 2024, 72(4): 291-302. DOI: 10.1007/s00106-024-01424-z.

[8] Achanta M, Kasetti P, Fortune-Ely M, et al. Adverse effects of steroid therapy in sudden sensorineural hearing loss: a scoping review[J]. Clin Otolaryngol, 2025, 50(5): 821-830. DOI: 10.1111/coa.14339.

[9] 彭新, 朱晓华, 黄邦清, 等 . 突发性聋治疗后遗留耳鸣远期评估及身心影响分析[J]. 中华耳鼻咽喉头颈外科杂志, 2023, 58(1): 42-46. DOI: 10.3760/cma.j.cn115330-20250421-00340.

[10] Peng X, Zhu X H, Huang B Q, et al. Long-term evaluation and physical and mental effects of residual tinnitus following treatment of sudden hearing loss[J]. Chin J Otorhinolaryngol Head Neck Surg, 2023, 58(1): 42-46. DOI: 10.3760/cma.j.cn115330-20250421-00340.

[11] 王寻雨, 张敏, 张勤修. 中医治疗气滞血瘀型突发性耳聋的临床研究进展[J]. 中国民族民间医药, 2023, 32(10): 63-65, 74.

[12] Wang X Y, Zhang M, Zhang Q X. Clinical research progress of TCM in the treatment of sudden deafness of qi stagnation and blood stasis type[J]. Chin J Ethnomed Ethnopharmacy, 2023, 32(10): 63-65, 74.

[13] Auger J P, Zimmermann M, Faas M, et al. Metabolic rewiring promotes anti-inflammatory effects of glucocorticoids[J]. Nature, 2024, 629(8010): 184-192. DOI: 10.1038/s41586-024-07282-7.

[14] Cummins C L, Goldstein I . New anti-inflammatory mechanism of glucocorticoids uncovered[J]. Trends Endocrinol Metab, 2025, 36(2): 99-101. DOI: 10.1016/j.tem.2024.08.003.

[15] Li Y, Song K, Zhang H, et al. Anti-inflammatory and immunomodulatory effects of baicalin in cerebrovascular and neurological disorders[J]. Brain Res Bull, 2020, 164: 314-324. DOI: 10.1016/j.brainresbull.2020.08.016.

[16] Zhao H, Wang Y, Xu C, et al. Potential molecular mechanisms of Erlongjiaonang action in idiopathic sudden hearing loss: a network pharmacology and molecular docking analyses[J]. Front Neurol, 2023, 14: 1121738. DOI: 10.3389/fneur.2023.1121738.

[17] Li N, Guo Y, Gong Y, et al. The anti-inflammatory actions and mechanisms of acupuncture from acupoint to target organs via neuro-immune regulation [J]. J Inflamm Res, 2021, 14: 7191-7224. DOI: 10.2147/JIR.S341581.

[18] 张冀琳, 蒋源, 张仕林. 甲泼尼龙联合前列地尔治疗老年突发性耳聋的疗效及对血浆 BNP、Hcy、DD 水平的影响[J]. 海南医学, 2022, 33(16): 2094-2096. DOI: 10.3969/j.issn.1003-6350.2022.16.014.

[19] Zhang J L, Jiang Y, Zhang S L. Efficacy of methylprednisolone combined with alprostadil in the treatment of senile sudden deafness and its effect on plasma B-type brain natriuretic peptide, homocysteine and D-dimer levels[J]. Hainan Med J, 2022, 33(16): 2094-2096. DOI: 10.3969/j.issn.1003-6350.2022.16.014.

[20] 王丽, 朱媛. 丹参川芎嗪注射液辅助治疗耳鸣的效果[J]. 临床合理用药杂志, 2021, 14(16): 6-8. DOI: 10.15887/j.cnki.13-1389/r.2021.16.003.

[21] Wang L, Zhu Y. Effect of salviae miltiorrhizae and ligustrazine hydrochloride injection on the auxiliary treatment of tinnitus[J]. Chin J Clin Ration Drug Use, 2021, 14(16): 6-8. DOI: 10.15887/j.cnki.13-1389/r.2021.16.003.

[22] 吴君, 顾晓峰. 乌灵胶囊联合胞磷胆碱钠胶囊治疗老年突发性耳聋[J]. 实用医学杂志, 2024, 40(21): 3090-3094. DOI: 10.3969/j.issn.1006-5725.2024.21.020.

[23] WU J, GU X F. Clinical effect of Wuling capsule combined with citicoline sodium capsule on sudden deafness in the elderly[J]. J Pract Med, 2024, 40(21): 3090-3094. DOI: 10.3969/j.issn.1006-5725.2024.21.020.

[24] Nitta Y, Sano H, Kurioka T, et al. Intratympanic injection of edaravone for idiopathic sudden sensorineural hearing loss with profound hearing loss[J]. J Int Adv Otol, 2025, 21(3): 1-7. DOI: 10.5152/iao.2025.251875.

[25] 郭本婕, 孙建华, 裴丽霞. 针灸改善氧化应激作用机制的研究进展[J]. 针刺研究, 2024, 49(03): 307-314. DOI: 10.13702/j.1000-0607.20221428.

[26] Guo B J, Sun J H, Pei L X. Research progress on mechanisms of acupuncture and moxibustion underlying improvement of oxidative stress[J]. Acupuncture Research, 2024, 49(03): 307-314. DOI: 10.13702/j.1000-0607.20221428.

[27] Bian Z, Zhang R, Zhang X, et al. Extraction, structure and bioactivities of polysaccharides from Rehmannia glutinosa: a review[J]. J Ethnopharmacol, 2023, 305: 116132. DOI: 10.1016/j.jep.2022.116132.

[28] Cui C, Liu W, Feng L, et al. Cornus officinalis Sieb.: an updated review on the ethnopharmacology, phytochemistry, pharmacology, toxicology, and pharmacokinetics[J]. J Ethnopharmacol, 2025, 353: 120365. DOI: 10.1016/j.jep.2025.120365.

[29] Zhi L E, Li S, Feng Y, et al. Effect of corticosteroid-based combination therapy on sudden deafness: a retrospective study[J]. Am J Otolaryngol, 2025, 46(5): 104666. DOI: 10.1016/j.amjoto.2025.104666.

[30] Aliyeva A, Edizer D T . Efficacy of intratympanic steroid therapy for severe and profound sudden sensorineural hearing loss[J]. Am J Otolaryngol, 2024, 45(2): 104170. DOI: 10.1016/j.amjoto.2023.104170.

[31] 李菁, 苏涛, 张舜, 等 . 补阳还五汤联合巴曲酶对突发性耳聋患者中医证候、听力水平及血清 ET-1、CysC、MMP-2 的影响[J]. 广州中医药大学学报, 2023, 40(11): 2786-2791. DOI: 10.13359/j.cnki.gzxbtcm.2023.11.015.

[32] Li J, Su T, Zhang S, et al. Effects of Buyang Huanwu decoction combined with batroxobin on traditional Chinese medicine syndromes, hearing level and serum endothelin 1, cystatin C and matrix metalloproteinase 2 in patients with sudden deafness[J]. J Guangzhou Univ Tradit Chin Med, 2023, 40(11): 2786-2791. DOI: 10.13359/j.cnki.gzxbtcm.2023.11.015.

[33] Wang H H, Chen Y T, Chou S F, et al. Effect of the timing of hyperbaric oxygen therapy on the prognosis of patients with idiopathic sudden sensorineural hearing loss[J]. Biomedicines, 2023, 11(10): 2670. DOI: 10.3390/biomedicines11102670.

[34] 刘欢兴, 刘莉萍, 苏涛, 等 . 龙胆泻肝汤联合盐酸倍他司汀对突发性耳聋患者细胞免疫功能及血清 CRP 水平的影响[J]. 中国中医急症, 2022, 31(8): 1258-1261. DOI: 10.3969/j.issn.1004-745X.2022.08.036.

[35] Liu H X, Liu L P, Su T, et al. Effect of Longdan Xiegan decoction combined with betahistine hydrochloride on cellular immune function and serum CRP level in patients with sudden deafness[J]. J Emerg Tradit Chin Med, 2022, 31(8): 1258-1261. DOI: 10.3969/j.issn.1004-745X.2022.08.036.

[36] 李杰, 朱雍鸣, 顾晓春. 通窍活血汤联合耳后注射疗法治疗突发性耳聋的效果[J]. 辽宁中医杂志, 2026, 53(5): 87-90. DOI: 10.13192/j.issn.1000-1719.2026.05.022.

[37] Li J, Zhu Y M, Gu X C. Effectof Tongqiao Huoxue Tang combined with postauricular injection therapy in treatment of sudden deafness[J]. Liaoning J Tradit Chin Med, 2026, 53(5): 87-90. DOI: 10.13192/j.issn.1000-1719.2026.05.022.

[38] 田立俊, 董文荣, 马丽霞, 等 . 清肝理肺汤口服联合针灸疗法治疗听力平坦下降型突发性耳聋肝火上炎证的临床观察[J]. 山东医药, 2024, 64(35): 84-87. DOI: 10.3969/j.issn.1002-266X.2024.35.020.

[39] Tian L J, Dong W R, Ma L X, et al. Clinical observation on oral administration of Qinggan Lifei decoction combined with acupuncture and moxibustion in the treatment of sudden deafness with flat hearing loss and liver-fire syndrome[J]. Shandong Med J, 2024, 64(35): 84-87. DOI: 10.3969/j.issn.1002-266X.2024.35.020.

[40] 孔娟, 陈杰. 中西医结合治疗突发性耳聋伴耳鸣的效果分析[J]. 世界复合医学, 2021, 7(5): 66-68. DOI: 10.11966/j.issn.2095-994X.2021.07.05.20.

[41] Kong J, Chen J. The effect of integrated traditional Chinese and western medicine in treating sud-den deafness with tinnitus[J]. World J Complex Med, 2021, 7(5): 66-68. DOI: 10.11966/j.issn.2095-994X.2021.07.05.20.

[42] 胡璐璐, 闫智强, 尹兴红, 等 . 耳聋左慈丸联合甲泼尼龙治疗突发性耳聋的临床研究[J]. 现代药物与临床, 2019, 34(9): 2690-2693. DOI: 10.7501/j.issn.1674-5515.2019.09.025.

[43] Hu L L, Yan Z Q, Yin X H, et al. Clinical study on Erlong Zuoci pills combined with methylprednisolone in treatment of sudden deafness[J]. Drugs Clinic, 2019, 34(9): 2690-2693. DOI: 10.7501/j.issn.1674-5515.2019.09.025.

[44] 熊艳丽, 陈晓铤, 丁海玲. 六味地黄丸辅助治疗肝肾阴虚型耳聋的临床效果[J]. 临床合理用药, 2023, 16(7): 105-107. DOI: 10.15887/j.cnki.13-1389/r.2023.07.032.

[45] Xiong Y L, Chen X T, Ding H L. Clinical effect of Liuwei Dihuang pill in adjuvant treatment of deafness caused by Yin deficiency of liver and kidney[J]. Chin J Clin Ration Drug Use, 2023, 16(7): 105-107. DOI: 10.15887/j.cnki.13-1389/r.2023.07.032.

[46] 王琦, 谭智敏. 柴胡加龙骨牡蛎汤耳鼻喉科应用举隅[J]. 环球中医药, 2020, 13(1): 103-105. DOI: 10.3969/j.issn.1674-1749.2020.01.025.

[47] Wang Q, Tan Z M. Examples of application of Chaihu jialonggu Muli decoction in otolaryngology[J]. Glob Tradit Chin Med, 2020, 13(1): 103-105. DOI: 10.3969/j.issn.1674-1749.2020.01.025.

[48] 杨浩, 杨佳, 俞红五, 等 . 通督调神法针灸治疗耳鸣的疗效观察[J]. 上海针灸杂志, 2025, 44(6): 728-733. DOI: 10.13460/j.issn.1005-0957.2025.06.0728.

[49] Yang H, Yang J, Yu H W, et al. Clinical observation on acupuncture based on Tong Du Tiao Shen method for the treatment of tinnitus[J]. Shanghai J Acupunct Moxibustion, 2025, 44(6): 728-733. DOI: 10.13460/j.issn.1005-0957.2025.06.0728.

[50] 姚庆, 康浩然. 补肾通络开窍汤联合艾灸对肾虚血瘀型老年突发性耳聋的影响[J]. 中医研究, 2024, 37(12): 32-36. DOI: 10.3969/j.issn.1001-6910.2024.12.09.

[51] Yao Q, Kang H R. Effect of Bushen Tongluo Kaiqiao decoction combined with moxibustion on sudden deafness in the elderly with kidney deficiency and blood stasis[J]. Tradit Chin Med Res, 2024, 37(12): 32-36. DOI: 10.3969/j.issn.1001-6910.2024.12.09.

[52] 肖琪, 张丹慧, 刘蓬, 等 . 中医综合治疗难治性突聋的临床疗效观察[J]. 广州中医药大学学报, 2024, 41(6): 1486-1492. DOI: 10.13359/j.cnki.gzxbtcm.2024.06.017.

[53] Xiao Q, Zhang D H, Liu P, et al. Clinical observation on comprehensive traditional Chinese medicine therapy in treating refractory sudden hearing loss[J]. J Guangzhou Univ Tradit Chin Med, 2024, 41(6): 1486-1492. DOI: 10.13359/j.cnki.gzxbtcm.2024.06.017.

[54] Si X, Yu Z, Ren X, et al. Efficacy and safety of standardized Ginkgo biloba L. leaves extract as an adjuvant therapy for sudden sensorineural hearing loss: a systematic review and meta-analysis[J]. J Ethnopharmacol, 2022, 282: 114587. DOI: 10.1016/j.jep.2021.114587.

[55] Yuan C, Zhang H, Sun C, et al. Efficacy and safety of Ginkgo biloba extract as an adjuvant in the treatment of Chinese patients with sudden hearing loss: a meta-analysis [J]. Pharm Biol, 2023, 61(1): 610-620. DOI: 10.1080/13880209.2023.2190782.

[56] 张薇薇, 杜兆文. 地塞米松联合葛根素注射液对突发性耳聋患者听力水平及凝血功能的影响[J]. 慢性病学杂志, 2025, 26(1): 50-53. DOI: 10.16440/J.CNKI.1674-8166.2025.01.12.

[57] Zhang W W, Du Z W. Effect of dexamethasone combined with puerarin injection on hearing level and coagulation function of patients with sudden deafness[J]. Chronic Pathematology J, 2025, 26(1): 50-53. DOI: 10.16440/J.CNKI.1674-8166.2025.01.12.

[58] 王新茹, 李阳, 张佳佳, 等 . 基于听力曲线分型的突发性聋中医辨治思路[J]. 中医杂志, 2024, 65(11): 1126-1131. DOI: 10.13288/j.11-2166/r.2024.11.007.

[59] Wang X R, Li Y, Zhang J J, et al. Discussion on differentiation and treatment of sudden hearing loss by traditional Chinese medicine based on the classification of hearing curve[J]. J Tradit Chin Med, 2024, 65(11): 1126-1131. DOI: 10.13288/j.11-2166/r.2024.11.007.

[60] Ren W, Tao B, Deng H . The efficacy and safety of acupuncture in the treatment of sudden sensorineural hearing loss: a systematic review and meta-analysis[J]. Integr Med Res, 2024, 13(4): 101087. DOI: 10.1016/j.imr.2024.101087.

[61] 石安妮, 李阳, 张佳佳, 等 . 针刺介入时机对突发性聋患者疗效的影响[J]. 针刺研究, 2024, 49(6): 618-624. DOI: 10.13702/j.1000-0607.20230299.

[62] Shi A N, Li Y, Zhang J J, et al. Effect of acupuncture intervention time on the therapeutic effect in patients with sudden hearing loss[J]. Acupunct Res, 2024, 49(6): 618-624. DOI: 10.13702/j.1000-0607.20230299.

[63] Wang T, Qi L, Hao X, et al. Combination of electroacupuncture and medication for patients with tinnitus associated with idiopathic sudden sensorineural hearing loss: protocol for a prospective randomized controlled trial[J]. JMIR Res Protoc, 2025, 14: e69163. DOI: 10.2196/69163.

[64] 王倩滢, 雷艳, 潘小燕, 等 . 突发性耳聋耳鸣与特发性耳鸣的临床特征比较[J]. 中华耳科学杂志, 2024, 22(3): 367-371. DOI: 10.3969/j.issn.1672-2922.2024.03.004.

[65] Wang Q Y, Lei Y, Pan X Y, et al. A comparative study on clinical characteristics of tinnitus in sudden sensorineural hearing loss and idiopathic tinnitus[J]. Chin J Otol, 2024, 22(3): 367-371. DOI: 10.3969/j.issn.1672-2922.2024.03.004.

[66] 曾宇涵, 张雪婷, 李柏洁, 等 . 耳鸣疗效评价指标的研究进展[J]. 中华耳科学杂志, 2025, 23(1): 119-123. DOI: 10.3969/j.issn.1672-2922.2025.01.023.

[67] Zeng Y H, Zhang X T, Li B J, et al. Progress of research on index of tinnitus treatment efficacy[J]. Chin J Otol, 2025, 23(1): 119-123. DOI: 10.3969/j.issn.1672-2922.2025.01.023.

基金资助

广西科技计划项目(2020AC03004)

国家中医药管理局高水平中医药重点学科建设项目(zyyzdxk-2023166)