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Plontke SK, Meisner C, Agrawal S, Cayé-Thomasen P, Galbraith K, Mikulec AA, Parnes L, Premakumar Y, Reiber J, Schilder AG, Liebau A. Intratympanic corticosteroids for sudden sensorineural hearing loss. Cochrane Database Syst Rev 2022; 7:CD008080. [PMID: 35867413 PMCID: PMC9307133 DOI: 10.1002/14651858.cd008080.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Idiopathic sudden sensorineural hearing loss (ISSNHL) is common, and defined as a sudden decrease in sensorineural hearing sensitivity of unknown aetiology. Systemic corticosteroids are widely used, however their value remains unclear. Intratympanic injections of corticosteroids have become increasingly common in the treatment of ISSNHL. OBJECTIVES To assess the effects of intratympanic corticosteroids in people with ISSNHL. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; CENTRAL (2021, Issue 9); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials (search date 23 September 2021). SELECTION CRITERIA We included randomised controlled trials (RCTs) involving people with ISSNHL and follow-up of over a week. Intratympanic corticosteroids were given as primary or secondary treatment (after failure of systemic therapy). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods, including GRADE to assess the certainty of the evidence. Our primary outcome was change in hearing threshold with pure tone audiometry. Secondary outcomes included the proportion of people whose hearing improved, final hearing threshold, speech audiometry, frequency-specific hearing changes and adverse effects. MAIN RESULTS We included 30 studies, comprising 2133 analysed participants. Some studies had more than two treatment arms and were therefore relevant to several comparisons. Studies investigated intratympanic corticosteroids as either primary (initial) therapy or secondary (rescue) therapy after failure of initial treatment. 1. Intratympanic corticosteroids versus systemic corticosteroids as primary therapy We identified 16 studies (1108 participants). Intratympanic therapy may result in little to no improvement in the change in hearing threshold (mean difference (MD) -5.93 dB better, 95% confidence interval (CI) -7.61 to -4.26; 10 studies; 701 participants; low-certainty). We found little to no difference in the proportion of participants whose hearing was improved (risk ratio (RR) 1.04, 95% CI 0.97 to 1.12; 14 studies; 972 participants; moderate-certainty). Intratympanic therapy may result in little to no difference in the final hearing threshold (MD -3.31 dB, 95% CI -6.16 to -0.47; 7 studies; 516 participants; low-certainty). Intratympanic therapy may increase the number of people who experience vertigo or dizziness (RR 2.53, 95% CI 1.41 to 4.54; 1 study; 250 participants; low-certainty) and probably increases the number of people with ear pain (RR 15.68, 95% CI 6.22 to 39.49; 2 studies; 289 participants; moderate-certainty). It also resulted in persistent tympanic membrane perforation (range 0% to 3.9%; 3 studies; 359 participants; very low-certainty), vertigo/dizziness at the time of injection (1% to 21%, 3 studies; 197 participants; very low-certainty) and ear pain at the time of injection (10.5% to 27.1%; 2 studies; 289 participants; low-certainty). 2. Intratympanic plus systemic corticosteroids (combined therapy) versus systemic corticosteroids alone as primary therapy We identified 10 studies (788 participants). Combined therapy may have a small effect on the change in hearing threshold (MD -8.55 dB better, 95% CI -12.48 to -4.61; 6 studies; 435 participants; low-certainty). The evidence is very uncertain as to whether combined therapy changes the proportion of participants whose hearing is improved (RR 1.27, 95% CI 1.15 to 1.41; 10 studies; 788 participants; very low-certainty). Combined therapy may result in slightly lower (more favourable) final hearing thresholds but the evidence is very uncertain, and it is not clear whether the change would be important to patients (MD -9.11 dB, 95% CI -16.56 to -1.67; 3 studies; 194 participants; very low-certainty). Some adverse effects only occurred in those who received combined therapy. These included persistent tympanic membrane perforation (range 0% to 5.5%; 5 studies; 474 participants; very low-certainty), vertigo or dizziness at the time of injection (range 0% to 8.1%; 4 studies; 341 participants; very low-certainty) and ear pain at the time of injection (13.5%; 1 study; 73 participants; very low-certainty). 3. Intratympanic corticosteroids versus no treatment or placebo as secondary therapy We identified seven studies (279 participants). Intratympanic therapy may have a small effect on the change in hearing threshold (MD -9.07 dB better, 95% CI -11.47 to -6.66; 7 studies; 280 participants; low-certainty). Intratympanic therapy may result in a much higher proportion of participants whose hearing is improved (RR 5.55, 95% CI 2.89 to 10.68; 6 studies; 232 participants; low-certainty). Intratympanic therapy may result in lower (more favourable) final hearing thresholds (MD -11.09 dB, 95% CI -17.46 to -4.72; 5 studies; 203 participants; low-certainty). Some adverse effects only occurred in those who received intratympanic injection. These included persistent tympanic membrane perforation (range 0% to 4.2%; 5 studies; 185 participants; very low-certainty), vertigo or dizziness at the time of injection (range 6.7% to 33%; 3 studies; 128 participants; very low-certainty) and ear pain at the time of injection (0%; 1 study; 44 participants; very low-certainty). 4. Intratympanic plus systemic corticosteroids (combined therapy) versus systemic corticosteroids alone as secondary therapy We identified one study with 76 participants. Change in hearing threshold was not reported. Combined therapy may result in a higher proportion with hearing improvement, but the evidence is very uncertain (RR 2.24, 95% CI 1.10 to 4.55; very low-certainty). Adverse effects were poorly reported with only data for persistent tympanic membrane perforation (rate 8.1%, very low-certainty). AUTHORS' CONCLUSIONS Most of the evidence in this review is low- or very low-certainty, therefore it is likely that further studies may change our conclusions. For primary therapy, intratympanic corticosteroids may have little or no effect compared with systemic corticosteroids. There may be a slight benefit from combined treatment when compared with systemic treatment alone, but the evidence is uncertain. For secondary therapy, there is low-certainty evidence that intratympanic corticosteroids, when compared to no treatment or placebo, may result in a much higher proportion of participants whose hearing is improved, but may only have a small effect on the change in hearing threshold. It is very uncertain whether there is additional benefit from combined treatment over systemic steroids alone. Although adverse effects were poorly reported, the different risk profiles of intratympanic treatment (including tympanic membrane perforation, pain and dizziness/vertigo) and systemic treatment (for example, blood glucose problems) should be considered when selecting appropriate treatment.
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Affiliation(s)
- Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christoph Meisner
- Robert Bosch Society for Medical Research, Robert Bosch Hospital, Stuttgart, Germany
| | - Sumit Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology, Head and Neck Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Anthony A Mikulec
- Department of Otolaryngology, St. Louis University, St Louis, Missouri, USA
| | - Lorne Parnes
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada
| | | | - Julia Reiber
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anne Gm Schilder
- evidENT, Ear Institute, University College London, London, UK
- Julius Center for Health Sciences and Primary Care & Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Arne Liebau
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Update on the Management of Idiopathic Sudden Sensorineural Hearing Loss. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00414-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Garov EV, E Garova E, Pryakhina MA. [Corticosteroids for acute sensorineural hearing loss treatment. The contemporary state of problem. Literature review. Part 1]. Vestn Otorinolaringol 2022; 87:51-56. [PMID: 35818946 DOI: 10.17116/otorino20228703151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article presents modern literary data relating to the expediency of the purpose of glucocorticosteroids in sudden sensorineural hearing loss (SSHL) of various genes. In detail, the radar molecular mechanisms and the anatomo-physiological features of the exposure to the inner ear, side effects, the introduction methods, their comparative efficacy and modern schemes of the SSHL.
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Affiliation(s)
- E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E E Garova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Pryakhina
- Pirogov Russian National Research Medical University, Moscow, Russia
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Kunelskaya NL, Garov EV, Garova EE, Yanyushkina ES, Nikitkina YY, Manaenkova EA, Pryakhina MA, Kovtun OV. [Glucocorticosteroids in the treatment of acute neurosensory hearing loss. The current state of the problem. Part 2]. Vestn Otorinolaringol 2022; 87:70-74. [PMID: 36404694 DOI: 10.17116/otorino20228705170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Modern literature data are presented on the choice of a drug for hormonal therapy in acute neurosensory hearing loss of various origins, the doses used for systemic therapy, the features and methods of intratympanic administration of glucocorticosteroids, and the evaluation of the effectiveness of treatment with this group of drugs.
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Affiliation(s)
- N L Kunelskaya
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
- Russian National Medical Research University N.I. Pirogova, Moscow, Russia
| | - E V Garov
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
- Russian National Medical Research University N.I. Pirogova, Moscow, Russia
| | - E E Garova
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - E S Yanyushkina
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - Ya Yu Nikitkina
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - E A Manaenkova
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - M A Pryakhina
- Russian National Medical Research University N.I. Pirogova, Moscow, Russia
| | - O V Kovtun
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
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Singh A, Kumar Irugu DV. Sudden sensorineural hearing loss - A contemporary review of management issues. J Otol 2020; 15:67-73. [PMID: 32440269 PMCID: PMC7231990 DOI: 10.1016/j.joto.2019.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 01/24/2023] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is an enigmatic entity, with obscure pathophysiology and debatable efficacy of the treatment agents used. An underlying cause is identified in only 10-15% of cases. The management of the remaining patients, classified as 'idiopathic', is empirical, and is conventionally with systemic steroids, vasodilator therapy, rheological agents, and antioxidants, to list a few amongst the host of the agents employed for the treatment. The availability of conflicting outcomes and lack of conclusive evidence has resulted in the propagation of consensus-based treatment protocols. In the present review, we discuss the various controversial issues and newer developments in the management of idiopathic SSNHL. The current review aims to present a narrative outlook of the updated evidence base available from PUBMED, augmented with relevant designated publications.
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Affiliation(s)
- Anup Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta- the Medicity, Gurugram, Haryana, India
| | - David Victor Kumar Irugu
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Hearing Changes After Intratympanically Applied Steroids for Primary Therapy of Sudden Hearing Loss: A Meta-analysis Using Mathematical Simulations of Drug Delivery Protocols. Otol Neurotol 2017; 38:19-30. [PMID: 27779563 DOI: 10.1097/mao.0000000000001254] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Controlled and uncontrolled studies with primary intratympanic or combined intratympanic and systemic application of glucocorticosteroids for idiopathic sudden hearing loss were analyzed by means of a meta-analysis in an attempt to establish optimal local drug delivery protocols. STUDY DESIGN A total of 25 studies with 28 treatment groups between January 2000 and June 2014 were selected that adequately described drug delivery protocols. Cochlear drug levels were calculated by a validated computer model of drug dispersion in the inner ear fluids based on the concentration and volume of glucocorticoids applied, the time the drug remained in the middle ear, and the specific timing of injections. Various factors were compared with hearing outcome, including baseline data, individual parameters of the application protocols, calculated peak concentration (Cmax), and total dose (area under the curve). RESULTS There was no dependence of hearing outcome on individual parameters of the application protocol, Cmax, or area under the curve. Final hearing threshold was notably independent of delay of treatment. CONCLUSION During primary intratympanic or combined steroid therapy of idiopathic sudden hearing loss, the tendency toward early treatment having a positive effect on hearing improvement is thought to be a "sham effect," likely related to spontaneous recovery. Change in pure-tone average may not be an adequate outcome parameter to assess effectiveness of the intervention, as it depends on the degree of initial hearing loss. Final pure-tone average provides a better alternative.
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PARDAL-REFOYO JL. Evidencia y recomendación. ¿Es eficaz el corticoide intratimpánico como tratamiento de la sordera súbita? REVISTA ORL 2016. [DOI: 10.14201/orl201672.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lamm H, Müller‐Kortkamp C, Warnecke A, Pohl F, Paasche G, Lenarz T, Stolle SRO. Concurrent hyperbaric oxygen therapy and intratympanic steroid application as salvage therapy after severe sudden sensorineural hearing loss. Clin Case Rep 2016; 4:287-93. [PMID: 27014454 PMCID: PMC4771854 DOI: 10.1002/ccr3.510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 11/19/2015] [Accepted: 01/14/2016] [Indexed: 11/07/2022] Open
Abstract
Concurrent hyperbaric oxygen therapy (HBOT) and intratympanic steroid application (ITS) are beneficial as salvage therapy for therapy‐refractory sudden sensorineural hearing loss (SSNHL). The findings encourage further research on the treatment of noise‐induced and idiopathic SSNHL with concurrent use of HBOT and ITS respecting also patients with long‐term or therapy‐refractory SSNHL.
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Affiliation(s)
- Hans Lamm
- Department of OtorhinolaryngologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Claus Müller‐Kortkamp
- Private Practice for OtorhinolaryngologyInstitute of Hyperbaric MedicineSeilerstr. 7‐9Hannover29614Germany
| | - Athanasia Warnecke
- Department of OtorhinolaryngologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
- Hearing 4 allCluster of ExcellenceHannoverGermany
| | - Friederike Pohl
- Department of OtorhinolaryngologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Gerrit Paasche
- Department of OtorhinolaryngologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
- Hearing 4 allCluster of ExcellenceHannoverGermany
| | - Thomas Lenarz
- Department of OtorhinolaryngologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
- Hearing 4 allCluster of ExcellenceHannoverGermany
| | - Stefan R. O. Stolle
- Department of OtorhinolaryngologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
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Lawrence R, Thevasagayam R. Controversies in the management of sudden sensorineural hearing loss: an evidence-based review. Clin Otolaryngol 2016; 40:176-82. [PMID: 25521864 DOI: 10.1111/coa.12363] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sudden sensorineural hearing loss (SSNHL) is considered an otological emergency. It may present as an isolated condition or be the presenting feature of a systemic disease process. Idiopathic sudden sensorineural hearing loss (ISSNHL) is diagnosed when an underlying cause or condition cannot be identified. OBJECTIVE OF REVIEW To review the current literature on SSNHL and propose a treatment algorithm based on the highest quality evidence. SEARCH STRATEGY AND TYPE OF REVIEW An evidence-based literature review using medline (search terms 'sudden sensorineural hearing loss' and 'acute sensorineural hearing loss'). RESULTS (i) Baseline Investigations: All patients should be assessed with a thorough history and examination. This should include a pure tone audiogram (PTA) where possible. Baseline and targeted laboratory tests should be carried out to diagnose specific conditions. (ii) Imaging: MRI should be carried out in all cases of ISSNHL. If MRI imaging is contraindicated either CT or auditory brainstem response (ABR) testing should be performed. (iii) Medical Management: If a specific cause for a SSNHL is found, the patient should be managed accordingly. If idiopathic in nature, patients may be offered a course of oral steroid. If systemic steroids are contraindicated and/or there is no improvement with initial oral therapy, intratympanic steroids (IT) as either primary or salvage therapy may be considered. (iv) Further Management: There is no evidence to support the routine use of antiviral therapy. The cost, limited availability and lack of strong evidence for hyperbaric oxygen therapy (HBOT) make it impractical at present. Due to the variability in the vasodilator and vasoactive agents used, there is insufficient evidence to support the routine use of these agents. Consideration should be given to both temporary and permanent hearing amplification when required. CONCLUSIONS SSNHL is an important condition that can have a significant impact on quality of life. Some patients respond spontaneously without intervention; however, evidence tells us that certain interventions such as corticosteroid treatment may improve outcomes. Further high-quality research is required. Meanwhile, an interim indicative treatment algorithm for SSNHL based on the current best evidence available is outlined.
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Affiliation(s)
- R Lawrence
- Sheffield Children's Hospital, Western Bank, Sheffield, UK
| | - R Thevasagayam
- Sheffield Children's Hospital, Western Bank, Sheffield, UK
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Syed MI. Comment on: Controversies in the management of sudden sensorineural hearing loss (SSNHL): an evidence based review. Clin Otolaryngol 2015; 40:293-4. [PMID: 25967888 DOI: 10.1111/coa.12399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- M I Syed
- Otology and Skull Base Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK.
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Kawano T, Matsuura M, Ishitoya J, Oridate N. [Efficacy of intratympanic steroid treatment for idiopathic sudden sensorineural hearing loss after failure of intravenous steroid treatment]. NIHON JIBIINKOKA GAKKAI KAIHO 2014; 117:802-8. [PMID: 25102738 DOI: 10.3950/jibiinkoka.117.802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study investigated the efficacy of intratympanic steroid (ITS) therapy as a salvage treatment for idiopathic sudden sensorineural hearing loss after failure of intravenous steroid (IVS) therapy. Systemic steroid therapy is the only standard drug therapy. However, ethically, we could not simply compare ITS with IVS. Conventionally, we have treated idiopahic sudden sensorineural hearing loss patients after failure of systemic steroid therapy with the double combined therapy IVS and hyperbaric oxygen (HBO), as the salvage modality. We examined the effect of ITS by adding it to the double combined therapy with IVS and HBO. Retrospectively, we clinically examined the effect of double combined therapy with IVS and HBO (A group) for 31 patients (12 men and 19 women) (median age: 54 years) with sudden hearing loss after failure of systemic steroid therapy between June, 2003 and July, 2010. Prospectively, we also examined clinically the effect of triple combined therapy with IVS and HBO, ITS (B group) for 29 patients (17 men and 12 women) (median age: 51 years) with sudden hearing loss after failure of systemic steroid therapy between August, 2010 and April, 2012. In the examination of patients treated within 30 days from the onset, one patient (3.2%) demonstrated remarkable recovery, 6 patients (19.4%) demonstrated mild recovery, while no change was noted in 24 patients (77.4%) in the A group. In the B group, 5 patients (17.2%) demonstrated complete recovery, 3 patients (10.3%) demonstrated remarkable recovery, mild recovery was seen in 14 patients (48.3%), and the remaining 7 patients (24.1%) showed no change. There was a significant difference (p < 0.05) between the A group and the B group. Furthermore, the hearing improvement in group B in five pure tone average was significantly better than in the group A (p < 0.05). We concluded that the B group demonstrated better hearing improvement than the A group. Therefore, ITS could be effective for idiopathic sudden sensorineural hearing loss patients after failure of systemic steroid therapy.
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Crane RA, Camilon M, Nguyen S, Meyer TA. Steroids for treatment of sudden sensorineural hearing loss: A meta-analysis of randomized controlled trials. Laryngoscope 2014; 125:209-17. [DOI: 10.1002/lary.24834] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Ryan A. Crane
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati; Cincinnati Ohio
| | - Marc Camilon
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Shaun Nguyen
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Ted A. Meyer
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
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Trune DR, Canlon B. Corticosteroid therapy for hearing and balance disorders. Anat Rec (Hoboken) 2012; 295:1928-43. [PMID: 23044978 PMCID: PMC3999710 DOI: 10.1002/ar.22576] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 12/20/2022]
Abstract
This review addresses the current status of steroid therapies for hearing and vestibular disorders and how certain misconceptions may be undermining the efficacy in restoring normal ear function, both experimentally and clinically. Specific misconceptions addressed are that steroid therapy is not effective, steroid-responsive hearing loss proves an underlying inflammatory problem in the ear, and steroids only have application to the hearing disorders listed below. Glucocorticoid therapy for hearing and balance disorders has been employed for over 60 years. It is recommended in cases of sudden hearing loss, Meniére's disease, immune-mediated hearing loss, and any vestibular dysfunction suspected of having an inflammatory etiology. The predominant steroids employed today are dexamethasone, prednisone, prednisolone, and methylprednisolone. Despite years of use, little is known of the steroid responsive mechanisms in the ear that are influenced by glucocorticoid therapy. Furthermore, meta-analyses and clinical study reviews occasionally question whether steroids offer any benefit at all. Foremost in the minds of clinicians is the immune suppression and anti-inflammatory functions of steroids because of their efficacy for autoimmune hearing loss. However, glucocorticoids have a strong binding affinity for the mineralocorticoid (aldosterone) and glucocorticoid receptors, both of which are prominent in the ear. Because the auditory and vestibular end organs require tightly regulated endolymph and perilymph fluids, this ion homeostasis role of the mineralocorticoid receptor cannot be overlooked in both normal and pathologic functions of the ear. The function of the glucocorticoid receptor is to provide anti-inflammatory and antiapoptotic signals by mediating survival factors.
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Affiliation(s)
- Dennis R Trune
- Oregon Hearing Research Center, Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon 97239-3098, USA.
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