Postauricular injection of methylprednisolone sodium succinate as a salvage treatment for refractory sudden sensorineural hearing loss

Salvage therapy for refractory sudden sensorineural hearing loss (RSSNHL): a systematic review and network meta-analysis

OBJECTIVE

Approximately 30-50% of sudden sensorineural hearing loss (SSNHL) patients show poor response to systemic steroid therapy. Additionally, the most appropriate treatment for patients with refractory sudden sensorineural hearing loss (RSSNHL) is unknown. This study aimed to explore the best treatment for RSSNHL.

DESIGN

Using a frequentist contrast-based model and PRISMA guidelines, this study compared five salvage regimes: intratympanic injection of steroids (ITS), hyperbaric oxygen (HBO) therapy, post auricle steroid injection (PSI), ITS combined with HBO therapy, and continued systemic steroids.

STUDY SAMPLE

We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases for randomised controlled trials and cohort studies comparing treatment regimens for RSSNHL.

RESULTS

Compared with the control group (no additional treatment), PSI and ITS demonstrated significant improvements. The mean hearing gain was greater after PSI (11.1 dB [95% CI, 4.4-17.9]) than after ITS (7.7 dB [95% CI, 4.8-10.7]). When a restricted definition of RSSNHL was used, the ITS + HBO therapy showed the largest difference in improvement for pure tone average compared with the control group (14.5 dB [95% CI, 4.2-25.0]).

CONCLUSIONS

The administration of either PSI or ITS leads to the greatest therapeutic effect in patients with RSSNHL. However, a consensus on the definition of RSSNHL is needed.

Effects of Oral Steroids Combined with Postauricular Steroid Injection on Patients with Sudden Sensorineural Hearing Loss with Delaying Intervention: A Retrospective Analysis

Background

In the otology clinic, we often receive some sudden sensorineural hearing loss (SSNHL) patients accompanied by annoying tinnitus, who usually visited over three weeks after the onset. Nevertheless, due to the high treatment cost and relatively low cure rate, there are still great disputes about hospitalization or not for these patients. Aim: This study aimed to perform a retrospective analysis for analyzing the efficacy of treatment with oral steroids combined with postauricular steroid injection in patients with delaying effective treatment.

Material/Methods

A total of 157 eligible SSNHL patients with delaying effective treatment over three weeks were enrolled in this study. According to different treatment methods of oral steroids with or without postauricular steroid injection, these patients were divided into three groups: PO (prednisone oral) group, PSI (prednisone oral and postauricular steroid injection) group, and PII (prednisone oral and postauricular lidocaine injection) group. The changes in level of hearing, mean subjective tinnitus loudness, and side effects were analyzed in the three groups.

Results

Hearing improvement and tinnitus remission were all observed in three groups after treatment. Compared with PO and PII groups, those patients in PSI groups had more improvement in level of hearing and mean subjective tinnitus. The level of tinnitus loudness was statistically significantly correlated with the level of PTA both before treatment and after treatment.

Conclusion

Oral steroids combined with postauricular steroid injection should be employed for treatment of SSNHL patients with delaying effective treatment over three weeks.

Efficacy of intratympanic or postauricular subperiosteal corticosteroid injection combined with systemic corticosteroid in the treatment of sudden sensorineural hearing loss: A prospective randomized study

Objectives

This study aimed to investigate the efficacy and safety of intratympanic or postauricular subperiosteal glucocorticoid injection combined with systemic glucocorticoid in the treatment of sudden sensorineural hearing loss (SSNHL).

Methods

This study is a prospective randomized controlled study. This study included unilateral SSNHL patients who were hospitalized in our department between January 2020 and June 2021. Patients were randomly divided into three groups (groups A, B, and C). Patients in group A were treated with an intratympanic corticosteroid injection combined with systemic corticosteroid treatment, and patients in group B received a postauricular corticosteroid injection combined with systemic corticosteroid treatment. Patients in group C (control group) were treated with systemic corticosteroid alone. The case number of groups A, B, and C was 311, 375, and 369, respectively.

Results

There was no significant difference in gender distribution, the proportion of left and right affected ears, and the average interval from onset to treatment among the three groups (P > 0.05). However, there were significant differences in their average age, distribution of audiogram type, and hearing loss levels among them (P < 0.01). Our study shows that there was no significant difference in average hearing threshold improvement before and after treatment in the three groups (P > 0.05). Regarding the complications, in group A, 33 patients (10.6%) had a transient vertigo attack during tympanic injection, which lasted for ~1-3 min. In group B, 20 patients (6.43%) complained of pain at the injection site, which disappeared after 1-3 days. No other complications occurred in all the other patients.

Conclusion

The addition of intratympanic or postauricular corticosteroid to systemic steroids did not result in a significant effect on hearing recovery in SSNHL. No obvious complications occur in SSNHL patients treated with intratympanic injection or postauricular injection of corticosteroid.

Clinical trial registration

[chictr.org.cn], registration number: ChiCTR2100048762.

Is postauricular injection a systemic or a topical route for inner ear drug delivery?

The challenges associated with the blood-labyrinth barrier and unwanted systemic adverse effects severely impede the development of systemic drug administration for inner ear therapy. Previous studies have demonstrated that postauricular injection might be an alternative route for the systemic administration for inner ear therapy because it is minimally invasive and can achieve a high drug concentration in the inner ear. However, the in vivo effects remain unclear. This study aimed to compare differences in cisplatin-induced ototoxicity and systemic adverse effects between postauricular and systemic administration. Here, we compared the differences in hair cell loss, body weight change, and renal dysfunction (indicated by serum levels of blood urea nitrogen and creatinine) between these two routes of administration. The results showed that although postauricular injection of cisplatin might induce greater hair cell damage in the ipsilateral cochleae than that after intraperitoneal injection, significant hair cell damage in the contralateral cochleae as well as systemic adverse effects were also observed. Our results indicated that: (1) topical administration effects might occur in the ipsilateral inner ear following postauricular injection, and (2) systemic circulation might also be an underestimated route of drug delivery to the inner ear following postauricular injection. Overall, postauricular injection is a hybrid administration route, which simultaneously shares the features of topical and systemic administration for inner ear drug delivery.

Clinical Efficacy of Retroauricular Injection of Methylprednisolone Sodium Succinate in the Treatment of Sudden Deafness with Type 2 Diabetes

Background

The etiology of sudden deafness is still unclear. In recent years, people's life rhythm is getting faster and faster. Fatigue, environment, diet, psychology, and other factors have increased the morbidity rate of sudden deafness and improved the quality of life of patients. And work efficiency is greatly affected.

Aims

A study to investigate the clinical efficacy of postauricular injection of methylprednisolone sodium succinate in the treatment of sudden deafness with type 2 diabetes.

Materials and Methods

Sixty patients with sudden deafness who were treated in our hospital from January 2018 to October 2020 were selected as the subjects of this prospective study and divided into 30 cases each in the comparison group and the observation group according to the random number remainder grouping method. The comparison group was treated conventionally, and the observation group was treated with postauricular injection of methylprednisolone sodium succinate on the basis of the comparison group. Patients in the two groups were observed and compared on the 3rd, 6th, and 9th days after treatment with pure-tone hearing threshold checks and regular monitoring of blood glucose, blood rheology, and other indexes.

Results

On the 7th, 14th, and 30th days after treatment, the pure-tone audiometric thresholds of the two groups were gradually decreased, and the changes in the pure-tone audiometric thresholds in the observation group were greater than those in the control group. After lunch on the 6th day and after lunch on the 9th day, it was lower than that in the control group, and the difference was statistically significant (P < 0.05). 30 days after treatment, the blood viscosity, fibrin, and platelet aggregation rate of the observation group were significantly lower than those of the control group. After treatment, the clinical efficacy rate of the observation group was 96%, which was significantly higher than that of the control group, 80%, and the above differences were statistically significant (P < 0.05).

Conclusion

Treatment with postauricular injection of methylprednisolone sodium succinate has shown better therapeutic recovery in patients with sudden deafness, improved pure-tone hearing threshold, reduced risk of blood glucose elevation, and improved clinical outcomes for patients with sudden deafness, providing some reference for the treatment of patients with sudden deafness.