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Oussoren FK, Schermer TR, Horn LR, van Leeuwen RB, Bruintjes TD. Assessing risk of stroke after idiopathic sudden sensorineural hearing loss using data from general practice. Sci Rep 2024; 14:10026. [PMID: 38693206 PMCID: PMC11063204 DOI: 10.1038/s41598-024-59934-3] [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] [Received: 02/06/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024] Open
Abstract
The cause of sudden sensorineural hearing loss (SSNHL) remains unknown in a significant number of cases, but vascular involvement in its pathophysiology has been proposed. Our study aimed to assess the incidence of stroke following idiopathic SSNHL (iSSNHL) and to evaluate associated cardiovascular risk factors and comorbidities. We extracted electronic medical record data from iSSNHL patients aged ≥ 50 years retrospectively from 84 general practices. Patients were matched for age, sex and general practice in a 1:4 ratio to controls. Primary outcome was the 5-years stroke risk following iSSNHL diagnosis. 480 iSSNHL cases could be matched to 1911 controls. The hazard ratio for iSSNHL compared with controls was 1.25 (95%CI 0.50-3.27; P = 0.646) for CVA (cerebrovascular accident) alone and 0.92 (95% CI 0.50-1.71; P = 0.804) for CVA and TIA (transient ischemic attack) combined. The hazard ratio for the interaction term between iSSNHL and age ≥ 60 years was 4.84 (95% CI 1.02-23.05; P = 0.048) for CVA and TIA combined. Patients with iSSNHL used antihypertensives and beta-blocking agents more frequently than controls (P = 0.006 and P = 0.022, respectively). In conclusion, no overall significant difference in the risk of stroke was observed, but the hazard ratio for stroke increased in iSSNHL patients aged 60 and older, suggesting potential vascular involvement in older subjects presenting with sudden sensorineural hearing loss.
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Affiliation(s)
- Fieke K Oussoren
- Department of Otorhinolaryngology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
- Apeldoorn Dizziness Centre, Gelre Hospitals, Apeldoorn, The Netherlands.
| | - Tjard R Schermer
- Apeldoorn Dizziness Centre, Gelre Hospitals, Apeldoorn, The Netherlands.
- Department of Primary and Community Care, Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Leonie R Horn
- Department of Primary and Community Care, Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Tjasse D Bruintjes
- Department of Otorhinolaryngology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Apeldoorn Dizziness Centre, Gelre Hospitals, Apeldoorn, The Netherlands
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Lee JW, Kim H, Kong SK, Kim J, Choi SW, Oh SJ. The Effectiveness of Salvage Hyperbaric Oxygen Therapy Following Combined Steroid Therapy for Refractory Sudden Sensorineural Hearing Loss. Ann Otol Rhinol Laryngol 2024; 133:400-405. [PMID: 38197374 DOI: 10.1177/00034894231222692] [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: 01/11/2024]
Abstract
OBJECTIVE Hyperbaric oxygen therapy (HBOT) is an accepted treatment option for sudden sensorineural hearing loss (SSNHL), but it is still recommended in combination with corticosteroids. We investigated the efficacy of salvage HBOT in refractory SSNHL that does not respond to corticosteroid combination therapy. METHODS Eighty-four patients were included, who had unilateral SSNHL with an improvement of pure-tone average (PTA) less than 10 dB after using intratympanic plus systemic corticosteroids (combined therapy) as the initial therapy. The control group (n = 66) received no further treatment, and the HBOT group (n = 18) received additional treatment with HBOT (10 sessions in total with 2.5 atmospheres absolute for 1 hour). RESULTS No differences in PTA or WDS were found between the 2 groups. However, the mean hearing gain in the HBOT group (16.8 ± 4.49 dB) was significantly higher than that in the control group (4.45 ± 1.03 dB) (P = .015). The proportion of patients with hearing recovery (hearing gain of 10 dB or more) after treatment was significantly higher in HBOT group (38.9%) than in the control group (10.6%). CONCLUSIONS In patients with refractory SSNHL after steroid combined therapy, salvage HBOT showed a significant effect on hearing gain and recovery rate.
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Affiliation(s)
- Jung Woo Lee
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hwabin Kim
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Busan, Republic of Korea
| | - Jia Kim
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sung-Won Choi
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Busan, Republic of Korea
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Hoch S, Kremper L, Rudhart SA, Stuck BA. [Role of intratympanic glucocorticoid treatment in sudden hearing loss]. HNO 2024; 72:291-302. [PMID: 38351342 DOI: 10.1007/s00106-024-01424-z] [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] [Accepted: 01/08/2024] [Indexed: 03/24/2024]
Abstract
Idiopathic sudden sensorineural hearing loss (ISSNHL) is one of the most common diseases in otolaryngology. Its etiology remains unknown. Furthermore, there is only a low level of evidence for the efficacy of established treatment modalities. In addition to systemic glucocorticoids, intratympanic corticosteroid treatment (ICT) has become increasingly important for treatment of ISSNHL. Different application strategies and treatment regimens have been described; however, uniform standards do not yet exist. ICT may be used for primary treatment as well as salvage therapy. Current data from meta-analyses show no benefit of intratympanic versus systemic primary therapy for sudden hearing loss (moderate evidence) but suggest a benefit of intratympanic secondary treatment over no treatment or placebo (high effect size, low evidence). Regarding combination of systemic and local glucocorticoid therapy in primary treatment of hearing loss, there may be a small benefit over systemic treatment alone (low effect size, low evidence).
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Affiliation(s)
- Stephan Hoch
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
| | - Luisa Kremper
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Stefan Alexander Rudhart
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Boris Alexander Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
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Lin CY, Chang CH, Chang CJ, Ko JY, Wu SY, Kuo PH. Salvage therapy for refractory sudden sensorineural hearing loss (RSSNHL): a systematic review and network meta-analysis. Int J Audiol 2024:1-10. [PMID: 38251843 DOI: 10.1080/14992027.2024.2303037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
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.
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Affiliation(s)
- Chuan-Yi Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Otorhinolaryngology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Chia-Hao Chang
- Department of Otorhinolaryngology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Chen-Jung Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otorhinolaryngology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health and Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Liang S, Li Y, Guo Z, Lu M, Li X, Xu J, Chen W, Gao J, Yi H. Modified intratympanic steroid therapy for sudden sensorineural hearing loss via tympanic tube and gelfoam as a salvage treatment. J Otol 2024; 19:19-23. [PMID: 38313760 PMCID: PMC10837542 DOI: 10.1016/j.joto.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 02/06/2024] Open
Abstract
Background Sudden sensorineural hearing loss (SSNHL) is a prevalent emergency in ear, nose, and throat practice. Previous studies have demonstrated that intratympanic steroid therapy (IST) can serve as a salvage treatment for SSNHL after the failure of systemic steroid therapy (SST). Objective This study aimed to analyze the efficacy of modified IST involving the insertion of a tympanic tube and gelfoam as a salvage treatment for patients with SSNHL, and to explore its associated factors. Methods Totally, 74 patients who were aged 22-81 years with SSNHL were enrolled and allocated to either the control group (n = 25) or the treatment group (n = 49) based on their treatment modalities. All patients received SST lasting for at least 7 days. Subsequently, patients in the treatment group, after SST failure, underwent IST twice a week for 2-6 weeks, while the control group did not. Efficacy was assessed by the improvement in pure tone average at the affected frequency at the beginning and end of IST. Results Hearing improvement in all patients after IST in the treatment group was 9.71 ± 14.84 dB, with significant improvement at affected frequencies (250-8000 Hz) compared with the control group (P < 0.05). The findings indicated the duration from the onset of SSNHL to the beginning of IST as an independent factor for pure tone average improvement after treatment (P = 0.002), whereas age, duration of SST, and time of IST were not (P > 0.05). Conclusion The modified IST was demonstrated to be a safe and effective method as a salvage treatment for SSNHL. This study explored the efficacy of a modified IST approach, incorporating the utilization of tympanic tubes and gelfoam as key components. The findings underscore the advantages of gelfoam as a strategic drug carrier placed in the round window niche. By minimizing drug loss, extending action time, and increasing perilymph concentration, gelfoam enhances the therapeutic impact of IST, contributing to improved hearing outcomes in patients with SSNHL.
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Affiliation(s)
- Sichao Liang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Yunshuo Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Zhenping Guo
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Manlin Lu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Xin Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Jia Xu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Wenjing Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Juanjuan Gao
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Haijin Yi
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
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Chen N, Karpeta N, Ma X, Ning X, Liu X, Song J, Jiang Z, Ma X, Liu X, Zhong S, Sun Q, Liu J, Chen G, Duan M, Yu L. Diagnosis, differential diagnosis, and treatment for sudden sensorineural hearing loss: Current otolaryngology practices in China. Front Neurol 2023; 14:1121324. [PMID: 36908605 PMCID: PMC9995834 DOI: 10.3389/fneur.2023.1121324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Although sudden sensorineural hearing loss (SSNHL) has been attempted to be understood for 70 years, diagnosis and treatment strategies still have strong heterogeneity worldwide, which are reflected in the guidelines issued by countries and the clinical practice of otolaryngologists. Methods Questionnaires were sent to registered otolaryngologists nationwide via an online questionnaire system. We investigated the current views and clinical practices of otolaryngologists in mainland China about the diagnosis, examination, and treatment strategies of SSNHL. Results Most otolaryngologists supported diagnostic classification via audiograms. Regional economic situation and hospital grade affected application strategies for differential diagnosis. Regarding corticosteroid therapy, 54.9% of respondents opted to discontinue the drug 5 days after systemic administration. Both intratympanic therapy and post-auricular injections were selected by more than half of the respondents as initial and salvage treatments. Discussion Chinese otolaryngologists exhibit heterogeneity in clinical practices for SSNHL, including distinct approaches to combination therapy and local application of steroids. This study pointed out Chinese doctors' similarities, differences, and unique strategies in diagnosing and treating SSNHL and analyzed the possible reasons to help the world understand the current otolaryngology practices in China.
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Affiliation(s)
- Nishan Chen
- Department of Otolaryngology, Head, and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Niki Karpeta
- Department of Otolaryngology, Head, and Neck Surgery, Karolinska University, Solna, Sweden
| | - Xin Ma
- Department of Otolaryngology, Head, and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Xianhui Ning
- Department of Otolaryngology, Head, and Neck Surgery, Zhongshan Hospital, Shanghai, China
| | - Xiaoling Liu
- Department of Otolaryngology, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia, China
| | - Jijun Song
- Department of Otolaryngology, Zhoukou Central Hospital, Zhoukou, China
| | - Zigang Jiang
- Department of Otolaryngology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiulan Ma
- Department of Otolaryngology, Head, and Neck Surgery, Sheng Jing Hospital, Shenyang, China
| | - Xiuli Liu
- Department of Otolaryngology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shixun Zhong
- Department of Otolaryngology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Sun
- Department of Otolaryngology, Head, and Neck Surgery, Third Medical Center of PLA General Hospital, Beijing, China
| | - Jun Liu
- Department of Otolaryngology, Head, and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Ganggang Chen
- Department of Otolaryngology, Head, and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Maoli Duan
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Lisheng Yu
- Department of Otolaryngology, Head, and Neck Surgery, Peking University People's Hospital, Beijing, China
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Cui Y, Liang W, Li M, Zhao Z, Jiang X, Zhao B, Xu Z, Mang J. Better late than never: initial experience of intra-arterial pulsed-urokinase-injection as a salvage therapy for refractory sudden sensorineural hearing loss. Interv Neuroradiol 2022; 28:575-580. [PMID: 34726104 PMCID: PMC9511619 DOI: 10.1177/15910199211056819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Cochlear vascular micro-thrombosis has been hypothesized as one of the pathogenic mechanisms for sudden sensorineural hearing loss (SSNHL) refractory to regular management. This study aimed to evaluate the feasibility and safety of intra-arterial pulsed-injection urokinase (IAPU) as a salvage therapy for SSNHL after the failure of conventional therapy. METHODS We retrospectively reviewed our patient database to identify refractory SSNHL patients between November 2017 and July 2020. Study outcomes before and after the IAPU therapy were compared between IAPU and conventional therapy groups. RESULTS Sixty-seven moderate-profound SSNHL patients (29 in IAUP group, 38 in control group) were included in this study. Compared to the control group, patients in the IAPU group showed more significant improvement in pure tone average (PTA) (34.2 ± 23.5 vs. 10.7 ± 13.1, p < 0.001) and degree of hearing recovery (total: 20.7% vs. 5.3%, partial: 24.1% vs. 10.5%, mild: 27.6% vs. 13.2% and non: 27.6% vs. 71.1%) 2 weeks after admission. In the IAPU group, a significant improvement of PTA (86.6 ± 11.5 vs. 54.6 ± 20.1 dB, p < 0.005) was observed on the first day after IAPU treatment. CONCLUSION In carefully selected SSNHL cases with a highly suspected vascular origin, IAPU is a safe and effective therapy when conventional treatments have failed. Despite the encouraging findings of our work, large studies are needed to better investigate the strengths and limitations of this salvage therapy.
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Affiliation(s)
- Yang Cui
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Wenzhao Liang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Mengxue Li
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Zhongyu Zhao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xinzhao Jiang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Bingyang Zhao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Zhongxin Xu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jing Mang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Probability of clinically significant hearing recovery following salvage intratympanic steroids for sudden sensorineural hearing loss in the ‘real world’. The Journal of Laryngology & Otology 2022; 136:831-838. [DOI: 10.1017/s0022215122001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveThis study aimed to determine the probability of hearing recovery in patients with idiopathic sudden sensorineural hearing loss following salvage intratympanic steroidsMethodA retrospective review of all patients receiving salvage intratympanic steroid injections for idiopathic sudden sensorineural hearing loss was performed (January 2014 to December 2019). Twenty-two patients were identified, of whom 15 met inclusion criteria. Pre- and post-treatment audiograms were compared with the unaffected ear. Hearing recovery was categorised based on American Academy of Otolaryngology Head and Neck Surgery criteria.ResultsOnly 1 patient out of 15 (6.7 per cent) made a partial recovery, and the remainder were non-responders. The median duration of time between symptom onset and first salvage intratympanic steroid treatment was 52 days (range, 14–81 days). No adverse reactions were observed.Conclusion‘Real world’ patients with idiopathic sudden sensorineural hearing loss present differently to those in the literature. Sudden sensorineural hearing loss should be diagnosed with care and intratympanic steroid injections initiated early if considered appropriate. Patients should make an informed decision on treatment based on prognostic factors and local success rates.
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Nelson L, Swanson D, Borowiec E, Crossley J, Geng X, Cao X, Kim HJ, Hoa M. The Impact of Intratympanic Steroid Dosage on Hearing Recovery in Sudden Sensorineural Hearing Loss. Ann Otol Rhinol Laryngol 2022:34894221120125. [PMID: 35993281 DOI: 10.1177/00034894221120125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate how dexamethasone dosage impacts intratympanic steroid therapy (IST) for treatment of sudden sensorineural hearing loss (SSNHL). STUDY DESIGN Retrospective review. METHODS Inclusion criteria identified subjects who received IST between January 1, 2010 and June 1, 2020 for iSSNHL. Subjects with Meniere's disease, autoimmune inner ear disease, subjects who received injections of non-dexamethasone steroid formulations, and subjects with missing audiogram data were excluded. Subjects were stratified by dexamethasone dosage: low-dose (10 mg/ml) versus high-dose (24 mg/ml), time-to-treatment and oral corticosteroid use. Outcome measures included post-treatment improvement in 4-frequency pure tone average (4F-PTA [500, 1000, 2000,4000 Hz]), low- and high-frequency PTA (250-1000 Hz and 2000-8000 Hz, respectively). RESULTS Of the 55 included subjects (50.9% male, mean age 48.9 ± 16.4 years), 31 received high-dose while 24 received low-dose injections. 90.9% of subjects were treated with oral steroids prior to or during IST. No significant differences in hearing outcomes were observed between low- and high-dose cohorts or when stratifying by oral steroid use. Time-to-treatment analysis comparing ≤1 month (67.3%) versus >1 month (32.7%) groups demonstrated a significant improvement in post-treatment 4F-PTA (P = .01) in the ≤1 month group. CONCLUSIONS Hearing recovery was not significantly different between the 10 mg/ml versus 24 mg/ml doses of intratympanic dexamethasone, suggesting that steroid dose may not impact the efficacy of IST. A shorter time-to-treatment was observed to be favorable for hearing improvement.
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Affiliation(s)
- Lacey Nelson
- Georgetown University School of Medicine, Washington, DC, USA
| | - Daniel Swanson
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Jason Crossley
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - Xue Geng
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Xiao Cao
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Hung Jeffrey Kim
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - Michael Hoa
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC, USA
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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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Plontke SK, Girndt M, Meisner C, Böselt I, Ludwig-Kraus B, Richter M, Rahne T. Efficacy and safety of systemic, high-dose glucocorticoid therapy for idiopathic sudden sensorineural hearing loss : Study protocol for a three-armed, randomized, triple-blind, multicenter trial (HODOKORT). HNO 2022; 70:30-44. [PMID: 35725822 PMCID: PMC9208545 DOI: 10.1007/s00106-022-01184-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systemic glucocorticosteroids ("steroids") are widely used worldwide as a standard of care for primary therapy of idiopathic sudden sensorineural hearing loss (ISSHL). The German ISSHL guideline recommends high-dose steroids without evidence from randomized controlled trials (RCTs) and refers solely to retrospective cohort studies. This RCT aims to assess the efficacy (improvement in hearing) and safety (especially systemic side effects) of high-dose steroids versus standard of care (standard dose systemic steroids) for the treatment of unilateral ISSHL, when given as a primary therapy. METHODS The study is designed as a multicenter (approximately 40 centers), randomized, triple-blind, three-armed, parallel group, clinical trial with 312 adult patients. The interventions consist of 5 days of 250 mg/day intravenous prednisolone (intervention 1) + oral placebo, or 5 days of 40 mg/day oral dexamethasone (intervention 2) + intravenous placebo. The control intervention consists of 60 mg oral prednisolone for 5 days followed by five tapering doses + intravenous placebo. The primary efficacy endpoint is the change in hearing threshold in the three most affected contiguous frequencies between 0.25 and 8 kHz 1 month after ISSHL. Secondary endpoints include further measures of hearing improvement including speech audiometry, tinnitus, quality of life, blood pressure, and altered glucose tolerance. DISCUSSION There is an unmet medical need for an effective medical therapy of ISSHL. Although sensorineural hearing impairment can be partially compensated by hearing aids or cochlear implants (CI), generic hearing is better than using hearing aids or CIs. Since adverse effects of a short course of high-dose systemic corticosteroids have not been documented with good evidence, the trial will improve knowledge on possible side effects in the different treatment arms with a focus on hyperglycemia and hypertension. TRIAL REGISTRATION EudraCT (European Union Drug Regulating Authorities Clinical Trials Database) Nr. 2015-002602-36; Sponsor code: KKSH-127.
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Affiliation(s)
- Stefan K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Matthias Girndt
- Department of Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christoph Meisner
- Robert Bosch Society for Medical Research, Robert Bosch Hospital, Stuttgart, Germany
| | - Iris Böselt
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Michael Richter
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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13
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Devantier L, Callesen HE, Jensen LR, Mirian C, Ovesen T. Intratympanic corticosteroid as salvage therapy in treatment of idiopathic sudden sensorineural hearing loss: A systematic review and meta-analysis. Heliyon 2022; 8:e08955. [PMID: 35243076 PMCID: PMC8860923 DOI: 10.1016/j.heliyon.2022.e08955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 12/05/2022] Open
Abstract
Background The standard treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) constitutes of systemic oral corticosteroid. Although oral corticosteroid might revert the acute deafness, some patients with ISSNHL display a more treatment refractory course. For these patients, corticosteroid installed directly into the middle ear has become a more frequent treatment, due to the potential benefits of a high, local concentration compared to a systemic administration. As such, for patients being refractory to standard treatment, intratympanic injection of a high dosage of corticosteroid as salvage therapy may be beneficial. Objectives To evaluate the efficacy of intratympanic corticosteroid (ITC) as a salvage treatment of ISSNHL. Methods A systematic literature search was performed in relevant databases. Both randomized trials and observational studies were considered for inclusion. The risk of bias was evaluated using the Cochrane risk of bias tool (randomized trials) or ROBINS-I tool (observational studies). Meta-analysis was performed to investigate the improvement of PTA (dB) and number of patients displaying recovery following salvage ITC injections. Occurrence of serious side effects was investigated. Finally, the certainty of the evidence was evaluated using the GRADE approach. Results Eleven relevant studies were identified (4 randomized trials and 7 observational studies). Both observational and randomized trials showed that salvage ITC significantly increased the number of patients displaying recovery. No serious adverse events were identified in any of the included studies. The certainty of evidence ranged from moderate to very low, due to risk of bias, imprecision, and heterogeneity. Conclusion Collectively, our findings indicate that salvage ITC treatment may be a beneficial and safe treatment for patients with sudden hearing loss, who otherwise are refractory to standard treatment approaches. However, the evidence level indicates need for a cautious interpretation of especially the magnitude of effect and thus the extrapolation on how much the individual may improve from this treatment. Furthermore, it remains to be investigated whether treatment outcomes may vary across different patient groups presenting with ISSNHL. This potential variation in treatment response should be kept in mind, when counselling the patient. Trial registration number The protocol is registered in PROSPERO. Registration number: CRD42019130586.
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Affiliation(s)
- Louise Devantier
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Audiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Oto-Rhino-Laryngology, Regional Hospital Gødstrup, Herning, Denmark
- Corresponding author.
| | | | - Lasse Rehné Jensen
- Department of Oto-Rhino-Laryngology, Regional Hospital Gødstrup, Herning, Denmark
| | - Christian Mirian
- Department of Oto-Rhino-Laryngology, Regional Hospital Gødstrup, Herning, Denmark
| | - Therese Ovesen
- Department of Oto-Rhino-Laryngology, Regional Hospital Gødstrup, Herning, Denmark
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14
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Nelson L, Lovett B, Johns JD, Gu S, Choi D, Trune D, Hoa M. In silico Single-Cell Analysis of Steroid-Responsive Gene Targets in the Mammalian Cochlea. Front Neurol 2022; 12:818157. [PMID: 35145472 PMCID: PMC8821961 DOI: 10.3389/fneur.2021.818157] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundTreatment of many types of hearing instability in humans, including sudden sensorineural hearing loss, Meniere's disease, and autoimmune inner ear disease, rely heavily on the utilization of corticosteroids delivered both by oral and transtympanic routes. Despite this use, there is heterogeneity in the response to treatment with corticosteroids in humans with these diseases. The mechanisms by which corticosteroids exert their effect and the cell types in which they exert their effects in the inner ear remain poorly characterized. In this study, we localize steroid-responsive genes to cochlear cell types using previously published transcriptome datasets from the mammalian cochlea.MethodsSteroid-responsive genes were localized to specific cochlear cell types using existing transcriptome datasets from wild-type mammalian cochlea exposed to systemic and transtympanic steroids, as well as previously published single-cell and single-nucleus RNA-sequencing datasets from the mammalian cochlea. Gene ontology (GO) analysis of differentially expressed genes (DEGs) was performed using PANTHER to investigate cellular processes implicated in transtympanic vs. systemic steroid action in the cochlea.ResultsSteroid-responsive genes were localized to specific cell types and regions in the cochlea including the stria vascularis, organ of Corti, and spiral ganglion neurons (SGN). Analyses demonstrate differential prevalence of steroid-responsive genes. GO analysis demonstrated steroid-responsive DEGs in the SGN to be associated with angiogenesis, apoptosis, and cytokine-mediated anti-inflammatory pathways.ConclusionsSingle-cell and single-nucleus transcriptome datasets localize steroid-responsive genes to specific regions in the cochlea. Further study of these regionally-specific steroid-responsive genes may provide insight into the mechanisms of and clinical response to corticosteroids in diseases of hearing instability.
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Affiliation(s)
- Lacey Nelson
- Department of Otolaryngology–Head and Neck Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Braeden Lovett
- Department of Otolaryngology–Head and Neck Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - J. Dixon Johns
- Department of Otolaryngology–Head and Neck Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Shoujun Gu
- Auditory Development and Restoration Program, NIDCD Otolaryngology Surgeon-Scientist Program, Division of Intramural Research, NIDCD/NIH, Bethesda, MD, United States
| | - Dongseok Choi
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, United States
| | - Dennis Trune
- Department of Otolaryngology, Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Michael Hoa
- Department of Otolaryngology–Head and Neck Surgery, Georgetown University School of Medicine, Washington, DC, United States
- Auditory Development and Restoration Program, NIDCD Otolaryngology Surgeon-Scientist Program, Division of Intramural Research, NIDCD/NIH, Bethesda, MD, United States
- *Correspondence: Michael Hoa
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15
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Lei X, Feng Y, Xia L, Sun C. Hyperbaric Oxygen Therapy Versus Intratympanic Steroid for Salvage Treatment of Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis. Otol Neurotol 2021; 42:e980-e986. [PMID: 34172651 DOI: 10.1097/mao.0000000000003198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this meta-analysis is to compare the efficacy of hyperbaric oxygen therapy (HBOT) and intratympanic steroids (ITS) as salvage treatment for patients with refractory sudden sensorineural hearing loss (SSNHL). DATA SOURCES Electronic search was performed in the PubMed, Embase, Cochrane Library, CNKI, and Wan Fang databases to June 1, 2020. METHODS For each outcome measure, a forest plot was generated and a pooled relative risk (RR) or mean difference (MD) was calculated. Potential publication bias in the meta-analysis was assessed using funnel plot. RESULTS The numbers of cases with hearing improvements and pure tone averages (PTA) changes after salvage treatment were entered into the R software to calculate the pooled effect of HBOT compared with ITS. When pooling the results of the studies reporting the proportion of patients with hearing improvement, a fixed-effects model was used. We calculated the RR and found no significant difference when HBOT compared with ITS (RR = 1.09, 95% confidence interval [CI]: 0.83-1.42, p = 0.55). With respect to the PTA changes, a fixed-effects model was used. The improvement in the PTA (in dB) was calculated in MD and no significant difference was found between the two groups (MD = 0.55, 95% CI: -1.76-2.86, p = 0.64). CONCLUSION Both HBOT and ITS offer some benefits for refractory SSNHL patients, and there were no significant differences in hearing outcomes between the two modalities. Future RCTs that include large samples are needed to demonstrate superiority of one of the treatments.
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Affiliation(s)
- Xia Lei
- Affiliated Hospital of Jiangnan University
| | | | - Ling Xia
- Affiliated Hospital of Jiangnan University
| | - Changling Sun
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu province, China
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Kuo TC, Chao WC, Yang CH, Tsai MS, Tsai YT, Lee YC. Intratympanic steroid injection versus hyperbaric oxygen therapy in refractory sudden sensorineural hearing loss: a meta-analysis. Eur Arch Otorhinolaryngol 2021; 279:83-90. [PMID: 33751195 DOI: 10.1007/s00405-021-06616-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The present meta-analysis aims to compare the efficacy of intratympanic steroid (ITS) injection and hyperbaric oxygen (HBO) therapy as salvage treatments for refractory sudden sensorineural hearing loss (SSNHL). DATA SOURCES Comprehensive searches were performed in PubMed, EMBASE and the Cochrane Library from the date of the database inception to June 2020. All studies reporting the use of salvage ITS and HBO treatments in refractory SSNHL patients were included. Subsequently, the full texts of the eligible studies were evaluated. METHODS The quality and bias of the studies were assessed using the Newcastle-Ottawa Scale and Cochrane's risk of bias tools for nonrandomized and randomized studies, respectively. The data were analyzed using Comprehensive Meta-Analysis software (Version 3; Biostat, Englewood, NJ). RESULTS Three hundred and fourteen subjects in 3 observational studies and 1 randomized controlled trial met our inclusion criteria. The pooled results demonstrated that there were no significant differences in the mean posttreatment hearing gain between the ITS and HBO groups. The changes in word discrimination and hearing gain at 250, 500, 1000, 2000, 4000 and 8000 Hz were also comparable between the two salvage treatment groups. CONCLUSIONS The pooled results demonstrated that there were no significant differences in hearing improvements between salvage ITS injection and salvage HBO therapy after failed primary systemic steroid treatment in patients with SSNHL. However, spontaneous recovery could bias the treatment outcomes, and these results should be interpreted with caution. Clinicians may choose these salvage treatments according to personal experience and treatment availability. In cases in which specialized HBO facilities are difficult to access, salvage ITS injection can be provided with comparable responses.
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Affiliation(s)
- Tz-Ching Kuo
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chieh Chao
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist., Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Hui Yang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist., Keelung, 204, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Bai X, Chen S, Xu K, Jin Y, Niu X, Xie L, Qiu Y, Liu XZ, Sun Y. N-Acetylcysteine Combined With Dexamethasone Treatment Improves Sudden Sensorineural Hearing Loss and Attenuates Hair Cell Death Caused by ROS Stress. Front Cell Dev Biol 2021; 9:659486. [PMID: 33816510 PMCID: PMC8014036 DOI: 10.3389/fcell.2021.659486] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 12/16/2022] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is a common emergency in the world. Increasing evidence of imbalance of oxidant–antioxidant were found in SSNHL patients. Steroids combined with antioxidants may be a potential strategy for the treatment of SSNHL. In cochlear explant experiment, we found that N-acetylcysteine (NAC) combined with dexamethasone can effectively protect hair cells from oxidative stress when they were both at ineffective concentrations alone. A clinic trial was designed to explore whether oral NAC combined with intratympanic dexamethasone (ITD) as a salvage treatment has a better therapeutic effect. 41 patients with SSNHL were randomized to two groups. 23 patients in control group received ITD therapy alone, while 18 patient s in NAC group were treated with oral NAC and ITD. The patients were followed-up on day 1st (initiation of treatment) and day 14th. Overall, there was no statistical difference in final pure-tone threshold average (PTA) improvement between those two groups. However, a significant hearing gain at 8,000 Hz was observed in NAC group. Moreover, the hearing recovery rates of NAC group is much higher than that in control group. These results demonstrated that oral NAC in combination with ITD therapy is a more effective therapy for SSNHL than ITD alone.
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Affiliation(s)
- Xue Bai
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sen Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Xu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Jin
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xun Niu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Le Xie
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Qiu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Zhou Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Amizadeh M, Mozafarnia K, Moslemikia J, Naghibzadeh-Tahami A. Combination of Pulse Steroid with Intratympanic Injections in Sudden Sensorineural Hearing Loss. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2021; 33:9-13. [PMID: 33654685 PMCID: PMC7897433 DOI: 10.22038/ijorl.2020.43887.2452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Oral prednisolone was suggested as the first step to treat idiopathic sudden sensorineural hearing loss (ISSHL). This study aimed to investigate the effect of pulse therapy with methylprednisolone and intratympanic methylprednisolone, compared to traditional oral prednisolone therapy on patients with ISSHL. Material and Methods This randomized control trial included an experimental group receiving 500 mg intravenous methylprednisolone for three sequential days, followed by 1 mg/kg oral prednisolone for 11 days, and intratympanic Depo-Medrol four times twice a week. On the other hand, the control group received 1 mg/kg oral prednisolone for 14 days. Hearing change was assessed through pure tone audiometry. Subsequently, hearing recovery was investigated and analyzed in this study. Result This study was conducted on 51 patients who were divided into two groups of experimental (n=26) and control (n=25). The result revealed no significant difference between the two groups in terms of hearing improvement (P=0.28). Conclusion This revealed no added benefit in pulse steroids combined with intratympanic injections in cases with sudden hearing loss.
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Affiliation(s)
- Maryam Amizadeh
- Clinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Keramat Mozafarnia
- Clinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Javad Moslemikia
- Clinical Research Unit, Jiroft University of Medical Science, Jiroft, Iran
| | - Ahmad Naghibzadeh-Tahami
- Modeling of Health Research Center, Institute for Futures Studies in Health, Kerman university ofMedical Science, Kerman, Iran
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Andrianakis A, Moser U, Kiss P, Holzmeister C, Andrianakis D, Tomazic PV, Wolf A, Graupp M. Comparison of two different intratympanic corticosteroid injection protocols as salvage treatments for idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 2021; 279:609-618. [PMID: 33591388 DOI: 10.1007/s00405-021-06676-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to investigate the effect of interval length and total count of intratympanic steroid (ITS) injections in salvage treatment of patients with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS This retrospective case-control study included 64 patients with ISSNHL, who were treated with ITS injections as salvage therapy at a tertiary referral centre. From September 2019 to December 2020, 32 patients received up to four injections every 2-4 days (revised-protocol group). These patients were 1:1 matched to patients, who received up to three injections at 1-week intervals between January 2014 and August 2019 (initial-protocol group). Hearing outcomes of the two groups were compared. RESULTS Both ITS salvage treatment protocols resulted in a statistically significant hearing improvement (p < 0.05). The initial-protocol declined hearing thresholds by 12 ± 11.7 dB (p < 0.001, d = 1, P = 99%). Mean hearing function was improved by 13.4 ± 19.1 dB in the revised-protocol group [p < 0.001, d = 0.7, P = 98%]. A clinically significant hearing improvement (> 10 dB) was seen in 18 patients (58.1%) in the initial-protocol group and in 14 patients (41.9%) in the revised-protocol group. A comparison of the hearing outcomes between protocol groups revealed no statistically significant differences (p > 0.05). CONCLUSION These results indicate that a shorter injection interval does not lead to better hearing outcomes in ITS salvage treatment for ISSNHL. Moreover, fewer ITS injections may reduce costs, physical/mental stress of the patients and lower the risk of persistent tympanic perforations.
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Affiliation(s)
- Alexandros Andrianakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Ulrich Moser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Peter Kiss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Clemens Holzmeister
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Damianos Andrianakis
- Institute of Mathematics and Scientific Computing, University of Graz, Graz, Austria
| | - Peter Valentin Tomazic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria.
| | - Axel Wolf
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Matthias Graupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
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Yao Q, Jiang Z, Zhang J, Huang S, He S, Feng Y, Wang H, Yin S. Steroid Administration Approach for Idiopathic Sudden Sensorineural Hearing Loss: A National Survey in China. Ann Otol Rhinol Laryngol 2020; 130:752-759. [PMID: 33185127 DOI: 10.1177/0003489420968879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To optimize a protocol for the steroid administration approach for idiopathic sudden sensorineural hearing loss (ISSNHL) in China. METHODS A questionnaire was distributed to otolaryngologists. The data on demographics, indications for first-line and salvage treatment, such as intratympanic administration of steroids (ITS) and postauricular steroids (PAS), and procedures were analyzed. RESULTS 74 respondents used oral steroids, 112 used intravenous injections, 10 used ITS and 6 used PAS as a monotherapy for first-line treatment, and 135 used ITS or PAS in conjunction with oral or intravenous injection as a first-line treatment. Of the 249 respondents who used ITS, 97.19% adopted it as salvage therapy. The most commonly used steroid was 0.5 ml dexamethasone at 5 mg/ml and the most common side effect was pain. Of the 174 respondents who used PAS, 94.25% used it as salvage therapy. The most commonly used steroid was 0.5 ml methylprednisolone mixed with 0.5 ml lidocaine. CONCLUSIONS The obtained data suggested that intravenous injection of steroids was the most popular treatment for ISSNHL and that ITS or PAS were used as a salvage treatment in China.
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Affiliation(s)
- Qingxiu Yao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Zhuang Jiang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jiajia Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shujian Huang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shouhuan He
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yanmei Feng
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Hui Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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21
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Sciancalepore PI, de Robertis V, Sardone R, Quaranta N. Sudden sensorineural hearing loss: What factors influence the response to therapy? Audiol Res 2020; 10:234. [PMID: 32944207 PMCID: PMC7479339 DOI: 10.4081/audiores.2020.234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/12/2020] [Indexed: 12/17/2022] Open
Abstract
The standard treatment of Sudden Sensorineural Hearing Loss is based on oral steroids. In addition, intratympanic steroid is currently used in patients who fail to respond to oral treatment. The aim of the present study was to evaluate, in patients affected by SSHL, factors that influence the response to systemic and intratympanic steroid treatment. A retrospective analysis was conducted on 149 patients, all treated with systemic steroids. Moreover, patients not responsive to systemic therapy were treated with intratympanic steroids as salvage therapy. Auditory gain was assessed through the recovery rate at the discharge and after 30 days. Statistical analysis demonstrated that patients with delayed treatment and down-sloping auditory curve presented a poor recovery. Linear and stepwise regression showed that hypertriglyceridemia and hyperglycemia were negative prognostic factors. The prognosis of SSHL is affected by hyperglycemia and hypertriglyceridemia suggesting that a microvascular dysfunction within the cochlea could impair hearing recovery. Intratympanic steroid treatment was used as salvage treatment, however in patients with poor prognostic factors or at risk for side effects, it could be used in association with systemic treatment.
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Affiliation(s)
| | - Valentina de Robertis
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari "Aldo Moro"
| | - Rodolfo Sardone
- Research Unit on Aging "Great Age Study", National Institute of Gastroenterology and Research Hospital IRCCS "S.DeBellis", Bari, Italy
| | - Nicola Quaranta
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari "Aldo Moro"
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Choi JW, Lee CK, Kim SB, Lee DY, Ko SC, Park KH, Choi SJ. Potential benefits of salvage intratympanic dexamethasone injection in profound idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 2020; 277:2219-2227. [PMID: 32296977 DOI: 10.1007/s00405-020-05967-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/03/2020] [Indexed: 01/23/2023]
Abstract
PURPOSES To compare hearing recovery levels after initial treatment or salvage intratympanic dexamethasone injection (ITDI), and to find the prognostic factor on salvage ITDI therapy in profound ISSNHL. METHODS We retrospectively reviewed 115 patients with profound ISSNHL. All patients were treated with combination or systemic steroid therapy as the initial treatment. Next, we used salvage ITDI therapy on patients who showed slight or no improvement according to Siegel's criteria. To find the prognostic factors for the effectiveness of salvage ITDI therapy, we analyzed clinical data, such as, age, sex, vertigo, symptom duration, diabetes, hypertension, initial PTA, pre-salvage PTA, and treatment methods, using multiple regression analyses. RESULTS The rate of serviceable hearing recovery were 10.4% (12/115) in the initial-treatment group and 20.4% (21/103) in the salvage group. The difference was statistically significant (p = 0.041). Pre-salvage PTA, diabetes mellitus, and symptom duration were affective factors for the effectiveness of salvage ITDI therapy in profound ISSNHL refractory to initial treatment, with odds ratios of 1.169 (95% confidence interval, 1.088-1.256), 0.069 (95% confidence interval, 0.005-0.889), and 9.242 (95% confidence interval, 1.079-79.146). CONCLUSIONS Salvage therapy should be considered for profound ISSNHL, which is expected to result in poor prognosis or hearing recovery: ITSI therapy might be an effective treatment as salvage therapy.
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Affiliation(s)
- Jin Woong Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Chi Kyou Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea
| | - Sang Bin Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea
| | - Dong Yun Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea
| | - Sung Chul Ko
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea
| | - Kye Hoon Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea
| | - Seong Jun Choi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea.
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Hughes CK, Ryan MT, Adams J, Esquivel CR. Guideline Adherence and Hearing Outcomes of Sudden Sensorineural Hearing Loss in the Military Health System. Mil Med 2020; 185:e853-e858. [PMID: 31912876 DOI: 10.1093/milmed/usz446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/04/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline (CPG) proposes several treatment recommendations regarding sudden sensorineural hearing loss (SSNHL). The treatments for this disorder have been controversial and remain varied. We sought to determine CPG adherence and hearing outcomes of SSNHL within the Military Health System (MHS). MATERIALS AND METHODS This was a retrospective case series with chart review of the MHS's electronic medical record. Patients with SSNHL (n = 112) were treated between March 1, 2012 and September 30, 2015. Clinical improvement was defined as a 20-dB improvement in pure tone averages or a 20% increase in word recognition scores. RESULTS Oral steroids were used in 63 (56%) patients, intratympanic (IT) steroids were utilized in 11 (10%) patients, and combination therapy was used in 38 (34%) patients. Average pure tone averages improvements with oral steroids, IT steroids, and combination therapy were 31.2 dB (95% CI, 24.4-38.0), 13.4 dB (95% CI, 0.4-29.6), and 17.3 dB (95% CI, 9.32-25.3), respectively. Average word recognition scores improvements with oral steroids, IT steroids, and combination therapy were 29.64% (95% CI, 19.5-39.7), 14.43% (95% CI, -8.32 to 45.3), and 18.48% (95% CI, 5.48-31.5), respectively. Clinical improvements with oral steroids, IT steroids, and combination therapy were 65, 46, and 50%, respectively. CONCLUSION The MHS is uniquely positioned to evaluate adherence to CPGs on a national and international level given the robust and standardized electronic medical record. Areas identified for improvement include more timely initiation of treatment, standardization of IT steroid dosing, more accurate coding for diagnosis and treatment, and standardization of audiology evaluation.
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Affiliation(s)
- Charlotte K Hughes
- Department of Otolaryngology, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, JBSA-Ft. Sam Houston, TX 78234
| | - Matthew T Ryan
- Uniformed Services University, F. Edward Herbert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Jason Adams
- Department of Otolaryngology, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, JBSA-Ft. Sam Houston, TX 78234
| | - Carlos R Esquivel
- Department of Otolaryngology, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, JBSA-Ft. Sam Houston, TX 78234.,Department of Defense Hearing Center of Excellence, 59MDW/SG02O, 2200 Bergquist Drive, Suite 1, Lackland Air Force Base, TX 78236
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Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, Hollingsworth DB, Kelley DM, Kmucha ST, Moonis G, Poling GL, Roberts JK, Stachler RJ, Zeitler DM, Corrigan MD, Nnacheta LC, Satterfield L. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg 2020; 161:S1-S45. [PMID: 31369359 DOI: 10.1177/0194599819859885] [Citation(s) in RCA: 345] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Sudden hearing loss is a frightening symptom that often prompts an urgent or emergent visit to a health care provider. It is frequently but not universally accompanied by tinnitus and/or vertigo. Sudden sensorineural hearing loss affects 5 to 27 per 100,000 people annually, with about 66,000 new cases per year in the United States. This guideline update provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with sudden hearing loss. It focuses on sudden sensorineural hearing loss in adult patients aged ≥18 years and primarily on those with idiopathic sudden sensorineural hearing loss. Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and patient quality of life. The guideline update is intended for all clinicians who diagnose or manage adult patients who present with sudden hearing loss. PURPOSE The purpose of this guideline update is to provide clinicians with evidence-based recommendations in evaluating patients with sudden hearing loss and sudden sensorineural hearing loss, with particular emphasis on managing idiopathic sudden sensorineural hearing loss. The guideline update group recognized that patients enter the health care system with sudden hearing loss as a nonspecific primary complaint. Therefore, the initial recommendations of this guideline update address distinguishing sensorineural hearing loss from conductive hearing loss at the time of presentation with hearing loss. They also clarify the need to identify rare, nonidiopathic sudden sensorineural hearing loss to help separate those patients from those with idiopathic sudden sensorineural hearing loss, who are the target population for the therapeutic interventions that make up the bulk of the guideline update. By focusing on opportunities for quality improvement, this guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. METHODS Consistent with the American Academy of Otolaryngology-Head and Neck Surgery Foundation's "Clinical Practice Guideline Development Manual, Third Edition" (Rosenfeld et al. Otolaryngol Head Neck Surg. 2013;148[1]:S1-S55), the guideline update group was convened with representation from the disciplines of otolaryngology-head and neck surgery, otology, neurotology, family medicine, audiology, emergency medicine, neurology, radiology, advanced practice nursing, and consumer advocacy. A systematic review of the literature was performed, and the prior clinical practice guideline on sudden hearing loss was reviewed in detail. Key Action Statements (KASs) were updated with new literature, and evidence profiles were brought up to the current standard. Research needs identified in the original clinical practice guideline and data addressing them were reviewed. Current research needs were identified and delineated. RESULTS The guideline update group made strong recommendations for the following: (KAS 1) Clinicians should distinguish sensorineural hearing loss from conductive hearing loss when a patient first presents with sudden hearing loss. (KAS 7) Clinicians should educate patients with sudden sensorineural hearing loss about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy. (KAS 13) Clinicians should counsel patients with sudden sensorineural hearing loss who have residual hearing loss and/or tinnitus about the possible benefits of audiologic rehabilitation and other supportive measures. These strong recommendations were modified from the initial clinical practice guideline for clarity and timing of intervention. The guideline update group made strong recommendations against the following: (KAS 3) Clinicians should not order routine computed tomography of the head in the initial evaluation of a patient with presumptive sudden sensorineural hearing loss. (KAS 5) Clinicians should not obtain routine laboratory tests in patients with sudden sensorineural hearing loss. (KAS 11) Clinicians should not routinely prescribe antivirals, thrombolytics, vasodilators, or vasoactive substances to patients with sudden sensorineural hearing loss. The guideline update group made recommendations for the following: (KAS 2) Clinicians should assess patients with presumptive sudden sensorineural hearing loss through history and physical examination for bilateral sudden hearing loss, recurrent episodes of sudden hearing loss, and/or focal neurologic findings. (KAS 4) In patients with sudden hearing loss, clinicians should obtain, or refer to a clinician who can obtain, audiometry as soon as possible (within 14 days of symptom onset) to confirm the diagnosis of sudden sensorineural hearing loss. (KAS 6) Clinicians should evaluate patients with sudden sensorineural hearing loss for retrocochlear pathology by obtaining magnetic resonance imaging or auditory brainstem response. (KAS 10) Clinicians should offer, or refer to a clinician who can offer, intratympanic steroid therapy when patients have incomplete recovery from sudden sensorineural hearing loss 2 to 6 weeks after onset of symptoms. (KAS 12) Clinicians should obtain follow-up audiometric evaluation for patients with sudden sensorineural hearing loss at the conclusion of treatment and within 6 months of completion of treatment. These recommendations were clarified in terms of timing of intervention and audiometry and method of retrocochlear workup. The guideline update group offered the following KASs as options: (KAS 8) Clinicians may offer corticosteroids as initial therapy to patients with sudden sensorineural hearing loss within 2 weeks of symptom onset. (KAS 9a) Clinicians may offer, or refer to a clinician who can offer, hyperbaric oxygen therapy combined with steroid therapy within 2 weeks of onset of sudden sensorineural hearing loss. (KAS 9b) Clinicians may offer, or refer to a clinician who can offer, hyperbaric oxygen therapy combined with steroid therapy as salvage therapy within 1 month of onset of sudden sensorineural hearing loss. DIFFERENCES FROM PRIOR GUIDELINE Incorporation of new evidence profiles to include quality improvement opportunities, confidence in the evidence, and differences of opinion Included 10 clinical practice guidelines, 29 new systematic reviews, and 36 new randomized controlled trials Highlights the urgency of evaluation and initiation of treatment, if treatment is offered, by emphasizing the time from symptom occurrence Clarification of terminology by changing potentially unclear statements; use of the term sudden sensorineural hearing loss to mean idiopathic sudden sensorineural hearing loss to emphasize that >90% of sudden sensorineural hearing loss is idiopathic sudden sensorineural hearing loss and to avoid confusion in nomenclature for the reader Changes to the KASs from the original guideline: KAS 1-When a patient first presents with sudden hearing loss, conductive hearing loss should be distinguished from sensorineural. KAS 2-The utility of history and physical examination when assessing for modifying factors is emphasized. KAS 3-The word "routine" is added to clarify that this statement addresses nontargeted head computerized tomography scan that is often ordered in the emergency room setting for patients presenting with sudden hearing loss. It does not refer to targeted scans, such as temporal bone computerized tomography scan, to assess for temporal bone pathology. KAS 4-The importance of audiometric confirmation of hearing status as soon as possible and within 14 days of symptom onset is emphasized. KAS 5-New studies were added to confirm the lack of benefit of nontargeted laboratory testing in sudden sensorineural hearing loss. KAS 6-Audiometric follow-up is excluded as a reasonable workup for retrocochlear pathology. Magnetic resonance imaging, computerized tomography scan if magnetic resonance imaging cannot be done, and, secondarily, auditory brainstem response evaluation are the modalities recommended. A time frame for such testing is not specified, nor is it specified which clinician should be ordering this workup; however, it is implied that it would be the general or subspecialty otolaryngologist. KAS 7-The importance of shared decision making is highlighted, and salient points are emphasized. KAS 8-The option for corticosteroid intervention within 2 weeks of symptom onset is emphasized. KAS 9-Changed to KAS 9A and 9B. Hyperbaric oxygen therapy remains an option but only when combined with steroid therapy for either initial treatment (9A) or salvage therapy (9B). The timing of initial therapy is within 2 weeks of onset, and that of salvage therapy is within 1 month of onset of sudden sensorineural hearing loss. KAS 10-Intratympanic steroid therapy for salvage is recommended within 2 to 6 weeks following onset of sudden sensorineural hearing loss. The time to treatment is defined and emphasized. KAS 11-Antioxidants were removed from the list of interventions that the clinical practice guideline recommends against using. KAS 12-Follow-up audiometry at conclusion of treatment and also within 6 months posttreatment is added. KAS 13-This statement on audiologic rehabilitation includes patients who have residual hearing loss and/or tinnitus who may benefit from treatment. Addition of an algorithm outlining KASs Enhanced emphasis on patient education and shared decision making with tools provided to assist in same.
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Affiliation(s)
- Sujana S Chandrasekhar
- 1 ENT & Allergy Associates, LLP, New York, New York, USA.,2 Zucker School of Medicine at Hofstra-Northwell, Hempstead, New York, USA.,3 Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Laura J Bontempo
- 6 University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Sandra A Finestone
- 8 Consumers United for Evidence-Based Healthcare, Baltimore, Maryland, USA
| | | | - David M Kelley
- 10 University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Steven T Kmucha
- 11 Gould Medical Group-Otolaryngology, Stockton, California, USA
| | - Gul Moonis
- 12 Columbia University Medical Center, New York, New York, USA
| | | | - J Kirk Roberts
- 12 Columbia University Medical Center, New York, New York, USA
| | | | | | - Maureen D Corrigan
- 15 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Lorraine C Nnacheta
- 15 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Lisa Satterfield
- 15 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Liu Y, Chen Q, Xu Y. Research progress in refractory sudden hearing loss: steroid therapy. J Int Med Res 2020; 48:300060519889426. [PMID: 31939327 PMCID: PMC7254608 DOI: 10.1177/0300060519889426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 10/30/2019] [Indexed: 11/15/2022] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is a common condition with a rapid onset, and its worldwide frequency is increasing each year. Importantly, a significant number of patients with SSNHL do not respond to initial treatment, which is termed refractory sudden hearing loss (RSHL), and further treatment is not standardized in terms of type, duration, administration route, and concentration of topical steroid therapy. Dexamethasone and methylprednisolone are effective in treating RSHL, and salvage treatment typically consists of 2 weeks of steroid therapy followed by 3–6 months of follow-up. Near-continual steroid perfusion appears to be more effective than intermittent steroid injection. Furthermore, several novel therapeutic regimens have shown promising results in small-scale studies. However, the optimum treatment needs to be confirmed in larger randomized controlled trials.
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Affiliation(s)
- Ya Liu
- Department of Otolaryngology – Head and Neck Surgery, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou City, Zhejiang Province, China
| | - Qiongqiong Chen
- Department of Otolaryngology – Head and Neck Surgery, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou City, Zhejiang Province, China
| | - Yaping Xu
- Department of Otolaryngology – Head and Neck Surgery, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou City, Zhejiang Province, China
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Hearing Changes After Intratympanic Steroids for Secondary (Salvage) Therapy of Sudden Hearing Loss: A Meta-Analysis Using Mathematical Simulations of Drug Delivery Protocols. Otol Neurotol 2019; 39:803-815. [PMID: 29995001 DOI: 10.1097/mao.0000000000001872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The use of glucocorticoids for secondary (salvage/rescue) therapy of idiopathic sudden hearing loss (ISSHL), including controlled and uncontrolled studies with intratympanic injections or continuous, catheter mediated applications, were evaluated by means of a meta-analysis in an attempt to define optimal local drug delivery protocols for ISSHL. STUDY DESIGN A total of 30 studies with 33 treatment groups between January 2000 and June 2014 were selected based on sufficiently detailed description of application 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 drug remained in the middle ear, and on 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, AUC). RESULTS There was no dependence of hearing outcome on individual parameters of the application protocol, Cmax or AUC. Hearing gain and final hearing thresholds were independent of treatment delay. CONCLUSION Based on the available data from uncontrolled and controlled randomized and non-randomized studies no clear recommendation can be made so far for a specific application protocol for either primary or secondary (salvage) intratympanic steroid treatment in patients with ISSHL. For meta-analyses, change in pure tone average (PTA) may not be an adequate outcome parameter to assess effectiveness of the intervention especially with inhomogeneity of patient populations. Final PTA might provide a better outcome parameter.
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Evidence Supporting the Hypothesis That Inflammation-Induced Vasospasm Is Involved in the Pathogenesis of Acquired Sensorineural Hearing Loss. Int J Otolaryngol 2019; 2019:4367240. [PMID: 31781229 PMCID: PMC6875011 DOI: 10.1155/2019/4367240] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/04/2019] [Accepted: 10/19/2019] [Indexed: 12/15/2022] Open
Abstract
Sensorineural hearing loss is mainly acquired and affects an estimated 1.3 billion humans worldwide. It is related to aging, noise, infection, ototoxic drugs, and genetic defects. It is essential to identify reversible and preventable causes to be able to reduce the burden of this disease. Inflammation is involved in most causes and leads to tissue injury through vasospasm-associated ischemia. Vasospasm is reversible. This review summarized evidence linking inflammation-induced vasospasm to several forms of acquired sensorineural hearing loss. The link between vasospasm and sensorineural hearing loss is directly evident in subarachnoid haemorrhage, which involves the release of vasoconstriction-inducing cytokines like interleukin-1, endothelin-1, and tumour necrosis factor. These proinflammatory cytokines can also be released in response to infection, autoimmune disease, and acute or chronically increased inflammation in the ageing organism as in presbyacusis or in noise-induced cochlear injury. Evidence of vasospasm and hearing loss has also been discovered in bacterial meningitis and brain injury. Resolution of inflammation-induced vasospasm has been associated with improvement of hearing in autoimmune diseases involving overproduction of interleukin-1 from inflammasomes. There is mainly indirect evidence for vasospasm-associated sensorineural hearing loss in most forms of systemic or injury- or infection-induced local vascular inflammation. This opens up avenues in prevention and treatment of vascular and systemic inflammation as well as vasospasm itself as a way to prevent and treat most forms of acquired sensorineural hearing loss. Future research needs to investigate interventions antagonising vasospasm and vasospasm-inducing proinflammatory cytokines and their production in randomised controlled trials of prevention and treatment of acquired sensorineural hearing loss. Prime candidates for interventions are hereby inflammasome inhibitors and vasospasm-reducing drugs like nitric oxide donors, rho-kinase inhibitors, and magnesium which have the potential to reduce sensorineural hearing loss in meningitis, exposure to noise, brain injury, arteriosclerosis, and advanced age-related and autoimmune disease-related inflammation.
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High Dose of Intratympanic Steroids for Sudden Sensorineural Hearing Loss Salvage. Otol Neurotol 2019; 40:1134-1138. [DOI: 10.1097/mao.0000000000002386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herrera M, Berrocal JRG, Arumí AG, Lavilla MJ, Plaza G. Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Eficacia del corticoide intratimpánico como tratamiento de rescate en sordera súbita neurosensorial idiopática. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 70:207-214. [DOI: 10.1016/j.otorri.2018.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 11/18/2022]
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Efficacy of Intratympanic Corticosteroid as a Salvage Treatment in Idiopathic Sudden Sensorineural Hearing Loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Comparison of intratympanic dexamethasone therapy and hyperbaric oxygen therapy for the salvage treatment of refractory high-frequency sudden sensorineural hearing loss. Am J Otolaryngol 2018; 39:531-535. [PMID: 29891394 DOI: 10.1016/j.amjoto.2018.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/30/2018] [Accepted: 06/03/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to compare the efficacy of intratympanic dexamethasone (ITD) therapy and hyperbaric oxygen(HBO) therapy for the salvage treatment of patients with high-frequency sudden sensorineural hearing loss (SSNHL) after the failure of conventional therapy. MATERIALS AND METHODS 104 refractory high-frequency SSNHL patients were enrolled in our study. Among them, 31 received ITD alone (ITD group), 32 received HBO alone (HBO group) and 41 received no salvage therapies (control group). Hearing outcomes were determined by pure-tone average measured by audiometry. The total effective rates in the hearing recovery and improvement of tinnitus were calculated before and after salvage treatment. RESULTS There was no significant difference of the total effective rates in the hearing recovery between ITD and HBO group (p = 0.368). However, ITD therapy showed much better improvements of tinnitus than HBO therapy (p = 0.039). After ITD and HBO therapy, there were no significant differences in hearing gains at 2 and 4 KHz between ITD and HBO group (p = 0.468 and 0.934, respectively). Nevertheless, ITD therapy showed significant improvements of hearing gains at 8 KHz (p = 0.049) compared to that of HBO therapy. CONCLUSION ITD therapy may have better improvements of tinnitus and hearing gains at 8 KHz than HBO therapy in patients with refractory high-frequency SSNHL.
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Herrera M, García Berrocal JR, García Arumí A, Lavilla MJ, Plaza G. Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:290-300. [PMID: 30093087 DOI: 10.1016/j.otorri.2018.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden, unexplained unilateral hearing loss. OBJECTIVES To update the Spanish Consensus on the diagnosis, treatment and follow-up of ISSNHL. MATERIAL AND METHODS After a systematic review of the literature from 1966 to March 2018, on MESH terms «(acute or sudden) hearing loss or deafness», a third update was performed, including 1508 relevant papers. RESULTS Regarding diagnosis, 11ISSNHL is clinically suspected, the following diagnostic tests are mandatory: otoscopy, acumetry, tonal audiometry, speech audiometry, and tympanometry, to discount conductive causes. After clinical diagnosis has been established, and before treatment is started, a full analysis should be performed. An MRI should then be requested, ideally performed during the first 15 days after diagnosis, to discount specific causes and to help to understand the physiopathological mechanisms in each case. Although treatment is very controversial, due to its effect on quality of life after ISSNHL and the few rare adverse effects associated with short-term steroid treatment, this consensus recommends that all patients should be treated with steroids, orally and/or intratympanically, depending on each patient. In the event of failure of systemic steroids, intratympanic rescue is also recommended. Follow-up should be at day 7, and after 12 months. CONCLUSION By consensus, results after treatment should be reported as absolute decibels recovered in pure tonal audiometry and as improvement in speech audiometry.
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Affiliation(s)
- Mayte Herrera
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España.
| | - José Ramón García Berrocal
- Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, España
| | - Ana García Arumí
- Servicio de Otorrinolaringología, Hospital Vall d'Hebron, Universidad Autónoma, Barcelona, España
| | - María José Lavilla
- Servicio de Otorrinolaringología, Hospital Clínico, Universidad de Zaragoza, España
| | - Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
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Sutton L, Schartinger V, Url C, Schmutzhard J, Lechner D, Kavasogullari C, Sandhu JS, Shaida A, Laszig R, Loehler J, Plontke S, Riechelmann H, Lechner M. Intratympanic steroid use for idiopathic sudden sensorineural hearing loss: current otolaryngology practice in Germany and Austria. Eur Arch Otorhinolaryngol 2018; 275:1103-1110. [PMID: 29605865 DOI: 10.1007/s00405-018-4958-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/27/2018] [Indexed: 01/23/2023]
Abstract
AIMS The frequency of the use of intratympanic steroids (ITS) as a treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) in Europe is still unknown and remains a contentious issue amongst otolaryngologists. We undertook a survey of otolaryngologists in Germany and Austria to establish if there is any professional consensus with which to form a protocol for its use. METHODS A survey of 21 questions was distributed electronically to otolaryngologists in Germany and Austria and data on demographics, indications for intratympanic treatment, procedure, follow-up, and outcomes were analysed. RESULTS We received 908 responses. 49.1% of otolaryngologists used ITS for ISSNHL. Of those otolaryngologists who use ITS, 73.7% do not use it as primary treatment. 20.6% use ITS in conjunction with oral steroids for primary treatment and only 5.8% use ITS as monotherapy for primary treatment. 90.5% use ITS as salvage therapy. 81.1% do not consider the use of ITS after 2 weeks from the onset of symptoms. 8.3% used a tympanostomy tube and while the most commonly used steroid was dexamethasone at a concentration of 4 mg/ml (61%), a wide variety or other steroids and concentrations were used. CONCLUSIONS This survey illustrates wide variation of current practice of intratympanic corticosteroid injection for ISSHL in Germany and Austria. In the absence of high-level evidence, knowing what current practice is allows clinicians to assess what they do against what their colleagues are doing, and if they do something very different, make them question their practice. Moreover, the obtained data will help to direct future clinical trials with the aim to compare the outcomes of more commonly used protocols.
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Affiliation(s)
- L Sutton
- Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6DD, UK
| | - V Schartinger
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria
| | - C Url
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria
| | - J Schmutzhard
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria
| | - D Lechner
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria
| | | | - J S Sandhu
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AT, UK
| | - A Shaida
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, 330 Grays Inn Road, London, WC1X 8DA, UK
| | - R Laszig
- Department of Otorhinolaryngology, University Hospital of Freiburg, Breisacher Str., Freiburg, Germany
| | - J Loehler
- ENT Clinic, Maienbeeck, Bad Bramstedt, Germany
| | - S Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle, Ernst-Grube-Str., Halle, Germany
| | - H Riechelmann
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria
| | - M Lechner
- Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK.
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6DD, UK.
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria.
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, 330 Grays Inn Road, London, WC1X 8DA, UK.
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Plontke SK. Diagnostics and therapy of sudden hearing loss. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2018; 16:Doc05. [PMID: 29503670 PMCID: PMC5818684 DOI: 10.3205/cto000144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article reviews recent aspects of diagnostics, differential diagnostics, and evidence in systemic and local therapy of idiopathic sudden sensorineural hearing loss (ISSHL). Since a number of disorders can be accompanied by sudden hearing loss, a meaningful and targeted diagnostic strategy is of utmost importance. An important differential diagnosis of sudden hearing loss are intralabyrinthine schwannomas (ILS). The incidence of ILS is probably significantly underestimated. This may be due to the lack of awareness or lack of explicit search for an intralabyrinthine tumor on MRI or an inappropriate MRI technique for the evaluation of sudden hearing loss ("head MRI" instead of "temporal bone MRI" with too high slice thicknesses). Therefore, the request to the radiologist should specifically include the question for (or exclusion of) an ILS. With special MRI techniques, it is possibly today to visualize an endolymphatic hydrops. The evidence in the therapy of ISSHL is - with respect to the quality and not quantity of studies - unsatisfying. The value of systemically (low dose) or intratympanically applied corticosteroids in the primary treatment of ISSHL is still unclear. In order to investigate the efficacy and safety of high dose corticosteroids as primary therapy for ISSHL, a national, multicenter, three-armed, randomized, triple-blind controlled clinical trial is currently performed in Germany (http://hodokort-studie.hno.org/). After insufficient recovery of the threshold with systemic therapy of ISSHL, intratympanic corticosteroid therapy appears to be associated with a significantly higher chance of an improved hearing threshold than no therapy or placebo. Both, hearing gain and final hearing threshold, however, appear to be independent from the onset of secondary therapy. Based on currently available data from clinical studies, no recommendation can be made with respect to the type of corticosteroid and specifics of the intratympanic application protocol.
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Affiliation(s)
- Stefan K. Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Current concepts in the management of idiopathic sudden sensorineural hearing loss. Curr Opin Otolaryngol Head Neck Surg 2018; 24:413-9. [PMID: 27348351 DOI: 10.1097/moo.0000000000000289] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The purpose of this manuscript is to review the initial management strategies for idiopathic sudden sensorineural hearing loss, with an emphasis on the role that steroids play in treatment of this condition, and discuss options for auditory rehabilitation of persistent unilateral hearing loss. RECENT FINDINGS Recent data suggest that hearing improvement may be greater for patients initially treated with both systemic and intratympanic steroid when compared with those treated with systemic steroids alone. Salvage intratympanic steroids have been shown to confer hearing benefit if initial management fails. The ideal dosing regimen for intratympanic steroids has not been established, but evidence supports that higher dosing strategies are advantageous. Cochlear implantation has emerged as a strategy for auditory rehabilitation of persistent unilateral hearing loss. Recent studies have demonstrated high patient satisfaction, subjective improvement in tinnitus, and objective performance benefit after cochlear implantation for single-sided deafness. SUMMARY Patients can be offered steroid therapy in the initial management of idiopathic sudden sensorineural hearing loss, but should be counseled that the efficacy of steroids remains unclear. If patients fail to improve with initial management, salvage intratympanic steroid administration should be considered. If hearing loss persists long term, options for auditory rehabilitation should be discussed.
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Marx M, Younes E, Chandrasekhar S, Ito J, Plontke S, O’Leary S, Sterkers O. International consensus (ICON) on treatment of sudden sensorineural hearing loss. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S23-S28. [DOI: 10.1016/j.anorl.2017.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/10/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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Tsounis M, Psillas G, Tsalighopoulos M, Vital V, Maroudias N, Markou K. Systemic, intratympanic and combined administration of steroids for sudden hearing loss. A prospective randomized multicenter trial. Eur Arch Otorhinolaryngol 2017; 275:103-110. [PMID: 29168028 DOI: 10.1007/s00405-017-4803-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this prospective, randomized, multicenter clinical trial was to compare the therapeutic efficacy of systemic versus intratympanic versus combined administration of steroids in the treatment of idiopathic sudden sensorineural hearing loss. METHODS 102 patients with an up to 14 days history of idiopathic sudden sensorineural hearing loss were randomized to 1 of 3 arms and followed prospectively. Group A (35 patients) received prednisolone intravenously followed by methylprednisolone orally, whereas Group B (34 patients) were administered intratympanic methylprednisolone. Patients in Group C (33 patients) were administered the combination of the above-mentioned treatment modalities. The patients were followed-up with pure tone audiograms on days 1 (initiation of treatment), 3, 5, 10, 30 and 90. RESULTS The final mean hearing gain was 29.0 dB HL for Group A, 27.0 dB HL for Group B and 29.8 dB HL for Group C. The differences between the three groups were not statistically significant. When hearing improvement was assessed according to Siegel's criteria, no statistically significant difference was recorded either. Furthermore, patients younger than 60 years old achieved significantly better hearing outcomes. CONCLUSIONS The results demonstrated that systemic, intratympanic and combined steroid administration have similar results in the primary treatment of idiopathic sudden hearing loss. Younger patients are more likely to achieve better hearing outcomes.
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Affiliation(s)
- Michael Tsounis
- Department of Otorhinolaryngology, Health Directorate of Hellenic Police Headquarters, 153 Piraeus Street, 11854, Athens, Greece
| | - George Psillas
- 1st Academic ENT Department, AHEPA Hospital, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Miltiadis Tsalighopoulos
- 1st Academic ENT Department, AHEPA Hospital, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Victor Vital
- 1st Academic ENT Department, AHEPA Hospital, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Nicolas Maroudias
- Department of Otorhinolaryngology, Konstantopouleio Hospital of Nea Ionia, 3-5 St Olga's Street, 14233, Athens, Greece
| | - Konstantinos Markou
- 2nd Academic ENT Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road, Municipality of Pavlos Melas Area of N. Efkarpia, 56403, Thessaloniki, Greece.
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Fransson AE, Kisiel M, Pirttilä K, Pettersson C, Videhult Pierre P, Laurell GFE. Hydrogen Inhalation Protects against Ototoxicity Induced by Intravenous Cisplatin in the Guinea Pig. Front Cell Neurosci 2017; 11:280. [PMID: 28955207 PMCID: PMC5601388 DOI: 10.3389/fncel.2017.00280] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/29/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction: Permanent hearing loss and tinnitus as side-effects from treatment with the anticancer drug cisplatin is a clinical problem. Ototoxicity may be reduced by co-administration of an otoprotective agent, but the results in humans have so far been modest. Aim: The present preclinical in vivo study aimed to explore the protective efficacy of hydrogen (H2) inhalation on ototoxicity induced by intravenous cisplatin. Materials and Methods: Albino guinea pigs were divided into four groups. The Cispt (n = 11) and Cispt+H2 (n = 11) groups were given intravenous cisplatin (8 mg/kg b.w., injection rate 0.2 ml/min). Immediately after, the Cispt+H2 group also received gaseous H2 (2% in air, 60 min). The H2 group (n = 5) received only H2 and the Control group (n = 7) received neither cisplatin nor H2. Ototoxicity was assessed by measuring frequency specific ABR thresholds before and 96 h after treatment, loss of inner (IHCs) and outer (OHCs) hair cells, and by performing densitometry-based immunohistochemistry analysis of cochlear synaptophysin, organic transporter 2 (OCT2), and copper transporter 1 (CTR1) at 12 and 7 mm from the round window. By utilizing metabolomics analysis of perilymph the change of metabolites in the perilymph was assessed. Results: Cisplatin induced electrophysiological threshold shifts, hair cell loss, and reduced synaptophysin immunoreactivity in the synapse area around the IHCs and OHCs. H2 inhalation mitigated all these effects. Cisplatin also reduced the OCT2 intensity in the inner and outer pillar cells and in the stria vascularis as well as the CTR1 intensity in the synapse area around the IHCs, the Deiters' cells, and the stria vascularis. H2 prevented the majority of these effects. Conclusion: H2 inhalation can reduce cisplatin-induced ototoxicity on functional, cellular, and subcellular levels. It is proposed that synaptopathy may serve as a marker for cisplatin ototoxicity. The effect of H2 on the antineoplastic activity of cisplatin needs to be further explored.
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Affiliation(s)
| | - Marta Kisiel
- Department of Surgical Science, Uppsala UniversityUppsala, Sweden
| | - Kristian Pirttilä
- Division of Analytical Pharmaceutical Chemistry, Department of Medical Chemistry, Uppsala UniversityUppsala, Sweden
| | - Curt Pettersson
- Division of Analytical Pharmaceutical Chemistry, Department of Medical Chemistry, Uppsala UniversityUppsala, Sweden
| | - Pernilla Videhult Pierre
- Division of Audiology, Department of Clinical Science, Intervention and Technology, Karolinska InstitutetStockholm, Sweden
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Zanetti D, Di Berardino F, Nassif N, Redaelli De Zinis LO. Intratympanic steroid delivery by an indwelling catheter in refractory severe sudden sensorineural hearing loss. Auris Nasus Larynx 2017; 45:227-233. [PMID: 28511890 DOI: 10.1016/j.anl.2017.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Many studies over the last decade showed favorable outcomes with intratympanic (IT) steroid treatment, alone as salvage treatment or in combination with conventional systemic therapy (ST). However, in severe to profound sensorineural hearing loss resistant to ST, the optimal infusion mode, the type and concentration of the solution, the preferable drug, its total amount, and the duration and fractionation of the treatment are still debated. Aim of the study was to investigate the feasibility and the outcomes of a direct and constant IT delivery of dexamethasone (DEX) by means of a new indwelling catheter. METHODS A prospective case-control study in a tertiary referral university hospital. Ninety-nine subjects treated with ST only and 28 with additional IT DEX have been included in the study. A 4 Fr catheter inserted in a sub-annular fashion with a minimal postero-inferior tympanotomy through and endocanalar approach under local anesthesia. DEX 4mg/ml delivered daily, up to 7 days. Daily bone and air-conducted pure tone and speech audiometry were performed with a follow-up at 1, 3, 6 months after treatment. RESULTS Twenty-one out of 28 patients (75%) refractory to ST gained on average 24.0dB±20.5dB HL after IT-DEX, compared to 35.4% (average 6.7dB±16.6dB HL) of those receiving only medical ST (p<0.001). No significant side effects were noted. CONCLUSION In severe to profound sudden deafness refractory to conventional ST, the daily perfusion of 4mg/ml DEX through an intratympanic catheter is an easy, well accepted procedure that enables patients to receive a drug in the middle ear in a repeatable or sustained form, with minimal discomfort and a partial rescue (67.86%) and a speech recognition gain of 39%.
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Affiliation(s)
- Diego Zanetti
- Audiology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico Milano, Department of Clinical Sciences and Community Health, University of Milano, Italy
| | - Federica Di Berardino
- Audiology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico Milano, Department of Clinical Sciences and Community Health, University of Milano, Italy.
| | - Nader Nassif
- Otorhinolaryngology Department-University of Brescia, Italy
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Gülüstan F, Yazıcı ZM, Alakhras WME, Erdur O, Acipayam H, Kufeciler L, Kayhan FT. Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss. Braz J Otorhinolaryngol 2016; 84:S1808-8694(16)30232-4. [PMID: 27964845 PMCID: PMC9442892 DOI: 10.1016/j.bjorl.2016.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/06/2016] [Accepted: 10/25/2016] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. OBJECTIVE We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. METHODS Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. RESULTS The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p=0.364 and p=0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. CONCLUSION ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss.
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Affiliation(s)
- Filiz Gülüstan
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey
| | - Zahide Mine Yazıcı
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey
| | - Wesam M E Alakhras
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey
| | - Omer Erdur
- Selcuk University, Otolaryngology Department, Konya, Turkey
| | - Harun Acipayam
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey.
| | - Levent Kufeciler
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey
| | - Fatma Tulin Kayhan
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey
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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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Morita S, Nakamaru Y, Fujiwara K, Iizuka K, Masuya M, Homma A, Fukuda A, Fukuda S. The Short- and Long-Term Outcome of Intratympanic Steroid Therapy as a Salvage Treatment for Acute Low-Tone Sensorineural Hearing Loss without Episodes of Vertigo. Audiol Neurootol 2016; 21:132-40. [PMID: 27077389 DOI: 10.1159/000444577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 02/08/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate the hearing outcomes of intratympanic steroid (ITS) treatment for patients with acute low-tone sensorineural hearing loss (ALHL) after failure of initial therapy and to investigate the recurrence and progression to definite Ménière's disease (MD) during a long-term follow-up. METHODS We retrospectively reviewed the medical records of 90 patients with refractory ALHL who were followed up for at least 1 year between January 2000 and April 2014. Patients who responded poorly to initial medical treatment received intratympanic dexamethasone injections (ITS group) or isosorbide administration for 4 weeks (diuretic group) as salvage treatment options according to their choice of management. The control group did not receive ITS or the diuretic, due to their refusal of both medical treatments. The hearing outcomes were evaluated 1 month, 1 year and 5 years after the completion of the second-line therapy, and the rates of recurrence and progression to MD were measured during a follow-up period of at least 1 year. RESULTS Twenty-seven patients in the ITS group, 39 patients in the diuretic group and 24 patients in the control group were enrolled. Of these, 12 patients in the ITS group, 15 patients in the diuretic group and 12 patients in the control group were followed up for over 5 years. We found that the recovery rates and the audiometric functional values after 1 month and 1 year in the ITS group were significantly higher than those in the diuretic and control groups. However, there were no significant differences in the recovery rates or the audiometric functional values after 5 years, or in the rates of recurrence and progression to MD between the groups. CONCLUSIONS Salvage ITS therapy can provide a relatively good short-term hearing outcome for ALHL patients who have persistent hearing loss despite conventional treatment. However, both recurrence and progression to MD after treatment were observed in some patients during the long-term follow-up.
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Affiliation(s)
- Shinya Morita
- Department of Otolaryngology, Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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44
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Abstract
Menière's disease (MD) is a chronic multifactorial disorder of the inner ear characterized by episodic vestibular symptoms associated with sensorineural hearing loss, tinnitus, and aural pressure. Epidemiologic and genomic evidence supports a genetic susceptibility with multiple biochemical pathways involved, including the endocrine system, innate immune response, and autonomic nervous system. Allergens, infectious agents, vascular events, or genetic factors could modify inner-ear homeostasis and trigger MD. The diagnosis of MD is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing loss, tinnitus, and/or fullness) in the affected ear. Headache is also found during the attacks and bilateral involvement is found in 25-40% of cases. Audiologic and vestibular assessment is recommended to monitor the clinical course. The treatment of MD is symptomatic to obtain relief of vestibular episodes and preventive to limit hearing loss progression. Treatment options include sodium restriction, betahistine, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation.
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Affiliation(s)
- J M Espinosa-Sanchez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Junta de Andalucia, Granada, Spain; Department of Otolaryngology, Hospital San Agustin, Linares, Jaen, Spain
| | - J A Lopez-Escamez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Junta de Andalucia, Granada, Spain; Department of Otolaryngology, Complejo Hospitalario Universitario de Granada, Granada, Spain.
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45
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Abstract
The inability of mammals to regenerate auditory hair cells creates a pressing need to understand the means of enhancing hair cell survival following insult or injury. Hair cells are easily damaged by noise exposure, by ototoxic medications and as a consequence of aging processes, all of which lead to progressive and permanent hearing impairment as hair cells are lost. Significant efforts have been invested in designing strategies to prevent this damage from occurring since permanent hearing loss has a profound impact on communication and quality of life for patients. In this mini-review, we discuss recent progress in the use of antioxidants, anti-inflammatories and apoptosis inhibitors to enhance hair cell survival. We conclude by clarifying the distinction between protection and rescue strategies and by highlighting important areas of future research.
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