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Kim DH, Nguyen TN, Han YM, Tran P, Rho J, Lee JY, Son HY, Park JS. Local drug delivery using poly(lactic-co-glycolic acid) nanoparticles in thermosensitive gels for inner ear disease treatment. Drug Deliv 2021; 28:2268-2277. [PMID: 34668836 PMCID: PMC8530482 DOI: 10.1080/10717544.2021.1992041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Intratympanic (IT) therapies have been explored to address several side effects that could be caused by systemic administration of steroids to treat inner ear diseases. For effective drug delivery to the inner ear, an IT delivery system was developed using poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) and thermosensitive gels to maintain sustained release. Dexamethasone (DEX) was used as a model drug. The size and zeta potential of PLGA NPs and the gelation time of the thermosensitive gel were measured. In vitro drug release was studied using a Franz diffusion cell. Cytotoxicity of the formulations was investigated using SK-MEL-31 cells. Inflammatory responses were evaluated by histological observation of spiral ganglion cells and stria vascularis in the mouse cochlea 24 h after IT administration. In addition, the biodistribution of the formulations in mouse ears was observed by fluorescence imaging using coumarin-6. DEX-NPs showed a particle size of 150.0 ± 3.2 nm in diameter and a zeta potential of −18.7 ± 0.6. The DEX-NP-gel showed a gelation time of approximately 64 s at 37 °C and presented a similar release profile and cytotoxicity as that for DEX-NP. Furthermore, no significant inflammatory response was observed after IT administration. Fluorescence imaging results suggested that DEX-NP-gel sustained release compared to the other formulations. In conclusion, the PLGA NP-loaded thermosensitive gel may be a potential drug delivery system for the inner ear.
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Affiliation(s)
- Dong-Hyun Kim
- College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea
| | - Thu Nhan Nguyen
- College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea
| | - Young-Min Han
- College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea
| | - Phuong Tran
- College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea
| | - Jinhyung Rho
- College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jae-Young Lee
- College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea
| | - Hwa-Young Son
- College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jeong-Sook Park
- College of Pharmacy, Chungnam National University, Daejeon, Republic of Korea
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Basura GJ, Adams ME, Monfared A, Schwartz SR, Antonelli PJ, Burkard R, Bush ML, Bykowski J, Colandrea M, Derebery J, Kelly EA, Kerber KA, Koopman CF, Kuch AA, Marcolini E, McKinnon BJ, Ruckenstein MJ, Valenzuela CV, Vosooney A, Walsh SA, Nnacheta LC, Dhepyasuwan N, Buchanan EM. Clinical Practice Guideline: Ménière's Disease. Otolaryngol Head Neck Surg 2020; 162:S1-S55. [PMID: 32267799 DOI: 10.1177/0194599820909438] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. PURPOSE The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
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Affiliation(s)
| | | | | | | | | | | | - Matthew L Bush
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Julie Bykowski
- University of California San Diego, San Diego, California, USA
| | - Maria Colandrea
- Duke University School of Nursing and Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | | | | | - Kevin A Kerber
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | | | - Evie Marcolini
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brian J McKinnon
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Baltimore, Maryland, USA
| | - Lorraine C Nnacheta
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Erin M Buchanan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
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Taş BM, Şimşek G, Azman M, Kılıç R. Efficacy of 2 Different Intratympanic Steroid Regimen on Prevention of Cisplatin Ototoxicity: An Experimental Study. EAR, NOSE & THROAT JOURNAL 2019; 100:417-422. [PMID: 31569969 DOI: 10.1177/0145561319874311] [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: 11/16/2022] Open
Abstract
Ototoxicity is the general name of cochlear and vestibular organ injury resulting from encountering various therapeutic agents and chemical substances. Cisplatin is commonly used in the treatment of many cancers. In this study, the efficacy of intratympanic steroids was compared for preventing cisplatin ototoxicity. In this study, 32 (64 ears) rats were used by separating into 4 groups. Cisplatin was administered intraperitoneally to the first group (n = 8). Methylprednisolone and then cisplatin were administered intratympanically to the second group (n = 8). On the third group (n = 8), dexamethasone and then cisplatin were administered intratympanically. To the fourth group (n = 8), 0.9% NaCl and then cisplatin were given intratympanically. Otoacoustic emission (OAE) measurements and auditory brainstem responses (ABRs) tests were performed on all groups before and 72 hours after the procedure. Pretreatment of ABR-IV values were 4.29 ± 0.19 milliseconds in group 2 and 4.27 ± 0.16 milliseconds in group 3, whereas posttreatment ABR-IV values were 4.95 ± 0.35 milliseconds in group 2 and 4.65 ± 0.26 milliseconds in group 3. The ABR-IV values were measured significantly shorter in the rats given dexamethasone and methylprednisolone, according to control and cisplatin groups (P < .001). Pretreatment of ABR I-IV interval values were 2.98 ± 0.34 milliseconds and 3.03 ± 0.42 milliseconds in group 1 and group 4, respectively, and ABR I-IV interval values in group 1 and group 4 posttreatment were 3.49 ± 0.39 milliseconds and 3.5 ± 0.39 milliseconds in group 1 and group 4, respectively. Auditory brainstem responses I-IV interval was significantly longer in the cisplatin and control group than in the rats given dexamethasone and methylprednisolone (P < .001). After cisplatin treatment, OAE amplitudes decreased significantly in group 1 and group 4 for all frequencies, while OAE values were protected in methylprednisolone and dexamethasone group (P < .001). In conclusion, it has been shown that both agents have protective effects on cisplatin ototoxicity, with dexamethasone slightly more than methylprednisolone.
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Affiliation(s)
- Burak Mustafa Taş
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kırıkkale Yuksek Ihtısas Hospital, Kırıkkale, Turkey
| | - Gökçe Şimşek
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kırıkkale University School of Medicine, Kırıkkale, Turkey
| | - Musa Azman
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kırıkkale University School of Medicine, Kırıkkale, Turkey
| | - Rahmi Kılıç
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kırıkkale University School of Medicine, Kırıkkale, Turkey
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Demirhan H, Gökduman AR, Hamit B, Yürekli Altındağ MF, Yiğit Ö. Contribution of intratympanic steroids in the primary treatment of sudden hearing loss. Acta Otolaryngol 2018. [PMID: 29513064 DOI: 10.1080/00016489.2018.1438660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The primary objective is to investigate the contribution of intratympanic steroids in the primary treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). The secondary objective is to compare methylprednisolone (MP) and dexamethasone in terms of their effectiveness and injection-site pain. METHODS Two hundred and four patients with ISSNHL, 144 patients underwent systemic steroid therapy (SST) alone and 60 patients underwent combined therapy (CT). The effectiveness of the treatment was assessed according to the Furuhashi criteria. Injection-site pain after the procedure was assessed at 5 and 60 min on a visual analog scale (VAS). RESULTS Successful recovery was 55% in the CT group and 34% in the SST alone group (p = .004). Patients whose initial hearing level is severe, the success rate was statistically significantly higher with CT (p = .0001). Hearing improvement differed significantly between the MP and dexamethasone (p = .015). Injection-site pain at 5 min after the procedure, higher VAS scores were obtained with MP (p = .002). CONCLUSION In the primary treatment of sudden hearing loss, in which the level of hearing loss is 70-89 dB HL, the addition of ITS to the treatment significantly increased the success rate. The pain occurring in the middle ear was high but tolerable in the first few minutes by MP.
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Affiliation(s)
- Hasan Demirhan
- Otorhinolaryngology Department, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ali Rıza Gökduman
- Otorhinolaryngology Department, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Bahtiyar Hamit
- Otorhinolaryngology Department, Istanbul Training and Research Hospital, Istanbul, Turkey
| | | | - Özgür Yiğit
- Otorhinolaryngology Department, Istanbul Training and Research Hospital, Istanbul, Turkey
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Kuthubutheen J, Smith L, Hwang E, Lin V. Preoperative steroids for hearing preservation cochlear implantation: A review. Cochlear Implants Int 2016; 17:63-74. [PMID: 26913646 DOI: 10.1080/14670100.2016.1148319] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Preoperative steroids have been shown to be beneficial in reducing the hearing loss associated with cochlear implantation. This review article discusses the mechanism of action, effects of differing routes of administration, and side effects of steroids administered to the inner ear. Studies on the role of preoperative steroids in animal and human studies are also examined and future directions for research in this area are discussed.
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Affiliation(s)
- Jafri Kuthubutheen
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada.,b Department of Otolaryngology - Head and Neck Surgery , School of Surgery, University of Western Australia , Perth , Australia
| | - Leah Smith
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada
| | - Euna Hwang
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada
| | - Vincent Lin
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada
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Abstract
The indications for local drug therapy of inner ear hearing loss include sudden sensorineural hearing loss, Menière's disease, autoimmune-associated hearing loss, ototoxicity as a side effect of other therapies, acute acoustic trauma and improvement of the safety and performance of cochlear implants. Various drugs are currently being used and tested for local treatment of inner ear hearing loss, including glucocorticoids, growth factors, apoptosis inhibitors, antioxidants, TNF-α inhibitors and antibodies. To further a better understanding of pharmacokinetics and the development of rational pharmacotherapy of the inner ear, the"liberation, absorption, distribution, metabolism, elimination" (LADME) principle can be applied to local therapy of the inner ear. Local application strategies can be differentiated into intratympanic applications to the middle ear cavity and direct intralabyrinthine or intracochlear applications.
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Dogan R, Merıc A, Gedık O, Tugrul S, Eren SB, Ozturan O. Does systemic steroid deficiency affect inner ear functions? Am J Otolaryngol 2015; 36:568-74. [PMID: 25599654 DOI: 10.1016/j.amjoto.2014.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/04/2014] [Accepted: 12/21/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Today corticosteroids are employed for the treatment of various inner ear disorders. In this study we have investigated probable changes in hearing functions resulting from a deficiency of systemic steroid secretions. MATERIALS AND METHODS Twenty four healthy female rats were used in our study, allocated into three groups (medical adrenalectomy, medical adrenalectomy+dexamethasone, no treatment). Audiological evaluations were conducted at the beginning of the study and on days 7, 14 and 21. Blood samples were taken at the beginning and at the end of the study and blood corticosterone levels were determined. RESULTS While there were no significant differences between the basal, 7th, 14th and 21st day DPOAE values of group 1, their ABR threshold values showed significant increases. In group 2, there were no significant differences between the basal, 7th, 14th and 21st day DPOAE values. ABR thresholds of group 2 showed significant increases on days 7 and 14 as compared to their basal values, but there were no significant differences between the 21st day and basal ABR threshold values. There were no significant differences between the basal cortisol levels of the three groups. The mean cortisol level of group 1 on day 21 was found to be significantly lower than those of groups 2 and 3. CONCLUSION The results of the study demonstrated that there were no significant changes in DPOAE values with the cessation of cortisol secretion, while there was a progressive increase in ABR thresholds, which could be overcome with cortisone replacement.
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Affiliation(s)
- Remzi Dogan
- Department of Otorhinolaryngology, Bayrampasa State Hospital, Bayrampasa, Istanbul, Turkey.
| | - Ayşenur Merıc
- Department of Otorhinolaryngology, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Ozge Gedık
- Faculty of Health Sciences, Department of Audiology, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Selahattin Tugrul
- Department of Otorhinolaryngology, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Sabri Baki Eren
- Department of Otorhinolaryngology, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Orhan Ozturan
- Department of Otorhinolaryngology, Bezmialem Vakif University, Fatih, Istanbul, Turkey
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Astolfi L, Guaran V, Marchetti N, Olivetto E, Simoni E, Cavazzini A, Jolly C, Martini A. Cochlear implants and drug delivery:In vitroevaluation of dexamethasone release. J Biomed Mater Res B Appl Biomater 2013; 102:267-73. [DOI: 10.1002/jbm.b.33004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/30/2013] [Accepted: 07/01/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Laura Astolfi
- Department of Neuroscience, Bioacoustics Research Laboratory; University of Padua; 35129 Padua Italy
| | - Valeria Guaran
- Department of Neuroscience, Bioacoustics Research Laboratory; University of Padua; 35129 Padua Italy
| | - Nicola Marchetti
- Department of Chemistry and Pharmaceutical Sciences; University of Ferrara; 44121 Ferrara Italy
| | - Elena Olivetto
- Department of Neuroscience, Bioacoustics Research Laboratory; University of Padua; 35129 Padua Italy
| | - Edi Simoni
- Department of Neuroscience, Bioacoustics Research Laboratory; University of Padua; 35129 Padua Italy
| | - Alberto Cavazzini
- Department of Chemistry and Pharmaceutical Sciences; University of Ferrara; 44121 Ferrara Italy
| | - Claude Jolly
- MED-EL Hearing Implants; Innsbruck A6020 Austria
| | - Alessandro Martini
- Department of Neurosciences, ENT and Otosurgery Unit; University of Padua; 35129 Padua Italy
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Tokarz SA, Pang J, Grosz A, Kempton JB, Trune DR, Pillers DAM. Age-related cochlear cytokine gene expression in the BALB/cJ mouse with systemic versus intratympanic dosing of steroid drugs. Acta Otolaryngol 2013; 133:685-91. [PMID: 23768053 DOI: 10.3109/00016489.2013.771407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONCLUSION Age-related differences in the expression of inflammatory cytokines in the inner ear may contribute to the development of age-related hearing loss (ARHL). OBJECTIVES ARHL is characterized by tissue remodeling, ischemia, ion homeostasis, and inflammation. Steroid therapy is an otoprotective strategy that likely acts by reducing inflammation. We examined age-related changes in cytokine gene expression in the cochlea of the BALB/cJ mouse model of premature ARHL after systemic or intratympanic steroid delivery. METHODS 'Young' (2.5-3 months) and 'Old' (5-9 months) mice were treated with dexamethasone or fludrocortisone administered either orally or intratympanically. Cytokine gene expression in cochlear RNA was analyzed using prefabricated cDNA arrays. Old groups were compared to Young groups to identify age-related changes. RESULTS Down-regulation of a cytokine associated with bone remodeling (SPP1) was observed in the untreated Old group. Numerous genes were up- or down-regulated by more than twofold by steroid treatment, including proinflammatory interleukins (IL-16) and anti-inflammatory cytokines.
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Affiliation(s)
- Sara A Tokarz
- Division of Neonatology, Department of Pediatrics, University of Wisconsin-Madison, Meriter Hospital, Madison, WI 53715, USA
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Wrzeszcz A, Dittrich B, Haamann D, Aliuos P, Klee D, Nolte I, Lenarz T, Reuter G. Dexamethasone released from cochlear implant coatings combined with a protein repellent hydrogel layer inhibits fibroblast proliferation. J Biomed Mater Res A 2013; 102:442-54. [PMID: 23533184 DOI: 10.1002/jbm.a.34719] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/15/2013] [Accepted: 02/11/2013] [Indexed: 12/20/2022]
Abstract
The insertion of cochlear implants into the inner ear often causes inflammation and fibrosis inside the scala tympani and thus growth of fibrous tissue on the implant surface. This deposition leads to the loss of function in both electrical and laser-based implants. The design of this study was to realize fibroblast growth inhibition by dexamethasone (Dex) released from the base material of the implant [polydimethylsiloxane (PDMS)]. To prevent cell and protein adhesion, the PDMS was coated with a hydrogel layer [star-shaped polyethylene glycol prepolymer (sPEG)]. Drug release rates were studied over 3 months, and surface characterization was performed. It was observed that the hydrogel slightly smoothened the surface roughened by the Dex crystals. The hydrogel coating reduced and prolonged the release of the drug over several months. Unmodified, sPEG-coated, Dex-loaded, and Dex/sPEG-equipped PDMS filaments were cocultivated in vitro with fluorescent fibroblasts, analyzed by fluorescent microscopy, and quantified by cell counting. Compared to the unmodified PDMS, cell growth on all modified filaments was averagely 95% ±standard deviation (SD) less, while cell growth on the bottom of the culture dishes containing Dex-loaded filaments was reduced by 70% ±SD. Both, Dex and sPEG prevented direct cell growth on the filament surfaces, while drug delivery was maintained for the duration of several months.
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Affiliation(s)
- Antonina Wrzeszcz
- Department of Otolaryngology, Hannover Medical School, 30625, Hannover, Germany
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Grewal AS, Nedzelski JM, Chen JM, Lin VYW. Dexamethasone uptake in the murine organ of Corti with transtympanic versus systemic administration. J Otolaryngol Head Neck Surg 2013; 42:19. [PMID: 23663237 PMCID: PMC3651220 DOI: 10.1186/1916-0216-42-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 01/06/2013] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate glucocorticoid uptake in auditory hair cells following transtympanic versus systemic administration of dexamethasone. Study design Controlled experimental study. Setting Translational science experimental laboratory. Methods Swiss-Webster mice were injected with dexamethasone via transtympanic or systemic administration. At 1, 6, or 12 hours post-injection the temporal bones were harvested. After cryosectioning, immunohistochemical staining was performed using an antibody for dexamethasone. Results Dexamethasone labelling was greatest at 1 hour. Inner hair cells demonstrated much higher steroid uptake than outer hair cells. Both transtympanic injection and high-dose systemic administration resulted in strong dexamethasone labelling of hair cells, and a decreasing basal-to-apical gradient of hair cell fluorescence intensity was observed. Systemically delivered dexamethasone was rapidly eliminated from the inner ear, demonstrating mild labelling after 6 hours and none after 12 hours. In contrast, the mice receiving transtympanic injection had persistent moderate intensity fluorescence at 6 and 12 hours post-injection. Conclusion There is similar uptake of dexamethasone by auditory hair cells after transtympanic and high-dose systemic delivery. Novel findings include the presence of a decreasing basal-apical gradient of steroid uptake, and demonstration of greater affinity of inner hair cells for dexamethasone compared to outer hair cells. In this animal model transtympanic injection resulted in prolonged steroid uptake. These findings help further our understanding of the pharmacokinetics of steroids in the cochlea, with a focus on auditory hair cells.
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Affiliation(s)
- Amandeep S Grewal
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Suite M1-102, Toronto, ON M4N 3M5, Canada.
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Shafik AG, Elkabarity RH, Thabet MT, Soliman NB, Kalleny NK. Effect of intratympanic dexamethasone administration on cisplatin-induced ototoxicity in adult guinea pigs. Auris Nasus Larynx 2013; 40:51-60. [DOI: 10.1016/j.anl.2012.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 05/15/2012] [Accepted: 05/23/2012] [Indexed: 12/13/2022]
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Egli Gallo D, Khojasteh E, Gloor M, Hegemann SC. Effectiveness of Systemic High-Dose Dexamethasone Therapy for Idiopathic Sudden Sensorineural Hearing Loss. ACTA ACUST UNITED AC 2013; 18:161-70. [DOI: 10.1159/000346938] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
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Perilymph pharmacokinetics of markers and dexamethasone applied and sampled at the lateral semi-circular canal. J Assoc Res Otolaryngol 2012; 13:771-83. [PMID: 22968908 DOI: 10.1007/s10162-012-0347-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/13/2012] [Indexed: 10/27/2022] Open
Abstract
Perilymph pharmacokinetics was investigated by a novel approach, in which solutions containing drug or marker were injected from a pipette sealed into the perilymphatic space of the lateral semi-circular canal (LSCC). The cochlear aqueduct provides the outlet for fluid flow so this procedure allows almost the entire perilymph to be exchanged. After wait times of up to 4 h the injection pipette was removed and multiple, sequential samples of perilymph were collected from the LSCC. Fluid efflux at this site results from cerebrospinal fluid (CSF) entry into the basal turn of scala tympani (ST) so the samples allow drug levels from different locations in the ear to be defined. This method allows the rate of elimination of substances from the inner ear to be determined more reliably than with other delivery methods in which drug may only be applied to part of the ear. Results were compared for the markers trimethylphenylammonium (TMPA) and fluorescein and for the drug dexamethasone (Dex). For each substance, the concentration in fluid samples showed a progressive decrease as the delay time between injection and sampling was increased. This is consistent with the elimination of substance from the ear with time. The decline with time was slowest for fluorescein, was fastest for Dex, with TMPA at an intermediate rate. Simulations of the experiments showed that elimination occurred more rapidly from scala tympani (ST) than from scala vestibuli (SV). Calculated elimination half-times from ST averaged 54.1, 24.5 and 22.5 min for fluorescein, TMPA and Dex respectively and from SV 1730, 229 and 111 min respectively. The elimination of Dex from ST occurred considerably faster than previously appreciated. These pharmacokinetic parameters provide an important foundation for understanding of drug treatments of the inner ear.
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Bohl A, Rohm HW, Ceschi P, Paasche G, Hahn A, Barcikowski S, Lenarz T, Stöver T, Pau HW, Schmitz KP, Sternberg K. Development of a specially tailored local drug delivery system for the prevention of fibrosis after insertion of cochlear implants into the inner ear. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:2151-2162. [PMID: 22706626 DOI: 10.1007/s10856-012-4698-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 05/27/2012] [Indexed: 06/01/2023]
Abstract
A cochlear implant (CI)-associated local drug delivery system based on dexamethasone (DMS) was developed with the purpose to inhibit the growth of fibrotic tissue which influences the signal transmission from the CI to the neurons of the inner ear. For the realization of a targeted DMS delivery the following concepts were combined: modification of the silicone-based electrode carrier by incorporation of DMS and a DMS-containing polymeric coating chemically attached on the surface of the electrode carrier. It was demonstrated that the coated CI showed a high coating stability in a simulated implantation procedure. The in vitro drug release studies in a quasi-stationary model revealed a faster DMS release in the initial phase originating from the DMS-containing coatings and then a lower and sustained DMS release originating from the DMS-loaded silicone carrier. The performed in vitro biocompatibility study confirmed that the released DMS was non-toxic for cultured spiral ganglion cells.
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Affiliation(s)
- Anne Bohl
- Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Str. 4, 18119, Rostock, Germany
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Distribution of glucocorticoid receptors and 11 beta-hydroxysteroid dehydrogenase isoforms in the rat inner ear. Hear Res 2011; 280:148-56. [DOI: 10.1016/j.heares.2011.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/05/2011] [Accepted: 05/12/2011] [Indexed: 02/07/2023]
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Are intra-tympanically administered steroids effective in patients with sudden deafness? Implications for current clinical practice. Eur Arch Otorhinolaryngol 2011; 269:363-80. [DOI: 10.1007/s00405-011-1738-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
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Fu Y, Zhao H, Zhang T, Chi F. Intratympanic dexamethasone as initial therapy for idiopathic sudden sensorineural hearing loss: Clinical evaluation and laboratory investigation. Auris Nasus Larynx 2011; 38:165-71. [PMID: 20817429 DOI: 10.1016/j.anl.2010.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 07/25/2010] [Accepted: 07/30/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effect of intratympanic dexamethasone (ITD) as initial therapy for idiopathic sudden sensorineural hearing loss (ISSHL) as well as to determine the concentration-dependent time course distribution of dexamethasone in the inner ear. METHODS Sixty-six patients with profound ISSHL were included. Twenty-two were treated with ITD and the rest as control. Audiograms were performed before the treatment and one month afterwards. In the animal study, dexamethasone of different concentrations (5, 10 and 20mg/ml) was injected into the tympanums of three groups of SD rats (Groups A, B and C), their inner ears dissected free at various postinjection survival intervals. Immunofluorescence was applied to detect the locations of dexamethasone. RESULTS The overall rate of good prognosis was 77.27% in ITD group, which was not significantly different from 81.82% in the control group. In the animal study, the higher local concentration and longer lasting period was found in Groups B and C. CONCLUSIONS ITD at 5mg/ml did not add effect to systemic steroids in improving hearing outcomes in patients with ISSHL. An increase in dexamethasone concentration led to large variations in pharmacokinetics in animal study, showing potential value in optimizing the drug delivery protocols and improving the therapeutic results.
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Affiliation(s)
- Yaoyao Fu
- Department of Otorhinolaryngology Head and Neck Surgery, EYE & ENT Hospital of Fudan University, Shanghai Medical School, Fudan University, Shanghai 200031, China
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Paksoy M, Ayduran E, Şanlı A, Eken M, Aydın S, Oktay ZA. The protective effects of intratympanic dexamethasone and vitamin E on cisplatin-induced ototoxicity are demonstrated in rats. Med Oncol 2010; 28:615-21. [DOI: 10.1007/s12032-010-9477-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 03/01/2010] [Indexed: 10/19/2022]
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Eastwood H, Chang A, Kel G, Sly D, Richardson R, O'Leary SJ. Round window delivery of dexamethasone ameliorates local and remote hearing loss produced by cochlear implantation into the second turn of the guinea pig cochlea. Hear Res 2010; 265:25-9. [PMID: 20303400 DOI: 10.1016/j.heares.2010.03.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/12/2010] [Accepted: 03/13/2010] [Indexed: 10/19/2022]
Abstract
Application of dexamethasone to the round window has been shown to ameliorate high frequency hearing loss resulting from the trauma of cochlear implantation in experimental animals, but elucidation of the factors influencing protection of the high frequencies has been confounded by the local trauma from electrode array insertion. In this experiment, a second turn cochleostomy and implantation was performed on guinea pigs, to examine protection in the basal turn without the confounding effect of local trauma, as well as to test the efficacy of hearing protection in the second cochlear turn. The implantation resulted in an increase in hearing thresholds across all frequencies examined (2-32 kHz). Local delivery of dexamethasone to the round window prior to implantation protected hearing across frequencies from 2 to 32 kHz. Auditory thresholds improved over the first week after surgery, and then remained stable for the month of the experiment. The protection of hearing in the basal turn increased with longer periods of drug application prior to implantation. The level of hearing protection in the second turn was similar irrespective of the time that the drug was applied, but was greater when a higher steroid concentration was used. It was concluded that steroids protect hearing in the basal turn of the cochlea even when there was no local trauma. The level of hearing protection in the second turn exceeded that expected from models of steroid diffusion through the cochlea, suggesting that inner ear surgery alters the distribution of dexamethasone within the cochlea.
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Affiliation(s)
- Hayden Eastwood
- Department of Otolaryngology, University of Melbourne, Australia
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Jin DX, Lin Z, Lei D, Bao J. The role of glucocorticoids for spiral ganglion neuron survival. Brain Res 2009; 1277:3-11. [PMID: 19233145 PMCID: PMC2700197 DOI: 10.1016/j.brainres.2009.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 02/09/2009] [Accepted: 02/11/2009] [Indexed: 12/20/2022]
Abstract
Glucocorticoids, which are steroidal stress hormones, have a broad array of biological functions. Synthetic glucocorticoids are frequently used therapeutically for many pathologic conditions, including diseases of the inner ear; however, their exact functions in the cochlea are not completely understood. Recent work has clearly demonstrated the presence of glucocorticoid signaling pathways in the cochlea and elucidated their protective roles against noise-induced hearing loss. Furthermore, indirect evidence suggests the involvement of glucocorticoids in age-related loss of spiral ganglion neurons and extensive studies in the central nervous system demonstrate profound effects of glucocorticoids on neuronal functions. With the advancement of recent pharmacologic and genetic tools, the role of these pathways in the survival of spiral ganglion neurons after noise exposure and during aging should be revealed.
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Affiliation(s)
- David Xu Jin
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Zhaoyu Lin
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Debin Lei
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Jianxin Bao
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri, 63110
- Center for Aging, Washington University School of Medicine, St. Louis, Missouri, 63110
- The Division of Biology & Biomedical Science and Neuroscience Program, Washington University School of Medicine, St. Louis, Missouri, 63110
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Otake H, Yamamoto H, Teranishi M, Sone M, Nakashima T. Cochlear blood flow during occlusion and reperfusion of the anterior inferior cerebellar artery--effect of topical application of dexamethasone to the round window. Acta Otolaryngol 2009; 129:127-31. [PMID: 18607911 DOI: 10.1080/00016480802078119] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION Topical application of dexamethasone may support autoregulation of cochlear blood flow (CBF), although it had no direct effect on CBF. OBJECTIVES Although intratympanic steroid therapy for patients with inner ear disorders is common, the mechanism by which steroids exert their effect is unclear. We investigated the response of CBF to topical application of dexamethasone onto the round window. MATERIALS AND METHODS Two concentrations of dexamethasone (3.3 mg/ml and 33 mg/ml dexamethasone in 0.5 microl saline) were applied to the round windows of rats, and CBF responses were measured using a laser Doppler flowmeter. The effects on CBF of a 2 h occlusion of the anterior inferior cerebellar artery (AICA) and subsequent release of the clamp with or without previous dexamethasone application were investigated. RESULTS No significant change in CBF was observed after topical application of dexamethasone, and it did not affect the decrease in CBF caused by AICA occlusion. However, recovery of CBF after release of the AICA clamp was better in animals treated with dexamethasone than in those that did not receive dexamethasone.
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Fry LC, Bellutti M, Neumann H, Malfertheiner P, Monkemuller K. Utility of double-balloon enteroscopy for the evaluation of malabsorption. Dig Dis 2008; 26:134-9. [PMID: 18431063 DOI: 10.1159/000116771] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Occasionally, patients with malabsorption represent a diagnostic challenge. Double-balloon enteroscopy (DBE) allows deep and detailed examination of the small bowel. AIM To determine the diagnostic value of DBE in patients with malabsorption of unclear origin. METHODS DBE was performed in a total of 12 patients with clinical malabsorption. Biopsy specimens were taken from macroscopic lesions or from examined small bowel at three different levels of scope insertion depth. Tissue specimens were evaluated with standard hematoxylin and eosin, the modified Marsh classification and, when indicated, special stains for amyloidosis. RESULTS Fifteen DBEs were successfully performed in 12 patients without complications. DBE with small bowel biopsies yielded a diagnosis in 8 patients (67%). A new diagnosis was reached in 4 patients (33%). The new diagnoses included: Crohn's disease, primary intestinal lymphangiectasia and jejunal amyloidosis. In none of these 4 patients did the duodenal biopsies yield a diagnosis. Also, DBE excluded enteropathy-associated T-cell lymphoma (EATL) and/or ulcerative jejunitis in symptomatic celiac disease patients. CONCLUSIONS DBE had a diagnostic value of 42% in patients with malabsorption of unclear origin. In addition, DBE was useful to rule out complications of long-standing celiac disease such as ulcerative jejunitis or EATL. DBE should be reserved for patients with unexplained malabsorption. DBE with jejunal and ileal biopsies appears to have a diagnostic value in patients with malabsorption, even when duodenal biopsies are histologically normal.
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Affiliation(s)
- Lucia C Fry
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
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Edmunds AL. Potential Complications Associated with Steroid Use in the Middle and Inner Ear. EAR, NOSE & THROAT JOURNAL 2007. [DOI: 10.1177/014556130708611s09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Trune DR, Kempton JB, Harrison AR, Wobig JL. Glucocorticoid impact on cochlear function and systemic side effects in autoimmune C3.MRL-Faslpr and normal C3H/HeJ mice. Hear Res 2007; 226:209-17. [PMID: 17098384 DOI: 10.1016/j.heares.2006.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 09/01/2006] [Accepted: 09/27/2006] [Indexed: 12/20/2022]
Abstract
Glucocorticoids are effective in reversing hearing loss, but their severe side effects limit long term management of many ear disorders. A clearer understanding of these side effects is critical for prolonged therapeutic control of hearing and vestibular dysfunction. Therefore, this study characterized the impact of the glucocorticoid prednisolone on cochlear dysfunction and systemic organ systems in C3.MRL-Fas(lpr) autoimmune mice and their normal C3H/HeJ parent strain. Following 3 months of treatment, autoimmune mice had better auditory thresholds and improved hematocrits, anti-nuclear antibodies, and immune complexes. Steroid treatment also lowered body and spleen weights, both of which rise with systemic autoimmune disease. Steroid treatment of the normal C3H/HeJ mice significantly elevated their blood hematocrits and lowered their body and spleen weights to abnormal levels. Thus, systemic autoimmune disease and its related hearing loss in C3.MRL-Fas(lpr) mice are steroid-responsive, but normal hemopoiesis and organ functions can be significantly compromised. This mouse model may be useful for studies of the detrimental side effects of steroid treatments for hearing loss.
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Affiliation(s)
- Dennis R Trune
- Oregon Hearing Research Center, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
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