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Özcan İ, Hira İ, Kaya A, Yaşar M, Doğan M, Mutlu C. The prognostic and predictive value of platelet parameters in diabetic and nondiabetic patients with sudden sensorineural hearing loss. Open Life Sci 2020; 15:884-889. [PMID: 33817275 PMCID: PMC7874536 DOI: 10.1515/biol-2020-0083] [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: 11/24/2019] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We aimed to evaluate the association between mean platelet volume, platelet distribution width (PDW), platelet count (PC) and plateletcrit (PCT), and the presence of sudden sensorineural hearing loss (SSNHL) and treatment response. In the literature, there is no study that investigates the platelet functions in diabetic patients with SSNHL. METHODS The patients were retrospectively assigned into Group 1 (68 diabetic patients with SSNHL), Group 2 (63 nondiabetic patients with SSNHL) and Group 3 (64 healthy controls). RESULTS PC was not significantly different between the groups (p > 0.05). MPV, PDW and PCT values were significantly higher in Group 1 as compared to Groups 2 and 3 (p < 0.05). Platelet parameters were not significantly different between the patients who were responsive and nonresponsive to the treatment. Therefore, the platelet parameters did not affect prognosis significantly in this study samples (p > 0.05). CONCLUSIONS This study showed that platelet parameters did not have a significant effect as a prognostic and predictive value in diabetic and nondiabetic patients with SSNHL. Further studies with more homogenous and larger study groups investigating the platelet parameters are needed to demonstrate microvascular damage and vascular alterations induced by diabetes mellitus.
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Affiliation(s)
- İbrahim Özcan
- Kayseri City Hospital, ENT Clinic. Şeker Mah. Molu Cad. Kocasinan, Kayseri, Turkey
| | - İbrahim Hira
- Kayseri City Hospital, ENT Clinic. Şeker Mah. Molu Cad. Kocasinan, Kayseri, Turkey
| | - Altan Kaya
- Kayseri City Hospital, ENT Clinic. Şeker Mah. Molu Cad. Kocasinan, Kayseri, Turkey
| | - Mehmet Yaşar
- Kayseri City Hospital, ENT Clinic. Şeker Mah. Molu Cad. Kocasinan, Kayseri, Turkey
| | - Murat Doğan
- Kayseri City Hospital, ENT Clinic. Şeker Mah. Molu Cad. Kocasinan, Kayseri, Turkey
| | - Cemil Mutlu
- Kayseri City Hospital, ENT Clinic. Şeker Mah. Molu Cad. Kocasinan, Kayseri, Turkey
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Bhandari A, Jain S. Early Intratympanic Methylprednisolone in Sudden SNHL: A Frequency-wise Analysis. Indian J Otolaryngol Head Neck Surg 2019; 71:390-395. [PMID: 31559209 PMCID: PMC6737101 DOI: 10.1007/s12070-019-01582-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022] Open
Abstract
Sudden sensorineural hearing loss is a dire medical emergency which must be treated at the earliest to get better long term hearing results. Our study aims to determine the efficacy of intratympanic steroid (Methylprednisolone) on auditory outcomes in patients of sudden sensorineural hearing loss and study the relation between time of onset of hearing loss to start of therapy and frequency-wise recovery of hearing loss. A prospective cohort clinical study with 33 patients with sudden hearing loss of 30 dB or more were treated with the intratympanic injection of methylprednisolone and the effect of the drug was observed. In this study, 33 patients with sudden onset (unilateral or bilateral) of hearing loss were treated with intratympanic methylprednisolone. The duration at which the drug was administered and the age of the participants was taken into consideration. Main outcome measures included audiometry results at low, medium and high hearing loss frequencies. The specific frequency at which the hearing improvement took place was tabulated. It was observed that hearing improved significantly if the steroid is injected within the first 4 days of onset (p < 0.05) at all the frequencies. A gain of 15 dB or more was achieved in more than 78% patients after injecting methylprednisolone intratympanically. A statistically significant association was found between recovery rate and frequency of hearing loss with patients showing greater improvement at low hearing loss frequency in comparison to mid and high frequencies (p < 0.05). The drug efficacy does not change with the age of the patient.
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Affiliation(s)
- Anita Bhandari
- Vertigo & Ear Clinic, S-271, Mahaveer Nagar, Jaipur, 302018 India
| | - Satish Jain
- Jain ENT Hospital, 23-24, Satya Vihar Colony, Pankaj Singhavi Marg, Near Vidhan Sabha, Lal Kothi, Jaipur, Rajasthan 302015 India
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Ermutlu G, Süslü N, Yılmaz T, Saraç S. Sudden hearing loss: an effectivity comparison of intratympanic and systemic steroid treatments. Eur Arch Otorhinolaryngol 2017; 274:3585-3591. [PMID: 28756569 DOI: 10.1007/s00405-017-4691-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/25/2017] [Indexed: 12/01/2022]
Abstract
Corticosteroid treatment has been considered the most effective treatment modality for sudden sensorineural hearing loss so far. Application route of corticosteroids may vary. We have designed a prospective randomized case-controlled clinical trial to evaluate the effectivenesses of the different application routes of steroids in the treatment of SSHL. Thirty-five patients were distributed randomly to two groups which were treated with either 'oral' or 'intratympanic' corticosteroids. Intratympanic steroid administration was performed three times every other day transtympanically. At the end of third month, recovery rate in the 'intratympanic' group was 84.2%, whereas in the 'oral' group, it was 87.5%. The difference between the recovery rates was not statistically significant. There were no major complications related to transtympanic steroid administration. These findings support that intratympanic steroid therapy is an alternative to systemic steroid therapy in the initial treatment of sudden hearing loss. In addition, transtympanic technique is an easy to perform and safe method for delivering steroids into the inner ear.
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Affiliation(s)
- Gülce Ermutlu
- Department of Otorhinolaryngology and Head and Neck Surgery, Hacettepe University, Ankara, Turkey. .,Kağıthane Devlet Hastanesi, Sanayi Mahallesi Sultan Selim Caddesi, Şahinler Sokak No:23 Kağıthane, İstanbul, Turkey.
| | - Nilda Süslü
- Department of Otorhinolaryngology and Head and Neck Surgery, Hacettepe University, Ankara, Turkey
| | - Taner Yılmaz
- Department of Otorhinolaryngology and Head and Neck Surgery, Hacettepe University, Ankara, Turkey
| | - Sarp Saraç
- Department of Otorhinolaryngology and Head and Neck Surgery, Koc University Hospital, İstanbul, Turkey
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Plaza G, Herráiz C. Intratympanic Steroids for Treatment of Sudden Hearing Loss after Failure of Intravenous Therapy. Otolaryngol Head Neck Surg 2016; 137:74-8. [PMID: 17599569 DOI: 10.1016/j.otohns.2007.01.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 01/17/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE: We sought to describe our experience with intratympanic steroid treatment of sudden sensorineural hearing loss after failure of intravenous steroid treatment. STUDY DESIGN AND SETTING: We conducted a nonrandomized prospective clinical trial. Fifty patients presenting with sudden onset idiopathic hearing loss were treated intravenously over five days. After this period, patients with treatment failure (18 cases) were offered intratympanic steroid treatment. Nine patients refused, whereas the other nine patients received three weekly injections of methylprednisolone. Recovery of hearing was reported as improvement of more than 15 dB in pure tone average. RESULTS: Intratympanic steroid treatment improved hearing loss in five patients (55%). This is significant compared with those patients who refused intratympanic treatment, who showed no further improvement ( P < 0.05). No serious adverse effects were observed. CONCLUSION: Intratympanic steroids significantly improve the recovery outcome of sudden hearing loss that had not recovered after intravenous steroid treatment. SIGNIFICANCE: Intratympanic steroids are an effective and safe therapy in sudden sensorineural hearing loss cases that are refractory to standard treatment.
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Affiliation(s)
- Guillermo Plaza
- Otolaryngology Department, Hospital de Fuenlabrada, Madrid, Spain.
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Barreto MADSC, Ledesma ALL, de Oliveira CACP, Bahmad Jr F. Intratympanic corticosteroid for sudden hearing loss: does it really work? Braz J Otorhinolaryngol 2016; 82:353-64. [PMID: 26873148 PMCID: PMC9444616 DOI: 10.1016/j.bjorl.2015.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/16/2015] [Accepted: 06/23/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction Sudden deafness is characterized by an abrupt hearing loss of at least 30 dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids. Objective To determine the effectiveness of therapy with intratympanic steroids in sudden deafness. Methods A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids. Results Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies. Conclusion Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient.
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Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, Brown SR, Fife TD, Ford P, Ganiats TG, Hollingsworth DB, Lewandowski CA, Montano JJ, Saunders JE, Tucci DL, Valente M, Warren BE, Yaremchuk KL, Robertson PJ. Clinical Practice Guideline. Otolaryngol Head Neck Surg 2012; 146:S1-35. [DOI: 10.1177/0194599812436449] [Citation(s) in RCA: 659] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective. Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL. Purpose. The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the 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. Results. The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.
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Affiliation(s)
- Robert J. Stachler
- Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Sanford M. Archer
- Division of Otolaryngology–Head & Neck Surgery, University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, New York, USA
| | - Seth R. Schwartz
- Department of Otolaryngology, Virginia Mason Hospital and Medical Center, Seattle, Washington, USA
| | - David M. Barrs
- Department of Otolaryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Steven R. Brown
- Department of Family and Community Medicine, University of Arizona School of Medicine, Phoenix, Arizona, USA
| | - Terry D. Fife
- Department of Neurology, University of Arizona, Phoenix, Arizona, USA
| | | | - Theodore G. Ganiats
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California, USA
| | | | | | | | | | - Debara L. Tucci
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Valente
- Department of Otolaryngology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Barbara E. Warren
- Center for LGBT Social Science & Public Policy, Hunter College, City University of New York, New York, New York, USA
| | | | - Peter J. Robertson
- American Academy of Otolaryngology–Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Barriat S, van Wijck F, Staecker H, Lefebvre PP. Intratympanic steroid therapy using the Silverstein Microwick™ for refractory sudden sensorineural hearing loss increases speech intelligibility. Audiol Neurootol 2011; 17:105-11. [PMID: 21860229 DOI: 10.1159/000329367] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 05/11/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine whether delivery of methylprednisolone to the round window (administered for 10 days after the onset of the hearing loss) can improve hearing and, in particular, speech intelligibility, after the failure of conventional treatment for idiopathic sudden sensorineural hearing loss. RESULTS Of the 26 patients enrolled in this non-randomized retrospective study, 14 patients (54%) showed an improvement in the pure tone average (PTA) and 12 remained unchanged. The topical steroid therapy brought about an overall improvement in PTA of 13.5 ± 7.3 dB for the 26 patients enrolled. The auditory capacity index, defined as the mean speech discrimination score obtained at 40, 55 and 70 dB, improved by 24.2 ± 8.7% in 26 patients. Among the 12 patients with a stable PTA, 9 showed an increase in speech intelligibility. CONCLUSION Local administration of steroids to the inner ear through the round window route improves hearing and speech intelligibility in patients after failure of conventional therapy.
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Affiliation(s)
- Sébastien Barriat
- Department of Otorhinolaryngology, University of Liege, Liege, Belgium
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Abstract
OBJECTIVE Administration of steroids systematically is considered to be the most commonly accepted treatment for idiopathic sudden sensorineural hearing loss (ISSNHL). In recent years there has been increasing scientific interest in treating ISSNHL by means of local steroid delivery. Usually, intratympanic steroids are used in three main protocols, as initial treatment, as adjunctive treatment given concomitantly with systemic steroids and as salvage treatment after failure of standard therapy. The purpose of this review is to examine the published literature regarding the therapeutic value of each method of treatment and to seek answers about the best delivery technique and the optimal administration schedule. DATA SOURCES Literature review from 1996 to 2009, PubMed and Medline. STUDY SELECTION We searched for trials concerning clinical evaluation of intratympanic steroids in ISSNHL patients, as a salvage treatment, as a first line therapy and in combination with the conventional therapy. Randomized and non-randomized case control studies and case series studies were the types of trials available for review. DATA EXTRACTION All the articles described in the study selection were used for this review. DATA SYNTHESIS Statistical techniques were not used. CONCLUSION On the basis of the available literature, it seems that topical steroids can be a valuable solution for ISSNHL patients who either cannot tolerate systemic steroid therapy or are refractory to it. Concerning the combined therapy, due to the controversial results of the existing studies, it cannot be determined yet whether this treatment protocol could yield superior results as a first line therapy. The need for establishment of standard criteria of hearing recovery should be underlined.
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Plaza G, Durio E, Herráiz C, Rivera T, García-Berrocal JR. Consensus on diagnosis and treatment of sudden hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/s2173-5735(11)70025-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Plaza G, Durio E, Herráiz C, Rivera T, García-Berrocal JR. [Consensus on diagnosis and treatment of sudden hearing loss. Asociación Madrileña de ORL]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 62:144-57. [PMID: 21112580 DOI: 10.1016/j.otorri.2010.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 08/09/2010] [Accepted: 09/03/2010] [Indexed: 12/19/2022]
Abstract
Idiopathic sudden sensorineural hearing loss is an unexplained unilateral hearing loss with onset over a period of less than 72 hours, without other known otological diseases. We present a consensus on the diagnosis, treatment and follow-up of this disease, designed by AMORL, after a systematic review of the literature from 1966 to June 2010. Diagnosis of sudden sensorineural hearing loss is based on mandatory otoscopy, acoumetry, tonal audiometry, speech audiometry, and tympanometry. After clinical diagnosis is settled, and before treatment is started, a full analysis should be done and an MRI should be requested later. Treatment is based on systemic corticosteroids (orally in most cases), helped by intratympanic doses as rescue after treatment failures. Follow-up should be done at day 7, with tonal and speech audiometries, and regularly at 15, 30, and 90 days after start of therapy, and after 12 months. By consensus, results after treatment should be reported as absolute dBs recovered in pure tonal audiometry, as improvement in the recovery rate in unilateral cases, and as improvement in speech audiometry.
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Affiliation(s)
- Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
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Filipo R, Covelli E, Balsamo G, Attanasio G. Intratympanic prednisolone therapy for sudden sensorineural hearing loss: A new protocol. Acta Otolaryngol 2010; 130:1209-13. [PMID: 20735183 DOI: 10.3109/00016481003793766] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Intratympanic administration of prednisolone at a dose of 62.5 mg/ml performed every day for 3 consecutive days is more efficacious than the therapeutic approaches described so far in the literature. OBJECTIVES The aim of the study was to evaluate the overall success rate, morbidity, and prognostic factors of a new protocol of intratympanic steroid administration as a means of primary therapy for idiopathic sensorineural hearing loss. METHODS Overall, 34 patients presenting sudden unilateral sensorineural hearing loss of at least 30 dB over three frequencies that had developed within 72 h were treated once a day for 3 consecutive days with a single intratympanic injection of prednisone diluted in saline solution. RESULTS Following intratympanic therapy with prednisone, 16 patients (47%) reported complete recovery of sudden sensorineural hearing loss, with a pure tone average that returned within 25 dB; 11 patients (32.3%) showed improvement in hearing of more than 30 dB; 4 patients presented improvement in pure-tone average between 10 and 30 dB. Only three patients failed to improve following intratympanic injection.
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Affiliation(s)
- Roberto Filipo
- Department of Neurology and Otolaryngology, ‘sapienza’ University of Rome, Italy
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Swan EEL, Mescher MJ, Sewell WF, Tao SL, Borenstein JT. Inner ear drug delivery for auditory applications. Adv Drug Deliv Rev 2008; 60:1583-99. [PMID: 18848590 PMCID: PMC2657604 DOI: 10.1016/j.addr.2008.08.001] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 08/21/2008] [Indexed: 02/07/2023]
Abstract
Many inner ear disorders cannot be adequately treated by systemic drug delivery. A blood-cochlear barrier exists, similar physiologically to the blood-brain barrier, which limits the concentration and size of molecules able to leave the circulation and gain access to the cells of the inner ear. However, research in novel therapeutics and delivery systems has led to significant progress in the development of local methods of drug delivery to the inner ear. Intratympanic approaches, which deliver therapeutics to the middle ear, rely on permeation through tissue for access to the structures of the inner ear, whereas intracochlear methods are able to directly insert drugs into the inner ear. Innovative drug delivery systems to treat various inner ear ailments such as ototoxicity, sudden sensorineural hearing loss, autoimmune inner ear disease, and for preserving neurons and regenerating sensory cells are being explored.
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Affiliation(s)
- Erin E Leary Swan
- Charles Stark Draper Laboratory, 555 Technology Square, Cambridge, MA 02139, USA.
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Abstract
Sudden sensorineural hearing loss is a medical emergency in search of an appropriate treatment. Almost all aspects of this disease process are disputed in the literature. The natural course of the disease process has not been well defined, although spontaneous recovery in a percentage of patients appears well accepted. Little scientific data exist to develop an evidence-based treatment protocol. The more common elements of treatment in the United States include oral steroid therapy, transtympanic steroid therapy, and potentially oral antiviral therapy. Other therapies are used with great frequency, and their potential should not be discounted.
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Affiliation(s)
- Matthew R O'Malley
- The Otology Group Vanderbilt, 300 20th Ave N., Suite 502, Nashville, TN 37203-2115, USA
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Bird PA, Begg EJ, Zhang M, Keast AT, Murray DP, Balkany TJ. Intratympanic Versus Intravenous Delivery of Methylprednisolone to Cochlear Perilymph. Otol Neurotol 2007; 28:1124-30. [DOI: 10.1097/mao.0b013e31815aee21] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Haynes DS, O'Malley M, Cohen S, Watford K, Labadie RF. Intratympanic Dexamethasone for Sudden Sensorineural Hearing Loss After Failure of Systemic Therapy. Laryngoscope 2007; 117:3-15. [PMID: 17202923 DOI: 10.1097/01.mlg.0000245058.11866.15] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Intratympanic steroids are increasingly used in the treatment of inner ear disorders, especially in patients with sudden sensorineural hearing loss (SNHL) who have failed systemic therapy. We reviewed our experience with intratympanic steroids in the treatment of patients with sudden SNHL to determine overall success, morbidity, and prognostic factors. HYPOTHESIS Intratympanic steroids have minimal morbidity and the potential to have a positive effect on hearing recovery in patients with sudden SNHL who have failed systemic therapy. STUDY DESIGN The authors conducted a retrospective review. METHODS Patients presenting with sudden SNHL defined as a rapid decline in hearing over 3 days or less affecting 3 or more frequencies by 30 dB or greater who underwent intratympanic steroids therapy (24 mg/mL dexamethasone) were reviewed. Excluded were patients with Meniere disease, retrocochlear disease, autoimmune HL, trauma, fluctuating HL, radiation-induced HL, noise-induced HL, or any other identifiable etiology for sudden HL. Patients who showed signs of fluctuation of hearing after injection were excluded. Pretreatment and posttreatment audiometric evaluations including pure-tone average (PTA) and speech reception threshold (SRT) were analyzed. Patient variables as they related to recovery were studied and included patient age, time to onset of therapy, status of the contralateral ear, presence of diabetes, severity of HL, and presence of associated symptoms (tinnitus, vertigo). A 20-dB gain in PTA or a 20% improvement in SDS was considered significant. RESULTS : Forty patients fit the criteria for inclusion in the study. The mean age of the patients was 54.8 years with a range from 17 to 84 years of age. Overall, 40% (n = 16) showed any improvement in PTA or SDS. Fourteen (35%) men and 26 (65%) women were included. Using the criteria of 20-dB improvement in PTA or 20% improvement in SDS for success, 27.5% (n = 11) showed improvement. The mean number of days from onset of symptoms to intratympanic therapy was 40 days with a range of 7 days to 310 days. A statistically significant difference was noted in those patients who received earlier injection (P = .0008, rank sum test). No patient receiving intratympanic dexamethasone after 36 days recovered hearing using 20-dB PTA decrease or a 20% increase in discrimination as criteria for recovery. Twelve percent (n = 5) of patients in the study had diabetes with 20% recovering after intratympanic dexamethasone (not significantly different from nondiabetics at 28.6%, Fisher exact test, P = 1.0). Comparison to other studies that used differing steroid type, concentration, dosing schedule, inclusion criteria, and criteria for success revealed, in many instances, a similar overall recovery rate. CONCLUSIONS Difficulty in proving efficacy of a single modality is present in all studies on SNHL secondary to multiple treatment protocols, variable rates of recovery, and a high rate of spontaneous recovery. Forty percent of patients showed some improvement in SDS or PTA after treatment failure. When criteria of 20-dB PTA or 20% is considered to define improvement, the recovery rate was 27.5%. Modest improvement is seen with the current protocol of a single intratympanic steroid injection of 24 mg/mL dexamethasone in patients who failed systemic therapy. Dramatic hearing recovery in treatment failures was rarely encountered. No patient showed significant benefit from intratympanic steroids after 36 days when using this protocol for idiopathic sudden SNHL. If patients injected after 6 weeks are excluded from the study, the improvement rate increases from 26.9% to 39.3%. Earlier intratympanic injection had a significant impact on hearing recovery, although with any therapeutic intervention for sudden SNHL, early success may be attributed to natural history. If we further exclude seven patients treated with intratympanic steroids within 2 weeks of the onset of symptoms (i.e., study only those patients treated with intratympanic dexamethasone between 2 and 6 weeks after onset of symptoms), still, 26% improved by 20 dB or 20% SDS. The recovery rates after initial systemic failure are higher than would be expected in this treatment failure group given our control group (9.1%) and literature review. These findings indicate a positive effect from steroid perfusion in this patient population.
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Affiliation(s)
- David S Haynes
- Vanderbilt University Medical Center/The Otology Group of Vanderbilt, Nashville, Tennessee 37232, USA.
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