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Mohseni-Dargah M, Falahati Z, Pastras C, Khajeh K, Mukherjee P, Razmjou A, Stefani S, Asadnia M. Meniere's disease: Pathogenesis, treatments, and emerging approaches for an idiopathic bioenvironmental disorder. ENVIRONMENTAL RESEARCH 2023; 238:116972. [PMID: 37648189 DOI: 10.1016/j.envres.2023.116972] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
Meniere's disease (MD) is a severe inner ear condition known by debilitating symptoms, including spontaneous vertigo, fluctuating and progressive hearing loss, tinnitus, and aural fullness or pressure within the affected ear. Prosper Meniere first described the origins of MD in the 1860s, but its underlying mechanisms remain largely elusive today. Nevertheless, researchers have identified a key histopathological feature called Endolymphatic Hydrops (ELH), which refers to the excessive buildup of endolymph fluid in the membranous labyrinth of the inner ear. The exact root of ELH is not fully understood. Still, it is believed to involve several biological and bioenvironmental etiological factors such as genetics, autoimmunity, infection, trauma, allergy, and new theories, such as saccular otoconia blocking the endolymphatic duct and sac. Regarding treatment, there are no reliable and definitive cures for MD. Most therapies focus on managing symptoms and improving the overall quality of patients' life. To make significant advancements in addressing MD, it is crucial to gain a fundamental understanding of the disease process, laying the groundwork for more effective therapeutic approaches. This paper provides a comprehensive review of the pathophysiology of MD with a focus on old and recent theories. Current treatment strategies and future translational approaches (with low-level evidence but promising results) related to MD are also discussed, including patents, drug delivery, and nanotechnology, that may provide future benefits to patients suffering from MD.
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Affiliation(s)
- Masoud Mohseni-Dargah
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109, Australia; Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zahra Falahati
- Department of Biological Sciences, Institute for Advanced Studies in Basic Sciences (IASBS), Zanjan, Iran
| | - Christopher Pastras
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109, Australia; The Meniere's Laboratory, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Khosro Khajeh
- Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Payal Mukherjee
- RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Amir Razmjou
- Centre for Technology in Water and Wastewater, University of Technology Sydney, New South Wales 2007, Australia
| | - Sebastian Stefani
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109, Australia
| | - Mohsen Asadnia
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109, Australia.
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Liu SS, Yang R. Inner Ear Drug Delivery for Sensorineural Hearing Loss: Current Challenges and Opportunities. Front Neurosci 2022; 16:867453. [PMID: 35685768 PMCID: PMC9170894 DOI: 10.3389/fnins.2022.867453] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/02/2022] [Indexed: 12/20/2022] Open
Abstract
Most therapies for treating sensorineural hearing loss are challenged by the delivery across multiple tissue barriers to the hard-to-access anatomical location of the inner ear. In this review, we will provide a recent update on various pharmacotherapy, gene therapy, and cell therapy approaches used in clinical and preclinical studies for the treatment of sensorineural hearing loss and approaches taken to overcome the drug delivery barriers in the ear. Small-molecule drugs for pharmacotherapy can be delivered via systemic or local delivery, where the blood-labyrinth barrier hinders the former and tissue barriers including the tympanic membrane, the round window membrane, and/or the oval window hinder the latter. Meanwhile, gene and cell therapies often require targeted delivery to the cochlea, which is currently achieved via intra-cochlear or intra-labyrinthine injection. To improve the stability of the biomacromolecules during treatment, e.g., RNAs, DNAs, proteins, additional packing vehicles are often required. To address the diverse range of biological barriers involved in inner ear drug delivery, each class of therapy and the intended therapeutic cargoes will be discussed in this review, in the context of delivery routes commonly used, delivery vehicles if required (e.g., viral and non-viral nanocarriers), and other strategies to improve drug permeation and sustained release (e.g., hydrogel, nanocarriers, permeation enhancers, and microfluidic systems). Overall, this review aims to capture the important advancements and key steps in the development of inner ear therapies and delivery strategies over the past two decades for the treatment and prophylaxis of sensorineural hearing loss.
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Affiliation(s)
- Sophie S. Liu
- Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY, United States
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
| | - Rong Yang
- Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY, United States
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
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Verma R, Vyas P, Kaur J, Javed MN, Sarafroz M, Ahmad M, Gilani SJ, Taleuzzaman M. Approaches for ear-targeted delivery systems in neurosensory disorders to avoid chronic hearing loss mediated neurological diseases. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 21:479-491. [PMID: 34477535 DOI: 10.2174/1871527320666210903102704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/17/2021] [Accepted: 04/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND & OBJECTIVE Hearing loss is a common audio-vestibular-related neurosensory disability of inner ears, in which patients exhibit clinical symptoms of dizziness, gait unsteadiness, and oscillopsia, at an initial stage. While, if such disorders are untreated for a prolonged duration then the progression of disease into a chronic state significantly decreases GABA level as well as an alteration in the neurotransmission of CNS systems. Hence, to control the progression of disease into a chronic state, timely and targeted delivery of the drug into the site of action in the ear is now attracting the interest of neurologists for effective and safe treatment of such disorders. Among delivery systems, owing to small dimension, better penetration, rate-controlled release, higher bioavailability; nanocarriers are preferred to overcome delivery barriers, improvement in residence time, and enhanced the performance of loaded drugs. Subsequently, these carriers also stabilize encapsulated drugs while the opportunity to modify the surface of carriers favors guided direction for site-specific targeting. Conventional routes of drug delivery such as oral. intravenous, and intramuscular are poorer in performance because of inadequate blood supply to the inner ear and limited penetration of blood-inner ear barrier. CONCLUSION This review summarized novel aspects of non-invasive and biocompatible nanoparticles-based approaches for targeted delivery of drugs into the cochlea of the ear to reduce the rate, and extent of the emergence of any hearing loss mediated neurological disorders.
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Affiliation(s)
- Rishabh Verma
- Department of Pharmacology, Faculty of Pharmacy, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi-110062, India
| | - Preeti Vyas
- Department of Pharmacology, Faculty of Pharmacy, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi-110062, India
| | - Jasmeet Kaur
- Department of Pharmacognosy, Faculty of Pharmacy, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi-110062, India
| | - Md Noushad Javed
- Department of Pharmaceutics, Faculty of Pharmacy, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi-110062, India
| | - Mohammad Sarafroz
- Department of Pharmaceutical Chemistry, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, City Dammam, Saudi Arabia
| | - Makhmur Ahmad
- Department of Pharmaceutics, Buraydah College of Pharmacy and Dentistry, P.O Box- 31717, Buraydah- 51452, Al-Qassim, Saudi Arabia
| | - Sadaf Jamal Gilani
- College of Basic Health Science, Princess Nourah bint Abdulrahman University, Riyadh. Saudi Arabia
| | - Mohamad Taleuzzaman
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Maulana Azad University, Jodhpur, 342802, Rajasthan, India
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Kim CS, Martinez U, Mulvey E, Nayak N, Silverstein H. Outcomes of transtympanic dexamethasone perfusion using the MicroWick TM in patients with Ménière's disease: A cross-sectional study. Am J Otolaryngol 2021; 42:103138. [PMID: 34214774 DOI: 10.1016/j.amjoto.2021.103138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the efficacy of a 4-week transtympanic dexamethasone perfusion using the Silverstein MicroWickTM in patients with Ménière's disease. MATERIALS AND METHODS A self-reported questionnaire was designed and sent to patients who underwent transtympanic dexamethasone perfusion using the Silverstein MicroWickTM from January 2017 to December 2020. A retrospective chart review was conducted to gather demographic and audiological data of those who responded. RESULTS Forty respondents were separated into Group 1 (n = 34), who required no further procedure, and Group 2 (n = 6), who required additional procedure for Ménière's disease. In Group 1, 50% reported subjective improvement in tinnitus, 59% in aural fullness, 79% in vertigo, and 21% in hearing loss after the MicroWickTM treatment. A statistical analysis of the scores revealed that the improvement in aural fullness and vertigo met significance (p = 0.03 and p = 0.002, respectively). In Group 2, no significant change was seen in their symptoms. Audiological data showed no significant change in the pure tone average or the word recognition score after the treatment. CONCLUSION Transtympanic dexamethasone perfusion using the Silverstein MicroWickTM is a well-tolerated treatment option for patients with Ménière's disease. Our survey data suggest its significant efficacy in reducing aural fullness and vertigo attacks in these patients. Prospective studies will be conducted to further establish its potential role in successfully managing patients with Ménière's disease.
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Affiliation(s)
- Christine S Kim
- Ear Research Foundation, 1901 Floyd Street, Sarasota, Florida 34239, United States; First Physicians Group Silverstein Institute, 1901 Floyd Street, Sarasota, Florida 34239, United States
| | - Ulyseius Martinez
- First Physicians Group Silverstein Institute, 1901 Floyd Street, Sarasota, Florida 34239, United States
| | - Elizabeth Mulvey
- First Physicians Group Silverstein Institute, 1901 Floyd Street, Sarasota, Florida 34239, United States
| | - Neil Nayak
- Ear Research Foundation, 1901 Floyd Street, Sarasota, Florida 34239, United States; First Physicians Group Silverstein Institute, 1901 Floyd Street, Sarasota, Florida 34239, United States
| | - Herbert Silverstein
- Ear Research Foundation, 1901 Floyd Street, Sarasota, Florida 34239, United States; First Physicians Group Silverstein Institute, 1901 Floyd Street, Sarasota, Florida 34239, United States.
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Nyberg S, Abbott NJ, Shi X, Steyger PS, Dabdoub A. Delivery of therapeutics to the inner ear: The challenge of the blood-labyrinth barrier. Sci Transl Med 2020; 11:11/482/eaao0935. [PMID: 30842313 DOI: 10.1126/scitranslmed.aao0935] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/01/2017] [Accepted: 03/22/2018] [Indexed: 12/20/2022]
Abstract
Permanent hearing loss affects more than 5% of the world's population, yet there are no nondevice therapies that can protect or restore hearing. Delivery of therapeutics to the cochlea and vestibular system of the inner ear is complicated by their inaccessible location. Drug delivery to the inner ear via the vasculature is an attractive noninvasive strategy, yet the blood-labyrinth barrier at the luminal surface of inner ear capillaries restricts entry of most blood-borne compounds into inner ear tissues. Here, we compare the blood-labyrinth barrier to the blood-brain barrier, discuss invasive intratympanic and intracochlear drug delivery methods, and evaluate noninvasive strategies for drug delivery to the inner ear.
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Affiliation(s)
- Sophie Nyberg
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - N Joan Abbott
- Institute of Pharmaceutical Science, King's College London, London SE1 9NH, UK
| | - Xiaorui Shi
- Oregon Hearing Research Center, Department of Otolaryngology, Head & Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Peter S Steyger
- Oregon Hearing Research Center, Department of Otolaryngology, Head & Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Alain Dabdoub
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada. .,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON M5G 2C4, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 2C4, Canada
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Rathnam C, Chueng STD, Ying YLM, Lee KB, Kwan K. Developments in Bio-Inspired Nanomaterials for Therapeutic Delivery to Treat Hearing Loss. Front Cell Neurosci 2019; 13:493. [PMID: 31780898 PMCID: PMC6851168 DOI: 10.3389/fncel.2019.00493] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023] Open
Abstract
Sensorineural hearing loss affects millions of people worldwide and is a growing concern in the aging population. Treatment using aminoglycoside antibiotics for infection and exposure to loud sounds contribute to the degeneration of cochlear hair cells and spiral ganglion neurons. Cell loss impacts cochlear function and causes hearing loss in ∼ 15% of adult Americans (∼36 million). The number of individuals with hearing loss will likely grow with increasing lifespans. Current prosthesis such as hearing aids and cochlear implants can ameliorate hearing loss. However, hearing aids are ineffective if hair cells or spiral ganglion neurons are severely damaged, and cochlear implants are ineffective without properly functioning spiral ganglion neurons. As such, strategies that alleviate hearing loss by preventing degeneration or promoting cell replacement are urgently needed. Despite showing great promise from in vitro studies, the complexity and delicate nature of the inner ear poses a huge challenge for delivering therapeutics. To mitigate risks and complications associated with surgery, new technologies and methodologies have emerged for efficient delivery of therapeutics. We will focus on biomaterials that allow controlled and local drug delivery into the inner ear. The rapid development of microsurgical techniques in conjunction with novel bio- and nanomaterials for sustained drug delivery appears bright for hearing loss treatment.
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Affiliation(s)
- Christopher Rathnam
- Department of Chemistry and Chemical Biology, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Sy-Tsong Dean Chueng
- Department of Chemistry and Chemical Biology, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Yu-Lan Mary Ying
- Department of Otolaryngology Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Ki-Bum Lee
- Department of Chemistry and Chemical Biology, Rutgers, The State University of New Jersey, Piscataway, NJ, United States.,Stem Cell Research Center and Keck Center for Collaborative Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Kelvin Kwan
- Stem Cell Research Center and Keck Center for Collaborative Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ, United States.,Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
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Piu F, Bishop KM. Local Drug Delivery for the Treatment of Neurotology Disorders. Front Cell Neurosci 2019; 13:238. [PMID: 31213983 PMCID: PMC6557301 DOI: 10.3389/fncel.2019.00238] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023] Open
Abstract
Neurotology disorders such as vertigo, tinnitus, and hearing loss affect a significant proportion of the population (estimated 39 million in the United States with moderate to severe symptoms). Yet no pharmacological treatments have been developed, in part due to limitations in effective drug delivery to the anatomically protected inner ear compartment. Intratympanic delivery, a minimally invasive injection performed in the office setting, offers a potential direct route of administration. Currently, off-label use of therapeutics approved to treat disorders via systemic administration are being injected intratympanically, mostly in the form of aqueous solutions, but provide variable levels of drug exposure for a limited time requiring repeated injections. Hence, current drug delivery approaches for neurotology disorders are sub-optimal. This review, following a description of pharmacokinetic considerations of the inner ear, explores the merits of novel delivery approaches toward the treatment of neurotology disorders. Methodologies employing local delivery to the inner ear are described, including direct intracochlear delivery as well as intratympanic methods of infusion and injection. Intratympanic injection delivery formulation strategies including hydrogels, polymers and nanoparticulate systems are explored. These approaches represent progress toward more effective delivery options for the clinical treatment of a variety of neurotology disorders.
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Liu X, Li M, Smyth H, Zhang F. Otic drug delivery systems: formulation principles and recent developments. Drug Dev Ind Pharm 2018; 44:1395-1408. [PMID: 29659300 DOI: 10.1080/03639045.2018.1464022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Disorders of the ear severely impact the quality of life of millions of people, but the treatment of these disorders is an ongoing, but often overlooked challenge particularly in terms of formulation design and product development. The prevalence of ear disorders has spurred significant efforts to develop new therapeutic agents, but perhaps less innovation has been applied to new drug delivery systems to improve the efficacy of ear disease treatments. This review provides a brief overview of physiology, major diseases, and current therapies used via the otic route of administration. The primary focuses are on the various administration routes and their formulation principles. The article also presents recent advances in otic drug deliveries as well as potential limitations. Otic drug delivery technology will likely evolve in the next decade and more efficient or specific treatments for ear disease will arise from the development of less invasive drug delivery methods, safe and highly controlled drug delivery systems, and biotechnology targeting therapies.
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Affiliation(s)
- Xu Liu
- a College of Pharmacy , The University of Texas at Austin , Austin , TX , USA
| | - Mingshuang Li
- b Department of Communication Sciences and Disorders , The University of Texas at Austin , Austin , TX , USA
| | - Hugh Smyth
- a College of Pharmacy , The University of Texas at Austin , Austin , TX , USA
| | - Feng Zhang
- a College of Pharmacy , The University of Texas at Austin , Austin , TX , USA
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Is gentamycin delivery via sustained-release vehicles a safe and effective treatment for refractory Meniere’s disease? A critical analysis of published interventional studies. Eur Arch Otorhinolaryngol 2016; 274:1309-1315. [DOI: 10.1007/s00405-016-4294-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
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Recent advances in local drug delivery to the inner ear. Int J Pharm 2015; 494:83-101. [PMID: 26260230 DOI: 10.1016/j.ijpharm.2015.08.015] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/31/2015] [Accepted: 08/05/2015] [Indexed: 12/14/2022]
Abstract
Inner ear diseases are not adequately treated by systemic drug administration mainly because of the blood-perilymph barrier that reduces exchanges between plasma and inner ear fluids. Local drug delivery methods including intratympanic and intracochlear administrations are currently developed to treat inner ear disorders more efficiently. Intratympanic administration is minimally invasive but relies on diffusion through middle ear barriers for drug entry into the cochlea, whereas intracochlear administration offers direct access to the colchlea but is rather invasive. A wide range of drug delivery systems or devices were evaluated in research and clinic over the last decade for inner ear applications. In this review, different strategies including medical devices, hydrogels and nanoparticulate systems for intratympanic administration, and cochlear implant coating or advanced medical devices for intracoclear administration were explored with special attention to in vivo studies. This review highlights the promising systems for future clinical applications as well as the current hurdles that remain to be overcome for efficient inner ear therapy.
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Ayoob AM, Borenstein JT. The role of intracochlear drug delivery devices in the management of inner ear disease. Expert Opin Drug Deliv 2014; 12:465-79. [PMID: 25347140 DOI: 10.1517/17425247.2015.974548] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Diseases of the inner ear include those of the auditory and vestibular systems, and frequently result in disabling hearing loss or vertigo. Despite a rapidly expanding pipeline of potential cochlear therapeutics, the inner ear remains a challenging organ for targeted drug delivery, and new technologies are required to deliver these therapies in a safe and efficacious manner. In addition to traditional approaches for direct inner ear drug delivery, novel microfluidics-based systems are under development, promising improved control over pharmacokinetics over longer periods of delivery, ultimately with application towards hair cell regeneration in humans. AREAS COVERED Advances in the development of intracochlear drug delivery systems are reviewed, including passive systems, active microfluidic technologies and cochlear prosthesis-mediated delivery. This article provides a description of novel delivery systems and their potential future clinical applications in treating inner ear disease. EXPERT OPINION Recent progresses in microfluidics and miniaturization technologies are enabling the development of wearable and ultimately implantable drug delivery microsystems. Progress in this field is being spurred by the convergence of advances in molecular biology, microfluidic flow control systems and models for drug transport in the inner ear. These advances will herald a new generation of devices, with near-term applications in preclinical models, and ultimately with human clinical use for a range of diseases of the inner ear.
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Abstract
Drug delivery to the ear is used to treat conditions of the middle and inner ear such as acute and chronic otitis media, Ménière’s disease, sensorineural hearing loss and tinnitus. Drugs used include antibiotics, antifungals, steroids, local anesthetics and neuroprotective agents. A literature review was conducted searching Medline (1966–2012), Embase (1988–2012), the Cochrane Library and Ovid (1966–2012), using search terms ‘drug delivery’, ‘middle ear’, ‘inner ear’ and ‘transtympanic’. There are numerous methods of drug delivery to the middle ear, which can be categorized as topical, systemic (intravenous), transtympanic and via the Eustachian tube. Localized treatments to the ear have the advantages of targeted drug delivery allowing higher therapeutic doses and minimizing systemic side effects. The ideal scenario would be a carrier system that could cross the intact tympanic membrane loaded with drugs or biochemical agents for the treatment of middle and inner ear conditions.
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Pararas EEL, Borkholder DA, Borenstein JT. Microsystems technologies for drug delivery to the inner ear. Adv Drug Deliv Rev 2012; 64:1650-60. [PMID: 22386561 DOI: 10.1016/j.addr.2012.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 02/06/2012] [Accepted: 02/15/2012] [Indexed: 12/20/2022]
Abstract
The inner ear represents one of the most technologically challenging targets for local drug delivery, but its clinical significance is rapidly increasing. The prevalence of sensorineural hearing loss and other auditory diseases, along with balance disorders and tinnitus, has spurred broad efforts to develop therapeutic compounds and regenerative approaches to treat these conditions, necessitating advances in systems capable of targeted and sustained drug delivery. The delicate nature of hearing structures combined with the relative inaccessibility of the cochlea by means of conventional delivery routes together necessitate significant advancements in both the precision and miniaturization of delivery systems, and the nature of the molecular and cellular targets for these therapies suggests that multiple compounds may need to be delivered in a time-sequenced fashion over an extended duration. Here we address the various approaches being developed for inner ear drug delivery, including micropump-based devices, reciprocating systems, and cochlear prosthesis-mediated delivery, concluding with an analysis of emerging challenges and opportunities for the first generation of technologies suitable for human clinical use. These developments represent exciting advances that have the potential to repair and regenerate hearing structures in millions of patients for whom no currently available medical treatments exist, a situation that requires them to function with electronic hearing augmentation devices or to live with severely impaired auditory function. These advances also have the potential for broader clinical applications that share similar requirements and challenges with the inner ear, such as drug delivery to the central nervous system.
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Affiliation(s)
- Erin E Leary Pararas
- Charles Stark Draper Laboratory, 555 Technology Square, Cambridge, MA 02139, USA
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Round window perfusion dynamics: implications for intracochlear therapy. Curr Opin Otolaryngol Head Neck Surg 2011; 18:377-85. [PMID: 20808222 DOI: 10.1097/moo.0b013e32833d30f0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The treatments for inner ear diseases are evolving as the systemic administration of medication is replaced by novel intratympanic and intracochlear drug delivery. The current review explores the background and recent developments in this field. RECENT FINDINGS Although still in various stages of clinical development, novel drug delivery techniques such as the Silverstein MicroWick, the round window microcatheter, biodegradable hydrogels, biopolymers, nanoparticles, newly designed cochlear implant arrays, osmotic mini/micro pumps, and reciprocating perfusion systems hold significant promise. Animal data suggest that sustained delivery systems have more reliable inner ear pharmacokinetics than both systemic administration and intratympanic injections. SUMMARY As research scientists advance technologies for treating inner ear diseases, drug delivery techniques must keep pace. Viable treatment options for sensorineural hearing loss, tinnitus, and vestibular disorders are on the horizon and may usher in a new golden age for otology.
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Medical management of Ménière’s disease: a 10-year case series and review of literature. Eur Arch Otorhinolaryngol 2010; 267:1371-6. [DOI: 10.1007/s00405-010-1265-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 04/22/2010] [Indexed: 10/19/2022]
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Transtympanic gentamicin treatment using Silverstein MicroWick in Ménière's disease patients: long term outcome. The Journal of Laryngology & Otology 2008; 123:45-9. [PMID: 18533050 DOI: 10.1017/s0022215108002776] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the long term outcome of gentamicin inner-ear perfusion using the Silverstein MicroWick in the treatment of Ménière's disease. STUDY DESIGN Retrospective questionnaire survey of patients and review of medical records. SETTING A district general hospital. PARTICIPANTS All 15 patients who completed a minimum follow up of at least 24 months were included. MAIN OUTCOME MEASURES Subjective symptoms, change in hearing thresholds and Glasgow benefit inventory scores. RESULTS Based on the American Association of Otolaryngology-Head and Neck Surgery (1995) guidelines for reporting, 80 per cent of respondents obtained class A vertigo control and 20 per cent obtained class B control. Respondents' functional level improved from pre-operative levels of between three and six to post-operative levels of between one and three. Three respondents had pre-operative 'dead ears' and one developed the condition post-operatively. Hearing deteriorated further in three respondents, improved in two and remained unchanged in the rest. Respondents with class A control demonstrated improved quality of life, with a mean Glasgow benefit inventory total score of +34. CONCLUSION Transtympanic gentamicin therapy via the Silverstein MicroWick results in good vertigo control. Patients should however be made fully aware of the risk of hearing deterioration.
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Long-Term Vertigo Control in Patients After Intratympanic Gentamicin Instillation for Méni;ère's Disease. Otol Neurotol 2007; 28:1140-4. [DOI: 10.1097/mao.0b013e31815aea05] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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