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Tsuda T, Hanada Y, Wada K, Fujiwara E, Takeda K, Nishimura H. Efficacy of Intratympanic Glucocorticoid Steroid Administration Therapy as an Initial Treatment for Idiopathic Sudden Sensorineural Hearing Loss During the COVID-19 Pandemic. EAR, NOSE & THROAT JOURNAL 2023; 102:772-779. [PMID: 34247535 DOI: 10.1177/01455613211032534] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Systemic administration of glucocorticoid steroids is the most common initial treatment for idiopathic sudden sensorineural hearing loss (ISSNHL); however, due to the prevalence of coronavirus disease, the indications for this treatment must be carefully determined. The aim of this study was to investigate the efficacy of intratympanic steroid therapy as an initial treatment for idiopathic SSNHL. METHODS Sixty-eight patients with idiopathic ISSNHL who were treated with intravenous or intratympanic steroids were included in this study. Patients were retrospectively evaluated regarding preoperative grade, type of additional treatment, outcome of treatment, and side effects of each treatment. RESULTS In 46 cases, patients received intravenous steroid therapy as the initial treatment, while 22 patients received intratympanic steroid therapy; 10 patients underwent salvage treatment due to inadequate improvement of symptoms. Regarding additional treatment, intravenous steroid monotherapy was used in 37 patients. The outcomes were similar after both treatments; 16 (43%) and 11 (52%) patients treated exclusively with intravenous and intratympanic steroids, respectively, were completely cured. There were no significant differences in the effects between the 2 treatments, indicating that they were almost equally effective. The side effects observed in patients treated with intravenous steroid therapy were increased blood pressure, acute gastric mucosal disorder, and insomnia. None of these side effects were observed in any of the patients treated with intratympanic steroids; however, 1 case of perforation of the tympanic membrane occurred due to the procedure. CONCLUSION There were no significant differences in posttreatment outcomes between patients treated with either intratympanic or intravenous steroids. The therapeutic effects were comparable, and no severe side effects were observed; therefore, intratympanic steroid therapy may be considered useful as an initial treatment for ISSNHL in the context of widespread coronavirus disease.
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Affiliation(s)
- Takeshi Tsuda
- Department of Otorhinolaryngology, National Hospital Organization Osaka National Hospital, Houenzaka, Osaka City, Osaka, Japan
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Suita City, Japan
| | - Yukiko Hanada
- Department of Otorhinolaryngology, National Hospital Organization Osaka National Hospital, Houenzaka, Osaka City, Osaka, Japan
| | - Kento Wada
- Department of Otorhinolaryngology, National Hospital Organization Osaka National Hospital, Houenzaka, Osaka City, Osaka, Japan
| | - Erina Fujiwara
- Department of Otorhinolaryngology, National Hospital Organization Osaka National Hospital, Houenzaka, Osaka City, Osaka, Japan
| | - Kazuya Takeda
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama City, Osaka, Oonohigashi, Sayama City, Osaka, Japan
| | - Hiroshi Nishimura
- Department of Otorhinolaryngology, National Hospital Organization Osaka National Hospital, Houenzaka, Osaka City, Osaka, Japan
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Intratympanic Corticosteroid Administration as a Primary Treatment for Idiopathic Sudden Sensorineural Hearing Loss. Indian J Otolaryngol Head Neck Surg 2022; 74:72-73. [PMID: 36032892 PMCID: PMC9411465 DOI: 10.1007/s12070-020-01831-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022] Open
Abstract
A retrospective review of 34 patients was done who had idiopathic sudden sensorineural hearing loss and were administered intratympanic corticosteroid in the form of dexamethasone (4 mg/ml). The results were interpreted based on pure tone audiometry and Speech discrimination score of the patient before commencing the treatment and after the treatment.
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Simani L, Shilo S, Oron Y, Eta RA, Handzel O, Muhanna N, Warshavsky A, Horowitz G, Ungar OJ. Residual Perforation Risk Assessment of Intratympanic Steroids via Tympanostomy Tube Versus Transtympanic Injections. Laryngoscope 2021; 131:E2583-E2591. [PMID: 34002883 DOI: 10.1002/lary.29609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the risk of residual tympanic membrane (TM) perforation after intratympanic (IT) steroidal treatment administered via transtympanic injection compared with trans-tympanostomy tube (TyT). STUDY DESIGN Case series, systematic review and meta analysis. METHODS Data were retrieved from the medical files of an original cohort of all consecutive patients with sudden sensorineural hearing loss necessitating IT steroidal treatment in a tertiary medical center between January 1, 2016 and November 20, 2020. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" on comparable published cases was performed and meta-analysis was established. RESULTS Eighteen studies describing 818 ears were included in the quantitative meta-analysis in addition to a local cohort of 140 ears. The proportion of residual TM perforation was 1.11% and 1.14% (95% confidence interval: 0.01%-3.27% and 0.028%-2.38%) in the TyT and trans-tympanic groups, respectively, suggesting no significant difference in residual TM perforation risk between these techniques. CONCLUSION IT steroid therapy via trans-TyT is not associated with more residual perforations than IT steroid therapy via transtympanic injections. LEVEL OF EVIDENCE NA Laryngoscope, 131:E2583-E2591, 2021.
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Affiliation(s)
- Liam Simani
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shahaf Shilo
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rani A Eta
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anton Warshavsky
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer J Ungar
- Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hu B, Chen M, Chen X, Zhao D, Zheng Q, Nie G, Ren H, Ren J. Effectiveness of salvage intratympanic dexamethasone treatment for refractory sudden sensorineural hearing loss classified by audiogram patterns. Acta Otolaryngol 2021; 141:449-453. [PMID: 33645435 DOI: 10.1080/00016489.2021.1889029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intratympanic dexamethasone is commonly conducted to treat refractory sudden sensorineural hearing loss (RSSNHL). However, no consensus has been reached on its effectiveness. OBJECTIVES The study aimed to evaluate the effectiveness of otoendoscope-assisted salvage intratympanic dexamethasone treatment (IDT) on RSSNHL with different audiogram patterns after failure of initial therapy. MATERIAL AND METHODS A total of 108 patients with unilateral RSSNHL were classified into 4 groups according to audiogram patterns. Hearing results were evaluated by pure-tone audiometry (PTA), which was performed at baseline and one month after otoendoscope-assisted salvage IDT. The effectiveness of otoendoscope-assisted salvage IDT was assessed in each group. RESULTS The efficiency in low-frequency, high-frequency, flat, and deaf group was 48%, 24.1%, 46.2%, 17.9%, respectively. The efficacy did not differ between the high-frequency and deaf group. Notably, the efficacy in the low-frequency and flat group was significantly higher than that in the deaf group. CONCLUSIONS Otoendoscope-assisted salvage IDT is a safe and effective treatment for RSSNHL. This treatment provided better results for patients with low-frequency damaged and flat curve audiogram than patients with other audiogram patterns. SIGNIFICANCE Audiogram patterns should be considered in the clinical management of patients with RSSHNL prior to salvage IDT.
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Affiliation(s)
- Bing Hu
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Institute of Translational Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Mo Chen
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaozhu Chen
- Department of Otolaryngology, Institute of Translational Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Duanlong Zhao
- Department of Otolaryngology, Institute of Translational Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Qingyin Zheng
- Department of Otolaryngology Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Guohui Nie
- Department of Otolaryngology, Institute of Translational Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Hongmiao Ren
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jihao Ren
- Department of Otolaryngology Head and Neck Surgery, Institute of Otology, The Second Xiangya Hospital, Central South University, Changsha, China
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Hearing Changes After Intratympanic Steroids for Secondary (Salvage) Therapy of Sudden Hearing Loss: A Meta-Analysis Using Mathematical Simulations of Drug Delivery Protocols. Otol Neurotol 2019; 39:803-815. [PMID: 29995001 DOI: 10.1097/mao.0000000000001872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The use of glucocorticoids for secondary (salvage/rescue) therapy of idiopathic sudden hearing loss (ISSHL), including controlled and uncontrolled studies with intratympanic injections or continuous, catheter mediated applications, were evaluated by means of a meta-analysis in an attempt to define optimal local drug delivery protocols for ISSHL. STUDY DESIGN A total of 30 studies with 33 treatment groups between January 2000 and June 2014 were selected based on sufficiently detailed description of application protocols. Cochlear drug levels were calculated by a validated computer model of drug dispersion in the inner ear fluids based on the concentration and volume of glucocorticoids applied, the time drug remained in the middle ear, and on the specific timing of injections. Various factors were compared with hearing outcome, including baseline data, individual parameters of the application protocols, calculated peak concentration (Cmax), and total dose (area under the curve, AUC). RESULTS There was no dependence of hearing outcome on individual parameters of the application protocol, Cmax or AUC. Hearing gain and final hearing thresholds were independent of treatment delay. CONCLUSION Based on the available data from uncontrolled and controlled randomized and non-randomized studies no clear recommendation can be made so far for a specific application protocol for either primary or secondary (salvage) intratympanic steroid treatment in patients with ISSHL. For meta-analyses, change in pure tone average (PTA) may not be an adequate outcome parameter to assess effectiveness of the intervention especially with inhomogeneity of patient populations. Final PTA might provide a better outcome parameter.
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Hearing Loss After Cisplatin: Oxidative Stress Pathways and Potential for Protection. FREE RADICALS IN ENT PATHOLOGY 2015. [DOI: 10.1007/978-3-319-13473-4_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Li H, Feng G, Wang H, Feng Y. Intratympanic Steroid Therapy as a Salvage Treatment for Sudden Sensorineural Hearing Loss After Failure of Conventional Therapy: A Meta-analysis of Randomized, Controlled Trials. Clin Ther 2015; 37:178-87. [DOI: 10.1016/j.clinthera.2014.11.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/06/2014] [Accepted: 11/15/2014] [Indexed: 11/26/2022]
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Yin T, Huang F, Ren J, Liu W, Chen X, Li L, Xie D, Lu Y. Bilateral sudden hearing loss following habitual abortion: a case report and review of literature. Int J Clin Exp Med 2013; 6:720-723. [PMID: 24040484 PMCID: PMC3762631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/18/2013] [Indexed: 06/02/2023]
Abstract
Sudden sensorineural hearing loss (SSNHL) is usually unilateral and can be associated with tinnitus and vertigo. The most common causes of this disease are known to be the vascular and viral agents, but immune disorders are involved in the development of sudden deafness. The antiphospholipid syndrome (APS) is an acquired autoimmune system disorder, which is defined as the presence of antiphospholipid antibodies (APA) in the patient's blood, then cause venous and/or arterial thrombosis in various organs of the body, for example, thrombosis can occur in the placenta and/or the inner ear. As a result, it can cause abortion and/or sudden deafness. Bilateral SSNHL following habitual abortion is a rare clinical event. Here, we report a case of 32-year-old woman who presented with bilateral sudden hearing loss following recurrent pregnancy loss (RPL) as the first manifestation of primary antiphospholipid syndrome. Combine the literature, the diagnosis, clinical implication and treatment are discussed.
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Affiliation(s)
- Tuanfang Yin
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China, 410011
| | - Fengying Huang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China, 410011
| | - Jihao Ren
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China, 410011
| | - Wei Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China, 410011
| | - Xing Chen
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China, 410011
| | - Lihua Li
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China, 410011
| | - Dinghua Xie
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China, 410011
| | - Yongde Lu
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China, 410011
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Abstract
BACKGROUND This is an update of a Cochrane review first published in The Cochrane Library in Issue 1, 2006 and previously updated in 2009.Idiopathic sudden sensorineural hearing loss (ISSHL) is a clinical diagnosis characterised by a sudden deafness of cochlear or retrocochlear origin in the absence of a clear precipitating cause. Steroids are commonly prescribed to treat this condition. There is no consensus on their effectiveness. OBJECTIVES To determine whether steroids in the treatment of ISSHL a) improve hearing (primary) and b) reduce tinnitus (secondary).To determine the incidence of significant side effects from the medication. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 22 April 2013. SELECTION CRITERIA We identified all randomised controlled trials (with or without blinding) in which steroids were evaluated in comparison with either no treatment or a placebo. We considered trials including the use of steroids in combination with another treatment if the comparison control group also received the same other treatment. The two authors reviewed the full-text articles of all the retrieved trials of possible relevance and applied the inclusion criteria independently. DATA COLLECTION AND ANALYSIS We graded trials for risk of bias using the Cochrane approach. The data extraction was performed in a standardised manner by one author and rechecked by the other author. Where necessary we contacted investigators to obtain the missing information. Meta-analysis was neither possible nor considered appropriate because of the heterogeneity of the populations studied and the differences in steroid formulations, dosages and duration of treatment. We analysed and reported the quality of the results of each study individually. A narrative overview of the results is presented. MAIN RESULTS Only three trials, involving 267 participants, satisfied the inclusion criteria and all three studies were at high risk of bias. One trial showed a lack of effect of oral steroids in improving hearing compared with the placebo control group. The second trial showed a significant improvement of hearing in 61% of the patients receiving oral steroid and in only 32% of the patients from the control group (combination of placebo-treated group and untreated control group). The third trial also showed a lack of effect of oral steroids in improving hearing compared with the placebo control. However, this trial did not follow strict inclusion criteria for participant selection and analysis of data was limited by significant exclusion of participants from the final analysis and lack of participant compliance to the treatment protocol. No clear evidence was presented in two trials about any harmful side effects of the steroids. Only one study declared that no patients suffered from adverse effects of the steroid treatment. AUTHORS' CONCLUSIONS The value of steroids in the treatment of idiopathic sudden sensorineural hearing loss remains unclear since the evidence obtained from randomised controlled trials is contradictory in outcome, in part because the studies are based upon too small a number of patients.
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Affiliation(s)
- Benjamin PC Wei
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of Otolaryngology32 Gisborne StreetMelbourneVictoria 3002Australia
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of SurgeryMelbourneAustralia
| | - Dimitra Stathopoulos
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of Otolaryngology32 Gisborne StreetMelbourneVictoria 3002Australia
| | - Stephen O'Leary
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of Otolaryngology32 Gisborne StreetMelbourneVictoria 3002Australia
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