Intratympanic steroid injection as a first-line therapy in uremia patients with sudden sensorineural hearing loss

Clinical Analysis of Intratympanic Injection of Dexamethasone for Treating Sudden Deafness

Introduction

A variety of causes may induce sudden deafness. However, it remains challenging to determine the exact cause in a clinic. There is no standard treatment for this disease due to its unclear etiology.

Objective

The present study aims to investigate the clinical efficacy of the intratympanic injection of dexamethasone for treating sudden deafness.

Methods

A total of 154 patients with sudden deafness were retrospectively analyzed. The evaluation of sudden deafness was based on the AAO-HNS efficacy evaluative criteria. All patients were initially treated within seven days by an intravenous drip of methylprednisolone, vasodilator, and neurotrophic agents. These patients were divided into two groups: the treatment group (91 patients) and the control group (63 patients). Patients in the treatment group were given an intratympanic injection of dexamethasone, while patients in the control group were given conventional vasodilators and neurotrophic treatment.

Results

The effective rate in the treatment group was 47.25% (43/91 patients), and this was significantly higher than in the control group (14.29%, 9/63 patients). The adverse reactions in the treatment group included transient pain (7.69%, 7/91), but there was no vertigo in either group. There was one case of tympanic membrane perforation.

Conclusion

The intratympanic injection of dexamethasone is a better choice for refractory sudden deafness due to its high efficacy and fewer adverse reactions.

Tympanic Membrane Perforation After Intratympanic Steroid Injection: A Systematic Review and Meta-analysis

OBJECTIVE

We investigated the incidence of tympanic membrane (TM) perforations induced after intratympanic steroid injection (ITSI) in patients with sudden sensorineural hearing loss (SSNHL) through a systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, and MEDLINE.

REVIEW METHODS

Primary database searches were performed, and 1901 records were identified. After removal of 1802 articles through abstract screening, the remaining 99 full-text journals were assessed for eligibility to be included in the study. Fifty-eight studies that used either ventilation tubing (VT) or tympanocentesis (TC) for ITSI were selected for analysis. The subjects were divided into VT and TC groups. The rate of TM perforation after ITSI in 2 groups, sites of ITSI, needle gauge, and influence on residual hearing were investigated.

RESULTS

The cohorts comprised patients who underwent VT (n = 257, 9.6%) and TC (n = 2415, 90.4%). The proportion of TM perforation after ITSI in each group was 0.073 (95% CI, 0.0469-0.1113) and 0.010 (95% CI, 0.0045-0.0215), respectively, which suggested that the VT group showed a significantly higher TM perforation rate than the TC group (P < .001). In the subgroup analyses, there was no significant difference in the odds ratio for the rate of TM perforation according to the injection site and needle gauge for TC. The proportion of surgical repair showed no significant difference between the 2 groups.

CONCLUSION

ITSI via VT may have a significantly higher risk of TM perforation than ITSI via TC, although those are relatively small overall. ITSI should be performed in the direction to minimize possible adverse effects.

Intratympanic Steroid Treatment of Bell's Palsy in Patients with Comorbid Disease: A Preliminary Report

OBJECTIVES

This study evaluated the efficacy of intratympanic steroid injection (ITSI)as initial treatment and therecovery speed for Bell's palsy (BP)inpatients with diabetes mellitus (DM)and/or hypertension (HT).

MATERIALS AND METHODS

In total,90 patients with comorbid diseases diagnosed with BP received either ITSI (study group, n=61) or systemic steroid treatment (SST) (control group, n=29).The facial nerve function was assessed using the House-Brackmann (HB) grading system for up to 6 months or until complete recovery from BP. To investigate a relationship with the complete recovery time from BP, hematologic and baseline characteristic parameters were analyzed.

RESULTS

The complete recovery rate of the ITSI and SST groups was 47.5% and 44.8% at the 1st month, 70.5% and 89.7% at the 3rd month, and 96.7% and 100% at the 6th month of the study, respectively. Lymphocyte and neutrophil values were significantly associated with the complete recovery time from BP. No major adverse events from ITSI itself were noticed during the procedure and during the follow-up of the treatment.

CONCLUSION

Both treatment types have no superiorities over each other in initial treatment for BP in patients with comorbid diseases. ITSI is effective and safe and may avoid the unwanted side effects associated with systemic steroids inthese patients.

Sudden sensorineural hearing loss with end-stage renal disease: a report of 32 cases

Background: Patients with end-stage renal disease (ESRD) have a higher risk of suffering sudden sensorineural hearing loss (SSNHL), but little is known about this population. Aims and objectives: To investigate the clinical characteristics, treatment and recovery of SSNHL patients with ESRD. Materials and methods: Records of 32 SSNHL patients with ESRD were reviewed, including clinical characteristics and hearing recovery. Patients were divided into intratympanic steroid (ITS) group and oral steroid (OS) group, and hearing recovery was compared between two groups. Results: Twenty-six patients (81.3%) exhibited tinnitus, and 18 patients (56.3%) suffered vertigo. Mean pure-tone threshold at the initial presentation was 73.2 ± 19.4 dB, and the audiogram configuration was ascending in 9.4%, descending in 9.4%, flat in 34.4% and profound in 46.9% cases. At 3-month follow-up, percentages of patients in complete recovery, partial recovery, slight recovery, and no improvement were 18.8%, 31.3%, 21.9% and 28.1%, respectively. Furthermore, the overall recovery rate, complete recovery rate and hearing improvement were significantly higher in the ITS group than those in the OS group. Conclusion: SSNHL patient with ESRD often suffered a severe hearing loss with a high rate of accompanying tinnitus and vertigo. ITS may provide better audiological results for SSNHL with ESRD than OS.

The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss

Introduction  Sudden hearing loss is one of the otologic emergencies. The treatment of this disease is affected negatively by some prognostic factors. Objective  In this study, the effects of early treatment initiation in patients with idiopathic sudden hearing loss and of prognostic factors in early treated patients were investigated. Methods  Out of the 216 patients admitted between September 2007 and September 2015, 154 were identified as having idiopathic sudden hearing loss; they were followed-up for a mean time of 7.4 months, and evaluated retrospectively. The effects of several parameters on the success of the treatment were statistically evaluated, such as the time the treatment was initiated, being of the female gender, the severity of the hearing loss, having descending type audiogram patterns, being older than 60 years old, and the co-presence of vertigo. Results  Success rates were found to be significantly higher in idiopathic hearing loss patients that were admitted within the first week ( p  < 0.05) of the onset of the hearing loss. However, the outcomes were found to be similar when patients admitted within the first 3 days and 4-7 days after the occurrence of the hearing loss were compared ( p  > 0.05). Parameters such as female gender, severe hearing loss, descending type audiogram, being older than 60 years old, and co-presence of vertigo didn't reveal statistically significant effects on the outcome ( p >0.05). Conclusion  The aforementioned prognostic factors, which are well-known in the literature, did not have significant effects when the idiopathic sudden hearing loss treatment was initiated within the first 7 days of the onset of the hearing loss.

Intratympanic methylprednisolone perfusion as a salvage treatment for profound idiopathic sudden sensorineural hearing loss

Objective:

This study aimed to examine the effectiveness of intratympanic methylprednisolone perfusion as salvage treatment for profound idiopathic sudden sensorineural hearing loss.

Methods:

A retrospective clinical study of 97 patients with unilateral profound idiopathic sudden sensorineural hearing loss was performed. In all, 83 patients who received salvage intratympanic methylprednisolone perfusion plus conventional treatment (except for steroids) as the second-line therapy were assigned to the study group, while 14 patients who received conventional treatment alone were assigned to the comparison group.

Results:

In the study group, treatments in patients with a shorter interval from disease onset to intratympanic methylprednisolone perfusion (up to 15 days) had significantly greater improvements in the overall effective rate and pure tone average compared with patients with a longer interval (over 15 days). For patients with a short interval from disease onset to intratympanic methylprednisolone perfusion, those in the study group had significantly greater improvements in the overall effective rate and pure tone average compared with those in the comparison group. In both the study and comparison groups, hearing improvements were greater at low frequencies than at medium and high frequencies.

Conclusion:

The interval from disease onset to intratympanic methylprednisolone perfusion was the major factor affecting hearing recovery. Early second-line salvage intratympanic methylprednisolone perfusion significantly improved the degree of hearing recovery in profound idiopathic sudden sensorineural hearing loss patients after failure of systemic steroid treatment.