The effect of direct application of dexamethasone on the round window membrane in patients with sudden sensorineural hearing loss (original) (raw)
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Intratympanic Dexamethasone as First-Line Treatment for Selected Patients With Hearing Loss
Revista de Chimie
There is no consensus among ENT (ear, nose and throat) physicians on the causes, diagnosis and especially therapeutic approach in sensorineural hearing loss (SSHL). The present paper describes our experience with intratympanic dexamethasone injection as initial treatment for selected patients with the sudden sensorineural hearing loss. The results obtained were fully encouraging. The sustained and coherent approaches of the national ENT society through his section of otoneurology, can lead to a diagnostic and therapeutic consensus in the sensorineural hearing loss. Further, the National Health Insurance House must introduce in the methodological norms the therapeutic variants and the concrete conditions for their realisation, in order to have a common medical practice.
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2020
Sudden sensorineural hearing loss (SSNHL) is a common otologic emergency, presenting mostly as an acute unilateral deafness, with an abrupt onset (generally within 3 days), of more than 30 dB hearing loss at three consecutive frequencies. 15,000 new cases are reported annually worldwide accounting for approximately 1% of all cases of sensorineural hearing loss. 1 SSNHL can occur due to various causes such as viral infection of the labyrinth or cochlear nerve, labyrinthine membrane rupture, perilymphatic hypoxia, vascular incident, inflammatory and autoimmune disorders. The etiology and pathogenesis of SSNHL are still unclear, and its treatment is still controversial. Spontaneous recovery occurs in approximately 30% of cases and recovery occurs usually within the first 2 weeks after onset. 2 Many factors affect the recovery; the degree of hearing loss, the audiogram, presence of vertigo and the time between the onset of SSNHL and treatment probably being the most important.
The Egyptian Journal of Otolaryngology
Background The aim of this study was to determine whether different concentrations of intratympanic (IT) injection of dexamethasone at a dose of 4 and 10 mg/mL have an effect on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Results Our study was conducted on 30 adult patients with unilateral ISSNHL who failed to respond or with contraindications to systemic steroids. Patients were categorized into two groups; each one included 15 patients. IT injection of 4 mg/mL dexamethasone was done in one group (IT dexamethasone (Dex) 4 mg/mL), while 10 mg/mL dexamethasone was administered intratympanically in the other group (IT Dex 10 mg/mL). IT injection was performed twice weekly for two successive weeks. PTA thresholds were assessed at 0.5, 1, 2 and 4 kHz before and 1 month after the treatment. In the group with IT Dex 10 mg/mL, the average PTA improved significantly from 75.50 ± 12.59 to 49 ± 24.04 dB with an average gain of 26.50 ± 14.25 (p = 0.0...
Intratympanic Dexamethasone for Sudden Sensorineural Hearing Loss After Failure of Systemic Therapy
The Laryngoscope, 2007
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 puretone 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 injec-Laryngoscope 117: January 2007
[Intratympanic dexamethasone as therapeutic option in sudden sensorineural hearing loss]
Acta otorrinolaringológica española
The administration of systemic corticosteroids has demonstrated effectiveness on the treatment of idiopathic sudden sensorineural hearing loss. However, its systemic toxicity and subsequent difficulty for its justification in some patients have led to it being applied intratympanically. The main aim of this study is to determine the effectiveness of intratympanic dexamethasone in these patients. In addition we evaluate the relationship between the prognosis of this condition and the magnitude of initial hearing loss, the presence of vertigo or delay in the beginning of therapy. We performed a retrospective case study of 18 patients. All of them were treated with intratympanic dexamethasone (4 mg/ml), administered weekly for 3 weeks. The follow-up was 1 month at least. The therapeutic success was arbitrarily defined to be a mean improvement of 25 dB or greater. 72.2% of the population recovered hearing successfully. The mean auditory threshold prior to treatment was 91+/-25 dB versus...
Effectiveness of intratympanic dexamethasone for refractory sudden sensorineural hearing loss
European Archives of Oto-Rhino-Laryngology, 2013
The purpose of this study was to investigate the effectiveness of intratympanic steroids in patients with idiopathic sudden sensorineural hearing loss who did not respond to initial systemic steroid therapy. This retrospective study involved 51 patients, who did not respond to systemic steroids as a first-line treatment. Initial systemic steroid therapy consisted of administration of methylprednisolon intravenously (250 mg) at the first day and followed by orally (1 mg/kg) tapering for 14 days. Twentyone patients accepted intratympanic treatment, and the remaining 30 patients who refused intratympanic treatment were evaluated as the control group. Steroids (dexamethasone drops, 1 mg/mL) were administered through a ventilation tube. Hearing was assessed immediately before treatment and 2 months after treatment. Recovery of hearing was defined as an improvement of [20 dB in the pure tone average. We tested 250, 500, 1,000, 2,000, 4,000, and 8,000 Hz frequencies for the pure tone audiometric evaluation. Statistically Student's t test, Mann-Whitney U test, Chi-squared and Fisher's exact tests were used. The pure tone average improved in 47.6 % of the intratympanic group and in 10 % of the control group (p = 0.002), with pure tone average improvements of 19.9 ± 16.5 and 4.76 ± 9.6 dB in the intratympanic and control groups, respectively. When the hearing threshold at each frequency was analyzed, improvements at all frequencies were significantly greater in the intratympanic steroid group when compared with the control group (p \ 0.01). Intratympanic steroid administration is an effective therapy for sudden sensorineural hearing loss in patients, who are refractory to primary systemic steroid therapy.
Laryngoscope, 2016
Objective: Systemic dexamethasone has demonstrated conclusive benefits in reversing sudden sensorineural hearing loss (SSNHL) despite considerable number of potential side effects. In contrast, the intratympanic route of steroid administration averts several possible complications. This study aims to examine the literature to delineate the efficacy and side effect of intratympanic dexamethasone (ITD) injection for the treatment of SSNHL.
Hearing Research, 2009
Aim: To protect hearing in an experimental model of cochlear implantation by the application of dexamethasone to the round window prior to surgery. The present study examined the dosage and timing relationships required to optimise the hearing protection. Methods: Dexamethasone or saline (control) was absorbed into a pledget of the carboxymethylcellulose and hyaluronic acid and applied to the round window of the guinea pig prior to cochlear implantation. The treatment groups were 2% w/v dexamethasone for 30, 60 and 120 min; 20% dexamethasone applied for 30 min. Auditory sensitivity was determined pre-operatively, and at 1 week after surgery, with puretone auditory brainstem response audiometry (2-32 kHz). Cochlear implantation was performed via a cochleostomy drilled into the basal turn of the cochlea, into which a miniature cochlear implant dummy electrode was inserted using soft-surgery techniques. Results: ABR thresholds were elevated after cochlear implantation, maximally at 32 kHz and to a lesser extent at lower frequencies. Thresholds were less elevated after dexamethasone treatment, and the hearing protection improved when 2% dexamethasone was applied to the round window for longer periods of time prior to implantation. The time that dexamethasone need be applied to achieve hearing protection could be reduced by increasing the concentration of steroid, with a 20% application for 30 min achieving similar levels of protection to a 60 min application of 2% dexamethasone. Conclusions: Hearing protection is improved by increasing the time that dexamethasone is applied to the round window prior to cochlear implantation, and the waiting time can be reduced by increasing the steroid concentration. These results suggest that the diffusion dexamethasone through the cochlea is the prime determinant of the extent of hearing protection.
The Laryngoscope, 2004
To study the effectiveness of intratympanic dexamethasone (IT-DEX) in patients with severe or profound sudden sensorineural hearing loss (SSNHL) after treatment failure with conventional therapy. Study Design: Randomized, controlled study. Methods: Patients who met the criteria for SSNHL, with a severity of severe to profound, underwent 10 days of standard treatment with oral steroid and other facilitating agents. Patients showing poor response to standard treatment were assigned randomly to a control group or to a group receiving IT-DEX. IT-DEX injections were performed once a week for 3 consecutive weeks. Pure-tone audiometry was obtained before each injection. Minimum follow-up time was 1 month. Successful treatment was defined as a hearing improvement of greater than 30 dB. Results: Thirty-nine patients meeting the inclusion criteria were studied. After treatment with oral steroid, 10 of 39 (26%) patients demonstrated hearing improvement, whereas the remaining 29 (74%) patients showed a hearing improvement of less than 30 dB. For those without hearing improvement, 15 received IT-DEX, and 14 received further standard treatment (except oral steroid and carbogen inhalation). Hearing improved in 8 of 15 (53.3%) compared with 1 of 14 (7.1%), with an average decrease in threshold of 28.4 dB and 13.2 dB for the IT-DEX group and the control group, respectively (P < .05). Prognostic factors such as age, treatment delay time, and sex did not significantly affect the response to therapy. Conclusions: IT-DEX injection effectively improves hearing in patients with severe or profound SSNHL after treatment failure with standard therapy and is not associated with major side effects. It is therefore a reasonable alternative as salvage treatment.
Effect of Intratympanic Dexamethasone in Idiopathic Sudden Sensorineural Hearing Loss
Bengal Journal of Otolaryngology and Head Neck Surgery, 2019
Introduction Oral steroids currently represent the standard treatment for idiopathic sudden sensorineural hearing loss The aim of this study is to assess the effectiveness of intratympanic dexamethasone injection for treating ‘Idiopathic sudden sensori-neural hearing loss’ (ISSNHL) not improved with conventional oral steroid. Materials and Methods A prospective study was conducted on 30 patients refractory to oral steroid therapy between June 2017 to May 2018. ‘Intratympanic dexamethasone injection’ (ITDI) was given every week for 3 consecutive weeks. Hearing was assessed by performing pure tone audiogram before every ITDI and also 1 week after the completion of treatment. Results Hearing improvement was found in 19 out of the 30 cases (63.3%). Conclusions Intratympanic dexamethasone significantly improves the prognosis of ISSNHL and is a safe, inexpensive and effective treatment.