The efficacy of intratympanic steroid injection for the treatment of idiopathic sudden sensorineural hearing loss

@#Objective: A systemic steroid is known to have a potential to recover hearing after idiopathic sudden sensorineural hearing loss (ISSHL). However, lately many centres have introduced the use of intratympanic (IT) steroid therapy as an option. We reviewed our experience in the treatment of patients with ISSHL looking at the overall success of using systemic steroid, IT steroid injections as salvage therapy and primary IT steroid injection. Methods: A retrospective study was conducted on 20 patients who had suffered from ISSHL from January 1, 2012, to December 31, 2017. ISSHL is defined as a rapid decline in hearing over three days or less affecting three or more frequencies by 30dB or greater. Comparison between the mode of steroid therapies and improvement in patients was done. At least 15dB improvement in pure tone audiogram (PTA) was considered as successful therapeutic intervention. Results: Twenty male and female patients who fit the inclusion and exclusion criteria were included. The mean age of the patients was 41.4 years with a range from 13 to 72 years. Ninety percent patients presented with unilateral ISSHL involvement. Eight ears of patients who received systemic steroid therapy alone had improved hearings (75%). Out of seven ears from six patients who received salvage therapy, four ears (57.1 %) had improvement in PTA. Seven ears showed improvement in PTA from a total of eight patients who primarily received IT injections. Conclusions: IT steroid therapy promises a favourable outcome in the improvement of the hearing, as compared to systemic steroid administration. Its usage is recommended not only for salvage therapy but should be used as primary treatment especially in those with co- morbiditie

Sudden Sensorineural Hearing Loss: Comparative Study of Different Treatment Modalities

Abstract Introduction Idiopathic sudden sensorineural hearing loss (ISSNHL) is hearing loss of at least 30 dB in at least 3 contiguous frequencies within at least 72 hours. There are many different theories to explain it, and many differentmodalities are used for its management, such as: systemic steroids (SSs), intratympanic steroid injection (ITSI), hyperbaric oxygen therapy (HOT), antiviral drugs, and vasodilators or vasoactive substances. Objectives This study aims to evaluate the efficacy of the combination of the most common treatmentmodalities of ISSNHL and to compare the results if HOTwas not one of the treatment modalities administered. Methods The study was conducted with 22 ISSNHL patients with ages ranging from 34 to 58 years. The patients were divided into 2 groups; group A included 11 patients managed by SSs, ITSI, antiviral therapy, and HOT simultaneously, and group B included 11 patients exposed to the aforementioned modalities, with the exception of HOT. Results After one month, all of the patients in group A showed total improvement in hearing in all frequencies, with pure tone average (PTA) of 18.1 ± 2.2, while in group B, 5/11 (45.5%) patients showed total improvement, and 6 /11 (54.5%) patients showed partial improvement, with a total mean PTA of 28.1 ± 8.7. Conclusion The early administration of HOT in combination with other clinically approved modalities (SSs, ITSI, antiviral therapy) provides better results than the administration of the same modalities, with the exception of HOT, in the treatment of ISSNHL.

Analysis of clinical effects of intratympanic injection of dexamethasone in treatment of sudden deafness in different time windows / 中国基层医药

Objective To investigate the clinical effect of intratympanic injection of dexamethasone in treatment of sudden deafness in different time windows.Methods 60 patients (60 ears) with sudden deafness were selected.Sixty patients were divided into control group and observation group according to the random number table method,30 cases (30 ears) in the control group and 30 cases (30 ears) in the observation group.The two groups were given systemic basic therapy, intravenous vinpocetine, alprostadil improve microcirculation, while hyperbaric oxygen therapy,12 days for a course of treatment, treatment for 2 courses.In the control group, dexamethasone was intravenously administered for 12 days.From the 7th day, dexamethasone was injected into the tympanic cavity and injected once every other day.The observation group was treated with dexamethasone at the same time.Injection of dexamethasone, treatment method and time were the same as the control group.At the end of the treatment, the clinical curative effect of the two groups was compared.The average hearing thresholds of the two groups were observed before and after treatment.The dizziness, tinnitus and hearing recovery time of the two groups were observed.Results The total effective rate was 96.67% in the observation group and 93.33% in the control group, the difference was not statistically significant (x2 =0.97,P> 0.05).After treatment, the average hearing threshold of the two groups was significantly improved (t=7.69,8.23,all P<0.05),the average hearing threshold of the observation group was higher than that of the control group, the average hearing threshold before and after treatment had statistically significant differences (t=2.34,2.67,all P<0.05).In the observation group, dizziness, tinnitus and hearing recovery time were shorter than those in the control group (t=3.32,3.14,3.67,all P<0.05).Conclusion The effect of dexamethasone combined with systemic treatment of sudden deafness in patients compared with intratympanic injection of dexamethasone after intravenous administration of dexamethasone is not significantly different, but the improvement of hearing threshold after treatment compared with the latter is obvious, and the average time to disappear symptoms is shorter than the latter, and therefore worthy of clinical promotion.

Efifcacy of early combination treatment with intratympanic glucocorticoid injection for sudden hearing loss / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo investigate the therapeutic effect of early combination treatment with intratympanic glucocorticoid injection for sudden sensorineural hearing loss(SSNHL).METHODSTotal of 178 patients with diagnosis of SSNHL, including 44 with hearing loss at middle-low frequencies,50 at high frequencies,44 at all frequencies and 40 at total deafness, were randomly divided into combination treatment group (CT group) and systemic oral prednisone group (OP group).CT group (82 patients) received intratympanic administration of methylprednisolone and oral prednisone in tapering doses. Pure-tone threshold audiometry (PTA) was performed at week 8 after beginning of therapy. RESULTSIn middle-low frequencies, the final PTA and PTA improvement were 26.14±24.82 dB and 42.23±1.61 dB in CT group respectively, and were 37.91±13.98 dB and 30.00±13.30 dB in OP group respectively (both P<0.05). In high frequencies, all frequencies and total deafness SSNHL group, the differences of the final PTA and PTA improvement were not statistically significant in both groups. The PTA improvement in CT group for total deafness (26.52±14.03) dB was more than that of OP group (22.06±11.17)dB (t=2.361,P<0.05). In middle-low frequencies, the recovery rate was 72.73%(16 cases) in CT group, and 40.91% (9 cases) in OP group, the difference was significant (χ2=4.539,P<0.05), but not in apparent effective rate, effective rate and total effective rate. In high frequencies, all frequencies and total deafness, there were no significant differences in therapeutic effect. The recovery rate of total CT group (40.24%) was significantly increased compared with that of OP group (26.04%)(χ2=4.061,P<0.05), the differences of apparent effective rate, effective rate and total effective rate were not statistically significant in both groups.CONCLUSIONFor low-middle frequencies SSNHL, the early combination treatment with intratympanic glucocorticoid injection leads to higher hearing recovery and therapeutic effect compared with traditional oral prednisone. Systemic application should be applied for high frequencies, all frequencies and total deafness of SSNHL.

The AppIication of EndoIymphatic Space Imaging in the Diagnosis of DeIayed EndoIymphatic Hydrops / 听力学及言语疾病杂志

Objective To investigate the pathological mechanism of delayed endolymphatic hydrops(DEH) , and clarify the clinical value of endolymphatic space imaging after intratympanic injection of gadolinium in the diag_nosis of delayed endolymphatic hydrops .Methods Twenty -four hours after bilateral intratympanic injection of gadolinium ,the locations and severity of endolymphatic hydrops of all patients were evaluated by using three dimen_sional fluid-attenuated inversion recovery (3D -FLAIR) and three dimensional real inversionrecovery (3D -real IR) .ResuIts All patients had unilateral or bilateral endolymphatic hydrops .Among 9 ipsilateral DEH patients , only 1 (11 .1% ) patient was identified as mild endolymphatic hydrops and the rest (88 .9% ) examined had signifi_cant endolymphatic hydrops in vestibule of their affected ears ;Endolymphatic hydrops appeared in cochlea of the af_fected ear in 8 (88 .9% ) patients ,except for 1 patient .Endolymphatic hydrops were not observed in the contralater_al ears of 9 ipsilateral DEH patients .Mild endolymphatic hydrops in bilateral vestibule ,severe in right cochlear and none in left cochlea of contralateral DEH patient were identified .ConcIusion Endolymphatic hydrops is the primary pathological factors of DEH .Endolymphatic space imaging after intratympanic injection of gadolinium can intuitively reflect the locations and severity of endolymphatic hydrops in DEH patients .

Efficacy of intratympanic dexamethasone combined with prednisone on idiopathic sudden sensorineural hearing loss / 实用医学杂志

Objective To evaluate the therapeutic efficacy of intratympanic dexamethasone injections combined with prednisone in patients with idiopathic sudden sensorineural hearing loss. Methods A total of 71 patients diagnosed with sudden hearing loss were treated with intratympanic dexamethasone injections plus prednisone (B group) or prednisone alone (A group). Hearing was evaluated by pure tone audiogram performed before initial treatment and at 4 weeks following the final treatment. Results The total recovery rate after the treatment was 81.8% in the B group and 55.3% in the A group. The diflference between two groups was statistically significant (P < 0.05). Conclusion The present study suggests that sudden sensorineural hearing loss patients treated with intratympanic dexamethasone combined with prednisone have a higher likelihood of hearing recovery than those treated with prednisone alone.

Intratympanic Steroid Therapy for Sudden Sensorineural Hearing Loss

While systemic steroid therapy is most widely considered as a main treatment for idiopathic sudden sensorineural hearing loss (SSHL), the disadvantages of its use are numerous side effects. Intratympanic steroid injection (ITS) delivers steroids through transtympanic route, hence avoids possible side effects with higher perilymph concentration. We conducted a reviewed 47 clinical studies after an online search of the PubMed databases for the following terms "sudden hearing loss, intratympanic steroid". Although the study settings are varied among reviewed articles, most studies in this review consistently showed some benefit of hearing in salvage cases. In addition, it is suggested that intratympanic steroids are equivalent to systemic steroid therapy as initial treatment for SSHL. In patients with contraindications against the use of systemic steroid, ITS may be considered as valuable option for primary therapy. Further studies are necessary to elucidate the optimal protocol of administration.

Intratympanic Steroid Therapy for Sudden Sensorineural Hearing Loss

While systemic steroid therapy is most widely considered as a main treatment for idiopathic sudden sensorineural hearing loss (SSHL), the disadvantages of its use are numerous side effects. Intratympanic steroid injection (ITS) delivers steroids through transtympanic route, hence avoids possible side effects with higher perilymph concentration. We conducted a reviewed 47 clinical studies after an online search of the PubMed databases for the following terms "sudden hearing loss, intratympanic steroid". Although the study settings are varied among reviewed articles, most studies in this review consistently showed some benefit of hearing in salvage cases. In addition, it is suggested that intratympanic steroids are equivalent to systemic steroid therapy as initial treatment for SSHL. In patients with contraindications against the use of systemic steroid, ITS may be considered as valuable option for primary therapy. Further studies are necessary to elucidate the optimal protocol of administration.

Visualization of endolymphatic hydrops using Magnetic Resonance Imaging after intratympanic Gd-DTPA administration in patients with Meniere's disease

BACKGROUND AND OBJECTIVES: Endolymphatic hydrops are known as major causes of Meniere's disease. MRI (Magnetic resonance imaging) with contrast tried recently makes it possible to visualize perilymphatic and endolymphatic space without invasive procedures. There are no tryouts in the interior of our country. We attempted MRI after injection of gadolinium-diethylen-triamine pentaacetic acid (Gd-DTPA) in normal adults and patients with Meniere's disease to make sure 3D-FLAIR (fluid-attenuated inversion recovery) MRI parameters and to visualize endolymphatic spaces. MATERIALS AND METHODS: Five normal adults and Five patients with Meniere's disease were included in this study. Twenty-four hours after Gd-DTPA intratympanic injection, we performed 3D-FLAIR and 3D-IR imaging at 3T. MRI region of interest signal intensity was used to determine the diffusion of Gd-DTPA into the perilymphatic fluid spaces over time. RESULTS: Five of five in normal group, using 3D-IR MRI after Gd injection, had enhanced imagings (perilymphatic spaces) of inner ears. Five of five in patients group, using 3D-IR after Gd injection, had enhanced perilymphatic spaces and non-enhanced endolymphatic hydrops. CONCLUSIONS: Delayed contrast imaging of the inner ear with 3D-IR MRI after Gd-DTPA intratympanic injection revealed in vivo visualization of endolymphatic hydrops.