Different prognoses in patients with profound sudden sensorineural hearing loss.

Background: Inner ear hemorrhage is increasingly recognized as a cochlear lesion that can cause profound sudden sensorineural hearing loss (SSNHL). Objectives: To investigate changes of cochlear and vestibular function and to compare therapeutic recovery from profound SSNHL induced by different etiologies. Material and methods: Eighty patients with profound SSNHL (≥90 dB) were divided into an inner ear hemorrhage group and a non-inner ear hemorrhage group by MRI. Statistical analysis was performed to compare the therapeutic effects from vertigo and hearing loss and the outcomes of follow-up in the two groups. Results: There were significant differences between the two groups in terms of the overall 14-day therapeutic response rate (20 vs. 48%), the incidence of imbalance (26.7 vs. 6%), the incidence of semicircular canal dysfunction on the affected side (60 vs. 20%), the incidence of abnormal C-VEMP and O-VEMP on the affected side (63.3 vs. 38%; and 60 vs. 30%, respectively), the average hearing threshold (74.2 ± 10.7 vs. 53.6 ± 11.4 dB), and the word recognition score (65.5 ± 21.7 vs. 83.5 ± 24.5%) at a 12-month follow-up. Conclusions and significance: A higher percentage of patients with profound SSNHL induced by inner ear hemorrhage were associated with vertigo and had a poor prognosis.

Comparison of intratympanic dexamethasone therapy and hyperbaric oxygen therapy for the salvage treatment of refractory high-frequency sudden sensorineural hearing loss.

OBJECTIVE: This study aimed to compare the efficacy of intratympanic dexamethasone (ITD) therapy and hyperbaric oxygen(HBO) therapy for the salvage treatment of patients with high-frequency sudden sensorineural hearing loss (SSNHL) after the failure of conventional therapy. MATERIALS AND METHODS: 104 refractory high-frequency SSNHL patients were enrolled in our study. Among them, 31 received ITD alone (ITD group), 32 received HBO alone (HBO group) and 41 received no salvage therapies (control group). Hearing outcomes were determined by pure-tone average measured by audiometry. The total effective rates in the hearing recovery and improvement of tinnitus were calculated before and after salvage treatment. RESULTS: There was no significant difference of the total effective rates in the hearing recovery between ITD and HBO group (p = 0.368). However, ITD therapy showed much better improvements of tinnitus than HBO therapy (p = 0.039). After ITD and HBO therapy, there were no significant differences in hearing gains at 2 and 4 KHz between ITD and HBO group (p = 0.468 and 0.934, respectively). Nevertheless, ITD therapy showed significant improvements of hearing gains at 8 KHz (p = 0.049) compared to that of HBO therapy. CONCLUSION: ITD therapy may have better improvements of tinnitus and hearing gains at 8 KHz than HBO therapy in patients with refractory high-frequency SSNHL.

The effect of Nigella sativa oil on prevention of myringosclerosis in a Guinea pig model.

OBJECTIVES: In this study, our aim was to identify the possible effects of Nigella sativa L. (NS) [blackcumin] seed oil on the prevention of experimentally induced myringosclerosis (MS). MATERIALS AND METHODS: Fourteen Guinea pigs were used and they were divided into three groups. Tympanic membranes (TM) of all animals were perforated and then group I was treated with saline soaked gel foams as a control group, group II was treated with 0.5 ml NS oil soaked gel foams at 0, 24 and 48 h and group III was treated with 5 ml NS oil orally at 0, 24, 48, 72 and 120 h. After 15 days, all animals were euthanized. Tympanic membranes were evaluated macroscopically and histopathologically. RESULTS: Groups I showed extensive myringosclerosis in contrast to those of Groups II and III which had significantly less changes (p < 0.05). The fibrosis and inflammation in the lamina propria of the tympanic membranes of Groups I was found to be significantly more pronounced (p < 0.05). The tympanic membranes were found to be significantly thinner in Groups II and III when compared with Groups I (p < 0.05). CONCLUSIONS: The results of this study suggested that topical or oral administration of NS oil supressed the inflammation and fibroblastic activity in the lamina propria of the myringotomized TMs of the Guinea pigs. For providing further evidence to use plant extracts as antioxidant and antiinflammatory therapy after myringotomy or ventilation tube insertion, further clinical studies with larger population will be essential.

Assessment of the ototoxicity of almond oil in a chinchilla animal model.

OBJECTIVES/HYPOTHESIS: Almond oil is frequently prescribed as a ceruminolytic, to soften ear wax or relieve ventilation tube occlusion. Ceruminolytics could lead to ototoxicity in the presence of a tympanic perforation. Reports on the safety of almond oil as a ceruminolytic is limited. The present study aimed to assess the effect of ototopic almond oil on hearing. STUDY DESIGN: Prospective, randomized, controlled trial in a chinchilla animal model. METHODS: Bilateral myringotomies were performed in 19 female chinchilla. One randomly selected ear received almond oil, whereas the other ear received saline applied transtympanically. Auditory Brainstem Response (ABR) testing was performed prior to application and at 14 and 30 days following application. Postmortem Scanning Electron Microscopy (SEM) images were obtained to assess cochlear hair cell status. RESULTS: At 30 days following application, there was no significant change in ABR thresholds at 16, 20, or 25 kHz. No cochlear hair cell loss was observed with SEM. CONCLUSIONS: In the chinchilla, when a tympanic perforation is present, almond oil does not seem to cause ototoxicity. Further studies are needed to better assess the effect of almond oil on hearing in humans.

Demographics and microbiology of otorrhea through patent tubes failing ototopical and/or oral antibiotic therapy.

OBJECTIVES: Posttympanostomy tube otorrhea (PTTO) results in significant health care cost and decreased satisfaction with care. The authors reviewed PTTO failing initial ototopical and/or oral antibiotic therapy and microbiology/susceptibility data from cultures. STUDY DESIGN: Case series with chart review. SETTING: A community university satellite ambulatory clinic and the outpatient clinic of a children's hospital. METHODS: Review of 202 patients with 228 discrete episodes of culture-positive otorrhea from January 2004 to January 2009. RESULTS: PTTO occurred an average of 13 months after tube placement. Median otorrhea duration was 21 days (mean, 42 days). A mean of 1.6 visits (range, 1-6) to the pediatric otolaryngology office was required for PTTO resolution. Ototopical therapy was reported used in 198 of 228 (87%) episodes of otorrhea prior to pediatric otolaryngology visit. Nearly 50% of patients were prescribed at least 1 or more courses of systemic antibiotics. Staphylococcus aureus accounted for 52% of the organisms cultured, with 57% methicillin-resistant S aureus (MRSA). S aureus resistance to clindamycin was high (49%) and resistance to levofloxacin was low (1.8%). MRSA was 68% clindamycin resistant, much higher than both ours and the children's hospital's clindamycin resistance rate of MRSA cultured from all other body sites. CONCLUSIONS: PTTO that presents as having failed ototopical and/or oral antibiotics most commonly consists of S aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa. MRSA is highly prevalent in this population. It is not necessary to culture PTTO that presents to an otolaryngology office, as resistance to levofloxacin was only 1.8%. It is unclear why the same fluoroquinolone ototopical therapy that failed initially is often successful in treating PTTO after otolaryngologist visit.

Topical dexamethasone and tympanic membrane perforation healing in otitis media: a short-term study.

BACKGROUND: The safety and efficacy of topical corticosteroids have not been established in the treatment of acute otitis media (AOM) with tympanic membrane (TM) perforation. Specific concerns include the risk for nonhealing TM perforations. Previous studies have not been done in models with concurrent AOM. The purpose of this study was to determine whether the addition of dexamethasone to topical ciprofloxacin affects healing of AOM-related TM perforations. METHODS: Bilateral AOM was induced in chinchillas by transbulla injection of Streptococcus pneumoniae, and TMs were perforated with a CO2 laser 3 to 5 days later. Each animal received ciprofloxacin-dexamethasone in one ear and ciprofloxacin in the other, twice daily for 7 days. Tympanic membranes were assessed for 4 weeks. RESULTS: Fifteen of 55 ciprofloxacin-treated and 37 of 55 ciprofloxacin-dexamethasone-treated TMs failed to heal within the 4-week study period (p < 0.001). Exposure to dexamethasone increased the odds for persistent perforation by 5.5 (95% confidence interval, 2.4-12.6). At 4 weeks, mean TM perforation diameter was 0.9 mm in ciprofloxacin-treated ears and 2.1 mm in ciprofloxacin-dexamethasone-treated ears (p < 0.001). CONCLUSION: Topical dexamethasone hinders TM healing in a chinchilla model of AOM at short-term follow-up. Longer follow-up is needed.

Effects of ciprofloxacin-dexamethasone on myringotomy wound healing.

OBJECTIVE: To evaluate the effects of the ciprofloxacin-dexamethasone (CDX) combination ototopical treatment after myringotomy on tympanic membrane (TM) healing in ears with eustachian tube obstruction (ETO) and unobstructed ears. STUDY DESIGN: Prospective, randomized, masked, controlled. METHODS: ETO was created in the left ear of 30 rats to induce a model of otitis media with effusion (OME). After 3 weeks, bilateral myringotomy was performed (day 0). Animals were randomized into three groups to receive no treatment or bilateral once daily ototopical treatment with balanced salt solution (BSS, vehicle) or CDX for 13 days. Bilateral otomicroscopy was performed on days 7, 14, and 28. On day 14, five randomly selected animals per group were humanely euthanized and the TM harvested for histology. Three additional rats provided normal negative control ears for histologic comparisons. RESULTS: On day 14, TM perforation healing rates were 100% in all ears of untreated and BSS-treated animals, 89% (8/9) in CDX-treated obstructed ears, and 30% (3/10) in CDX-treated unobstructed ears (P < .05 vs. BSS). On day 28, 100% (5/5) of the CDX-treated unobstructed ears and 80% (4/5) of the CDX-treated obstructed ears were healed. Histology showed initial TM thickening postmyringotomy in all ears but no significant qualitative differences between groups on day 28. CONCLUSION: Myringotomy healing was transiently modulated by treatment with CDX but proceeded normally after CDX discontinuation. This early modulation might enhance middle ear drainage and middle ear concentrations of CDX when tympanostomy tube surgery is performed in patients with active OME and ETO, thus potentially reducing otorrhea and preventing or treating infection. It would not be expected to increase the risk of premature tube extrusion or adversely affect normal healing of the TM after usual spontaneous extrusion.

Effect of intratympanic application of aminoglycosides on click-evoked myogenic potentials in Guinea pigs.

OBJECTIVES: Although numerous studies have identified damage to the cochlear and vestibular end organs as the primary site of aminoglycoside-induced ototoxicity, the effect on the saccule remains poorly understood, possibly due to lack of monitoring saccular function in experimental animals. Therefore, this study applied three kinds of aminoglycosides into the tympanic space of guinea pigs to examine their toxic impact on the saccule by way of click-evoked myogenic potential test coupled with morphologic assessment. DESIGN: Albino guinea pigs were treated with saline, gentamicin, tobramycin, or amikacin, with 10 animals assigned to each group. Each compound was injected directly overlying but not through the round window membrane on the left ear, with the right ear serving as a control. One week after injection, each animal underwent auditory brain stem response, caloric test, and click-evoked myogenic potential test. Animals were then killed for morphologic assessment through the use of light and electron microscopic examinations. RESULTS: The animals treated with saline, gentamicin, tobramycin, or amikacin exhibited abnormal auditory brain stem response in 0%, 30%, 100%, and 30% of cases; abnormal caloric responses were found in 0%, 100%, 40%, and 40% of cases; absent click-evoked myogenic potentials were found in 0%, 100%, 30%, and 40% of cases, respectively. Gentamicin and other groups differed significantly in abnormal rates of caloric responses and click-evoked myogenic potentials. Morphologic study of the gentamicin-treated animals confirmed that the absence of click-evoked myogenic potential originated from the lesion in the saccular macula. CONCLUSIONS: Gentamicin represents the dominant susceptibility of aminoglycoside-induced vestibulotoxicity for eliminating both semicircular canal and saccular functions. This study further confirms the findings of human studies in which the caloric and vestibular evoked myogenic potentials responses were monitored to assess the abolition of vestibular function in patients treated with intratympanic gentamicin injection.

Effective anaesthesia for transtympanic electrocochleography.

The objective of this study was to quantify the anaesthetic effect of EMLA cream during transtympanic electrocochleography (TTECochG) and thereby to determine if the application of EMLA should be recommended in routine practice of electrocochleography (ECochG). ECochG provides useful information in patients with inner ear fluid disorders. A major concern regarding transtympanic positioning of the electrode in ECochG is patient discomfort. Previous work has suggested that EMLA cream may make this technique more tolerable to patients. A prospective randomized study was performed evaluating the discomfort associated with unilateral TTECochG in a group where EMLA cream was used to anaesthesize the tympanic membrane (n = 24), and in a group where no anaesthesia was used (n = 22). A statistically significant difference was evident between the discomfort ratings of the groups (P < 0.0001, Mann-Whitney U test), the discomfort being greater in the no anaesthesia group. EMLA cream has thus been shown to alleviate the level of discomfort associated with TTECochG and so to be an acceptable modification of this technique.

Effects of intratympanically delivered lidocaine on the auditory system in humans.

Since lidocaine is used to relieve the symptoms of Meniere's disease and tinnitus, its effects on the human cochlea is of specific interest. In experimental animals, topically administered lidocaine affects cochlear electrophysiology in a specific, dose-dependent manner. In the current study, lidocaine (40 mg in 1 ml of saline) was delivered intratympanically in six patients with essentially normal hearing in an attempt to alleviate tinnitus. Auditory function was assessed by pure tone audiometry, auditory evoked brain stem responses (ABR), and transiently evoked otoacoustic emissions (TEOAE) to observe possible drug effect in the auditory system. In five patients, saline was injected prior to lidocaine for control purposes. Saline injection did not create significant changes in any of the measures. After a 2 hr follow-up period, intratympanic injection of lidocaine caused a 2 to 10 dB reduction in TEOAE level at 1 to 3 kHz frequencies. This reduction was at its maximum at the 30 min post-injection sampling point, and was followed by a slow recovery. At 2 hr post-injection, TEOAE amplitude was still 2 to 4 dB below baseline level. Pure tone thresholds were slightly affected 30 min after intratympanic lidocaine injection, but were fully recovered 1 hr after the injection. Lidocaine injection did not cause any changes in ABR latencies or amplitudes in any of the patients. These results suggest that the dose of intratympanically administered lidocaine used here has a specific effect on the organ of Corti structures in human subjects, without significantly affecting the auditory nerve or central auditory pathways. The relationship of the drug effect in conjunction with a possible effect on inner ear disorder might help to localize the site of disorder.

A comparison of topical Emla cream with Bonain's solution for anesthesia of the tympanic membrane during tympanocentesis.

The purpose of this study was to investigate the relative efficacy of Emla cream (a eutectic formulation of lignocaine and prilocaine) and Bonain's solution (equal amounts of cocaine hydrochloride, menthol and phenol) as local anesthetic agents to the tympanic membrane. Fifty patients undergoing bilateral tympanocentesis were included. The patients were used as their own controls. One tympanic membrane was anesthetized with Emla cream and the other with Bonain's solution. The operating microscope was used. After a 30 min analgesic time, tympanocentesis was performed with aspiration of middle ear secretions. Each patient was then asked to fill in a questionnaire that graded the severity of pain experienced: none, very mild, mild, moderate or severe. Findings showed that Bonain's solution was more effective in tympanocentesis. All patients experienced no pain to very mild pain. With Emla cream 15 of 50 patients experienced mild to moderate pain. No significant side effects occurred with either anesthetic agent.

[Topical anesthesia of the tympanic membrane and tubal function--is there a correlation?]. / Topische Trommelfellanästhesie und Tubenfunktion--gibt es Zusammenhänge?

The influence of topical anaesthesia of the tympanic membrane on Eustachian tube function was investigated using the pressure chamber impedance method, thus obtaining quantitative data. Anaesthesia was performed by application to the tympanic membrane of small cotton balls containing lidocaine and dimethylsulfoxide. We did not observe significant alterations of tubal parameters after unilateral or bilateral anaesthesia. Our observations are in contrast to investigations published by Nagai. We suppose that differences in methods of topical anaesthesia are responsible for this discrepancy. Our technique of topical anaesthesia of the tympanic membrane excludes any effect on the Eustachian tube, thereby avoiding negative consequences of middle ear pressure on wound healing.

Phenol anesthesia of the tympanic membrane in purulent otitis media: a structural analysis in the rat.

In the present study, local anesthetics were applied to the tympanic membrane (TM) of rats following experimentally evoked purulent otitis media (POM). The structure of the TM was evaluated 24 h, 2 weeks and 3 months after application of phenol to a discrete are of the right TM. The left ear was used as a control. POM induced swelling of all tissue layers of the pears tensa. The tissues were invaded by inflammatory cells and disintegrated. The fibrous layer also dissolved, leaving spontaneous perforations. However, phenol on inflamed TMs did not further alter the TM structure. These findings infer that the injurious effect of topical anesthesia on the intact TM is more or less negligible when applied to diseased TMs.

Topical anaesthesia of the normal tympanic membrane: a controlled clinical trial of different suspensions of lidocaine.

The purpose of this investigation was to find an effective method for topical lidocaine anaesthesia of the tympanic membrane for minor therapeutical procedures. Twelve subjects with healthy ears were tested in a randomized double-blind crossover trial. Xylocaine (lidocaine) aerosol 10%, lidocaine 4%, and lidocaine hydrochloride 5% were tested against placebo. Xylocaine aerosol was sprayed into a small container, shaken, and tempered. This made the application painless. The eardrum was stimulated by a point of a needle effective 25 min after application (p = 0.008 and p less than 0.05, respectively). Lidocaine hydrochloride showed no effect. No side effects were observed. The effectiveness seems to be dependent on the ionization of the drug, since the two effective drugs lidocaine and Xylocaine are un-ionized, whereas the ineffective lidocaine hydrochloride is ionized.

[A lidocaine base for surface anesthesia of the tympanic membrane]. / Lidocain-Base zur Oberflächenanästhesie des Trommelfells.

An anatomical study was conducted to determine the effects of 10% lidocain base (dissolved in DMSO) on the structure of the tympanic membrane. Survival times ranged from 1 day to 3 months. Membranes were embedded in plastic and cut in semithin sections. Within 1 and 3 days mild swelling of the epithelium was seen; 1 month after treatment the connective tissue layers of the lamina propria were severely hyperplastic. 2 months after lidocain-Base application additional collagen fibres, loosely packed and less regularly, appeared in the submucosal connective tissue layer. However, normal appearance of the drums was noticeable after 3 months survival.

Iontophoretic anaesthesia of the tympanic membrane.

Anaesthesia of the tympanic membrane by iontophoresis of lidocaine is a painless and safe method for myringotomy and grommet insertion. Thirty-nine patients with serous otitis media and 11 patients with Ménière's disease had their tympanic membranes anaesthetized by iontophoresis of lidocaine; analgesia was perfect for all of them. In the patients with serous otitis media, the insertion of grommets was carried out easily and without pain. Major problems or complications have not been encountered during this study.