Mid-term evaluation of perioperative i.v. corticosteroid treatment efficacy on overall and audiological outcome following CO2 laser stapedotomy: a retrospective study of 84 cases.

PURPOSE: Our aim was to determine whether perioperatively administered corticosteroid treatment has any beneficial effect on the outcome of stapes surgery, with special regard to the audiological results and early postoperative morbidity. METHODS: 84 CO2 laser stapedotomies performed in our institute between 2013 and 2018 were included in our investigation. All cases underwent preoperative and mid-term postoperative pure-tone audiometric evaluation. Vestibular complications were also evaluated. The cases were subdivided into two groups, 23 patients received perioperative i.v. methylprednisolone treatment ("S") while the other 61 patients ("nS") did not receive any adjuvant pharmacological therapy. The data were analyzed retrospectively using IBM SPSS Statistics. RESULTS: CO2 laser stapedotomy proved to be a successful intervention with a significant improvement in ABG and AC thresholds as well. Long-term BC levels were significantly better compared to preoperative ones in the S group; however, in the nS group, no difference could be shown. Hearing and ABG gain were significantly superior in group S [28.1 dB (SD11.2) vs. 18.1 dB (SD 10.9) and 23.9 dB(SD 9.8) vs. 17.2 dB (SD 9.5), respectively]. CONCLUSION: No significant inner ear damage was detectable in the results of our CO2 laser stapedotomy method; however, the positive effect of corticosteroid treatment could be demonstrated through the postoperative hearing levels. We found no statistical difference in early postoperative morbidity. According to our data, the routine administration of corticosteroids during stapes surgery could be an issue worthy of consideration. The effects of perioperative treatment vs that on the first day after surgery, and topical vs. systemic treatment could be the subject of further investigation in a prospective manner.

Ipriflavone: an important bone-building isoflavone.

Ipriflavone, an isoflavone synthesized from the soy isoflavone daidzein, holds great promise in the prevention and treatment of osteoporosis and other metabolic bone diseases. It has been widely studied in humans and found effective for inhibiting bone resorption and enhancing bone formation, the net result being an increase in bone density and a decrease in fracture rates in osteoporotic women. While ipriflavone appears to enhance estrogen's effect, it does not possess intrinsic estrogenic activity, making it an attractive adjunct or alternative to conventional hormone replacement therapy. Preliminary studies have also found ipriflavone effective in preventing bone loss associated with chronic steroid use, immobility, ovariectomy, renal osteodystrophy, and gonadotrophin hormone-releasing hormone agonists. In addition, it holds promise for the treatment of other metabolic diseases affecting the bones, including Paget's disease of the bone, hyperparathyroidism, and tinnitus caused by otosclerosis.

Menière's syndrome: an approach to therapy.

There are patients with symptoms similar to those of Menière's disease who do not have Menière's disease and therefore do not respond to conventional medical or conservative surgical management. Some have subtle disorders of carbohydrate and lipid metabolism and inner ear otosclerosis, which are responsible for the production of their symptoms. The response to dietary therapy confirms that glucose tolerance levels which are not diabetic nor hypoglycemic may be sufficiently significant in relation to inner ear function to produce the symptoms like those of Menière's Disease. Management of inner ear otosclerosis with supplemental sodium fluoride, calcium carbonate, and Vitamin D was also effective in controlling the symptoms in some patients.

Otospongiosis and sodium fluoride. A blind experimental and clinical evaluation of the effect of sodium fluoride treatment in patients with otospongiosis.

The effect of sodium fluoride treatment in patients with otospongiosis has been evaluated blindly in a morphological and microchemical element analysis of otospongiotic specimens together with a prospective clinical double-blind, placebo-controlled study. The results show that using the calcium/phosphorus ratio as an indication for bone maturity, the sodium fluoride treatment can stabilize otospongiotic lesions in retaining calcium relative to phosphorus. The clinical double-blind, placebo-controlled study of 95 patients showed a statistically significant worse deterioration of the hearing loss in the placebo group than in the active treated (40 mg sodium fluoride daily) group, supporting the view that sodium fluoride can change otospongiotic, active lesions to more dense, inactive otosclerotic lesions. We have postulated in the past that the actual mechanism of the cochlear loss is toxic enzymes produced by histiocytes at the periphery of the microfoci, and it may be that sodium fluoride has some effect on these enzymes.

Otospongiosis: morphologic and microchemical investigation after NaF-treatment.

Element analysis of microareas of otospongiotic specimens is described. A total of 36 otospongiotic stapes are ultrasectioned without decalcification and examined using a transmission and a scanning electron microscopy (STEM-mode). The latter was equipped with an energy dispersive x-ray analyzer. Twenty of the stapes came from patients who have had sodium fluoride (NaF) treatment (15 to 45 mg/day) for a minimum of 12 months. The otospongiotic stapes are classified as spongiotic and sclerotic according to their pathologic characteristics and state of mineralization. Using the Ca/P ratio as criterion--measured by the characteristic x-ray fluorescence--it was shown in a blind study that the NaF-treated otospongiotic stapes had a statistically higher Ca/P ratio, indicating that the fluoride may stabilize otospongiotic lesions, particularly the spongiotic type with unstable mineralization.