Comparison between postauricular steroid injection and intratympanic steroid perfusion for refractory severe and profound sudden sensorineural hearing loss.

BACKGROUND: To analyze the clinical efficacy of intratympanic steroid perfusion (ISP) and postauricular steroid injection (PSI) for refractory severe and profound sudden sensorineural hearing loss (SSNHL). METHODS: SSNHL patients who failed a conventional treatment with severe to profound hearing loss [pure tone average (PTA, 0.25-8 kHz) > 60 dB] were treated with ISP or PSI plus antioxidant and neurotrophin for 10 consecutive days. Antioxidant and neurotrophin were administrated either intravenously and/or orally. All patients were assigned into the ISP group or the PSI group and followed up for more than three months. The changes in PTA, effective rate and side effects were analyzed in the two groups. RESULTS: Similar hearing improvements and effective rates were observed in the two groups. However, a slightly better efficacy was observed in the PSI group compared to the ISP group. Patients with shorter intervals from onset to treatment had significantly more hearing improvements. The route of antioxidant and neurotrophin administration had no impact on treatment effects. CONCLUSION: Both ISP and PSI could be used as salvage treatments for refractory SSNHL. These salvage treatments should be started as soon as possible once SSNHL patients fail a conventional treatment.

Sudden hearing loss and coronavirus disease 2019: the role of corticosteroid intra-tympanic injection in hearing improvement.

BACKGROUND: Coronavirus disease 2019 was first seen in December 2019. Due to the insidious and complex nature of the disease, the list of symptoms is rapidly expanding. So far, few studies have reported sudden sensorineural hearing loss as a possible symptom of coronavirus disease 2019. CASE REPORT: A 60-year-old woman with a complaint of sudden sensorineural hearing loss and subjective severe tinnitus presented to the ENT clinic. Coronavirus disease 2019 was subsequently confirmed with a polymerase chain reaction test. At the time of presentation, she was treated with intra-tympanic dexamethasone. Improvements in hearing threshold and speech perception, and a subjective reduction in tinnitus, were observed after treatment. CONCLUSION: This case report supports evidence from other case reports of a possible association between coronavirus disease 2019 and sudden sensorineural hearing loss. Sudden sensorineural hearing loss may be a symptom of this disease that behaves as an underlying aggravating factor. Intra-tympanic injection of corticosteroids is recommended for managing these patients during the pandemic.

Effect of video-assisted information prior to intratympanic steroid injection on patient anxiety.

OBJECTIVE: Patients may be afraid when they receive knowledge that medications are injected into the middle ear through the tympanic membrane using a fine needle during intratympanic treatment. The aim of this study was to evaluate the effect of video-assisted information prior to intratympanic steroid injection on patient anxiety. STUDY DESIGN: Prospective, Non-randomized, controlled trial. SETTING: Tertiary academic medical center. METHODS: A total of 85 patients who had an indication for intratympanic treatment due to idiopathic sudden sensorineural hearing loss and tinnitus were included in this prospective study. 40 cases received video-assisted information before intratympanic steroid injection in the study group, while 45 cases were verbally informed face-to-face in the control group. Then, patient anxiety was measured using the Visual Analog Scale (VAS) and Spielberger State-Trait Anxiety Inventory (STAI). RESULTS: The mean VAS score was 3.58 ± 3.37 (mean rank = 42.09) in the study group and 3.87 ± 3.56 (mean rank = 43.81) in the control group. The mean STAI-S score was 37.03 ± 10.637 in the study group and 39.11 ± 11.783 in the control group. The mean STAI-T score was 40.18 ± 9.151 in the study group and 38.73 ± 11.438 in the control group. It was found that there were no statistically significant differences in the mean VAS, STAI-S and STAI-T scores between the two groups (p > 0.05). CONCLUSION: We revealed that video-assisted information prior to intratympanic steroid injection had no superiority in reducing anxiety over face-to-face verbal information.

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.

Targeting murine alveolar macrophages by the intratracheal administration of locked nucleic acid containing antisense oligonucleotides.

The pulmonary delivery of locked nucleic acid containing antisense oligonucleotides (LNA-ASOs) is expected to be a novel therapeutic approach for lung diseases. However, there are two concerns to be considered: immune responses, as the lung has a distinct immune mechanism to protect it from inhaled pathogens; and leakage into blood, since the lung is permeable to small molecules. As phagocytic alveolar macrophages reside in the alveolar space, it is hypothesized that inhaled LNA-ASOs effectively accumulate and exert a knockdown (KD) effect on these cells at low doses. Thus, targeting alveolar macrophages by inhaled LNA-ASOs may reduce these risks. To test this hypothesis, LNA-ASOs targeting Scarb1 or Hprt1 were intratracheally administered to mice. We confirmed the remarkable accumulation of intratracheally administered LNA-ASOs in murine alveolar macrophages and found that they exerted a significant and sequence-dependent KD effect. The dose required for KD in alveolar macrophages was lower than that required to induce KD in the whole lung. Furthermore, when a KD effect was observed in alveolar macrophages, no KD effect was observed in the liver or kidney; however, several inflammatory cytokines were increased in the lung. These results suggest the potential application of LNA-ASOs as an inhaled drug specific to alveolar macrophages. However, further studies on the immuno-stimulatory effects of LNA-ASOs will be necessary for the development of novel inhaled therapeutic agents.

Biophysical and chemical stability of surfactant/budesonide and the pulmonary distribution following intra-tracheal administration.

Intra-tracheal instillation of budesonide using surfactant as a vehicle significantly decreased the incidence of bronchopulmonary dysplasia or death in preterm infants. The formularity of surfactant supplemented with budesonide and biophysical and chemical stability of the suspension has not been well reported. The aims are to investigate the biophysical and chemical stability of two surfactant preparations, Survanta and Curosurf, supplemented with budesonide. Biophysical property of the surface tension of Survanta and Survanta/budesonide suspension and of Curosurf and Curosurf/budesonide suspension was conducted by a pulsating bubble surfactometer and by a drop shape tensiometer. Chemical stability of Survanta/budesonide and of Curosurf/budesonide suspensions was tested by high-performance liquid chromatography analysis (HPLC). Pulmonary distribution of Survanta/18F-budesonide suspension was examined by a Nano/PET digital scan in rats. The Marangoni effect of Survanta, Curosurf, and budesonide was tested by digital high speed photography. For Survanta supplemented with budesonide, with a concentration ratio of ≥50, the surface tension-lowering activity was minimally affected. Similarly, the surface tension-lowering activity of Curosurf was not significantly affected by addition of budesonide, if the concentration ratio was ≥160. With these concentration ratios of both suspensions, HPLC analysis revealed no new compounds identified. Curosurf as compared to Survanta exhibited a significantly higher Marangoni effect. We conclude that with current dosage recommended for Survanta and Curosurf, both surfactant/budesonide suspensions are biophysically and chemically stable. Both surfactants can act as an effective vehicle for budesonide delivery.

Intratympanic dexamethasone for managing pregnant women with sudden hearing loss.

OBJECTIVE: This study aimed to investigate the effect and safety of intratympanic dexamethasone in pregnant women with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: We performed a prospective study on pregnant women who suffered from ISSNHL and were treated in our clinic during 2016. The patients received intratympanic treatment three to four times a week. A pure tone audiogram (PTA) was performed before treatment and patients were followed up until 2 months after treatment was finished. RESULTS: A total of six pregnant women were included. All of the patients tolerated intratympanic treatment well. The mean improvement in hearing was 48 ± 7.33 dB. There were no complications, including permanent perforation of the ear drum or middle ear infection. Each patient delivered a healthy newborn. CONCLUSION: Intratympanic dexamethasone is effective and safe for treating pregnant women with ISSNHL. Further randomized, controlled studies on this treatment need to be performed.

Bilateral delayed endolymphatic hydrops evaluated by bilateral intratympanic injection of gadodiamide with 3T-MRI.

The purpose of this study was to assess the diagnostic performance of 3T MRI after intratympanic injection of gadodiamide for delayed endolymphatic hydrops (DEH), and assess the relationship between endolymphatic hydrops (ELH) and vestibular function in patients diagnosed with DEH and confirmed by 3T MRI. Nineteen patients clinically diagnosed with DEH (11 ipsilateral DEH, 8 contralateral DEH) participated in this study. Diluted gadodiamide was administered to the bilateral tympanic cavity by injection through the tympanic membrane. At 24 hours post-injection, the ELH was evaluated by MRI. Patient vestibular functions were evaluated by caloric testing and cVEMP. ELH was observed in all patients (19/19: positive rate 100%). The distribution patterns of ELH varied between the cochlear or vestibular region. Vestibular ELH was observed in the affected ear in all ipsilateral DEH patients. In the contralateral DEH patients, however, there were individual differences in the distribution patterns of ELH. Six patients (1 ipsilateral DEH, 5 contralateral DEH) had bilateral ELH. No obvious relationships were observed between ELH and vestibular function. ELH distribution was complicated, particularly in the contralateral DEH cases. It was difficult to identify the existence of ELH by vestibular functional testing alone; therefore, 3T MRI is thought to be useful for identifying the affected ear. A significant number of cases had "bilateral" DEH, particularly among the contralateral DEH cases, indicating that we should pay careful attention to this pathology when treating DEH.

[The application of contrast-enhanced X-ray salpingography for the evaluation of the effectiveness of catheterization of the acoustic tube with the use of the Eustachian catheters]. / Rentgenokontrastnaia sal'pingografiia v otsenke éffektivnosti kateterizatsii slukhovoi truby ushnymi kateterami.

The objective of the present study was to evaluate the effectiveness of the administration of a medication into the middle ear structures during catheterization of the acoustic tube (AT) in the course of the contrast-enhanced X-ray salpingographic investigation. The study included 18 patients (18 ears) presenting with chronic otitis media and the perforated tympanic membrane without the disturbances of the ventilation function of the auditory tube. All the patients were allocated to two groups depending on the type of the Eustachian catheters being used. Group 1 was comprised of 9 patients treated with the use of traditional Giyot's catheter, group 2 was composed of another nine patients who were treated with the use of the Eustachian catheters having an original shape with a specific configuration of its distal part. The X-ray studies were carried out before and after catheterization of the acoustic tube with the administration of 1 ml of the hypaque contrast medium. The study has demonstrated that the X-ray contrast agent did not penetrate into the inner structures of the middle ear of the patients comprising group 1 whereas in the patients of the second group the contrast medium reached as far as the bony portion of the acoustic tube.

Comparison of 2 and 4 Intratympanic Steroid Injections in the Treatment of Idiopathic Sudden Sensorineural Hearing Loss.

OBJECTIVE: We studied the effect of intratympanic steroid administration with different total injection times on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: The subjects were 191 consecutive patients (192 ears) with ISSNHL (hearing level ≥40 dB, interval between onset and treatment ≤30 days). They received systemic prednisolone (100 mg followed by tapered doses) combined with intratympanic injection of dexamethasone (4 mg/ml). Intratympanic injection was performed 4 times (days 1, 2, 4, and 7) in 92 patients (92 ears) or 2 times (days 1 and 2) in 99 patients (100 ears). The hearing outcomes were evaluated at 1 week from the start of treatment and 1 to 2 months after the completion of treatment. RESULTS: There was no significant difference in hearing outcomes between the 4- and 2-injection groups at either time point. Multiple regression analysis also showed that the hearing level after treatment did not depend on the total number of intratympanic steroid injections. CONCLUSION: These results indicate that a protocol using only 2 intratympanic steroid injections exerts a sufficient effect on the hearing outcomes of ISSNHL. This simplified treatment protocol would be greatly beneficial to relieve the physical and mental stress of patients.

Control of vertigo in Ménière's disease by intratympanic dexamethasone.

OBJECTIVE: The main objective was to assess the efficacy of intratympanic dexamethasone injection in controlling vertigo in unilateral Ménière's disease refractory to medical treatment. MATERIALS AND METHODS: A retrospective study included 25 patients with disabling unilateral Ménière's disease, defined according to the American Academy of Otorhinolaryngology-Head and Neck Surgery (AAO-HNS) criteria. Patients received intratympanic dexamethasone during the monitoring period. Control of vertigo was classified according to AAO-HNS vertigo control index, at 6 months, 1 year, and 2 years after treatment initiation. Complications and progression of hearing were also assessed. RESULTS: Satisfactory control (class A or B) was obtained in 92% of patients (n=23/25) at 6 months, 68% (n=17/25) at 1 year, and 70% (n=16/23) at 2 years. There was no worsening of hearing in those patients who were well-controlled by this therapeutic strategy. No local or systemic complications were observed during follow-up. CONCLUSION: Dexamethasone is part of the management strategy for patients with Ménière's disease refractory to conventional treatment, implemented before destructive treatment. It achieves control of vertigo in 70% of patients at 2 years.

Sudden hearing loss: an effectivity comparison of intratympanic and systemic steroid treatments.

Corticosteroid treatment has been considered the most effective treatment modality for sudden sensorineural hearing loss so far. Application route of corticosteroids may vary. We have designed a prospective randomized case-controlled clinical trial to evaluate the effectivenesses of the different application routes of steroids in the treatment of SSHL. Thirty-five patients were distributed randomly to two groups which were treated with either 'oral' or 'intratympanic' corticosteroids. Intratympanic steroid administration was performed three times every other day transtympanically. At the end of third month, recovery rate in the 'intratympanic' group was 84.2%, whereas in the 'oral' group, it was 87.5%. The difference between the recovery rates was not statistically significant. There were no major complications related to transtympanic steroid administration. These findings support that intratympanic steroid therapy is an alternative to systemic steroid therapy in the initial treatment of sudden hearing loss. In addition, transtympanic technique is an easy to perform and safe method for delivering steroids into the inner ear.

Comparison of Long-Term Outcome of Intratympanic Dexamethasone Therapy between Acute Noise-Induced Tinnitus and Acute Idiopathic Tinnitus.

OBJECTIVE: To compare the long-term outcomes of acute noise-induced tinnitus (ANT) and acute idiopathic tinnitus (AIT) to intratympanic dexamethasone (ITD) therapy. MATERIALS AND METHODS: Patients treated for tinnitus occurring immediately after noise exposure comprised the ANT group (n=20) and patients treated for idiopathic tinnitus comprised the AIT group (n=39). All patients were treated with ITD within 3 months of the onset of tinnitus. Quantitative assessment of the improvement in tinnitus using questionnaires and changes in hearing thresholds were compared between the two groups. RESULTS: Mean follow-up durations were 75.90±69.83 weeks in the ANT group and 93.41±101.43 weeks in the AIT group. Patients with ANT were younger in age than those with AIT (38.30±18.28 vs. 53.56±14.08, p=0.00) and were predominately male (Male: Female, M:F 13:7 vs. 13:26, p=0.02, respectively). The subjective tinnitus loudness, time of tinnitus awareness, and Tinnitus Handicap Inventory score improved in both groups, although the changes in these parameters were not significantly different between the groups. The cure and overall improvement rates of the ANT group were and 10.00% and 25.00%, respectively. The cure and overall improvement rates of the AIT groups were 25.64% and 35.90%, respectively and there were no significant differences between the two groups in terms of the cure and overall improvement rates (p=0.19 and 0.40, respectively). CONCLUSION: The long-term outcome in terms of control of tinnitus with ITD in the ANT group was similar to that in the AIT group. Thus, ITD injection may be a useful treatment option for acute tinnitus caused by noise trauma.

Intratracheal therapy with autologous bone marrow-derived mononuclear cells reduces airway inflammation in horses with recurrent airway obstruction.

This research evaluated the effects of bone marrow-derived mononuclear cells (BMMCs) on the inflammatory process in the equine recurrent airway obstruction (RAO). Eight horses in RAO clinical score were divided into cell therapy group (Gcel) treated with a single intratracheal dose of BMMCs, and dexamethasone group (Gdex) treated with 21days of oral dexamethasone. The horses were clinically revaluated on days 7 and 21, together with cytological evaluation of the BALF, and detection of inflammatory markers (interleukins [IL]-10, -4, and -17, and interferon γ and α). There were decreases in respiratory effort and clinical score on days 7 and 21(p<0.05) for both groups. The percentage of neutrophils decreased and macrophages increased on days 7 and 21 (p<0.005) in both groups. IL-10 levels increased in the Gcel group on day 21 compared to days 0 and 7 (p<0.05), but this was not observed in the Gdex group. The quantification of IL-4, IL-17, IFN-γ, and IFN-α did not change between evaluations in both groups. These preliminary results suggest that BMMCs may ameliorate the inflammatory response of RAO.

Sudden Pediatric Hearing Loss: Comparing the Results of Combined Treatment (Intratympanic Dexamethasone and Systemic Steroids) With Systemic Steroid Treatment Alone.

OBJECTIVE: The aim of the present study was to compare hearing improvements obtained with combined intratympanic and systemic steroid therapy, and systemic steroid therapy alone in pediatric patients with idiopathic sudden sensorineural hearing loss (SSHL). STUDY DESIGN: Retrospective. SETTING: Tertiary referral hospital. PATIENTS: Pediatric patients with SSHL. INTERVENTIONS: The patients were divided into two groups, based on the method of steroid administration: Group 1 (systemic therapy group, n = 23) was treated with oral methylprednisolone alone whereas Group 2 (combination therapy group, n = 26) was treated with combination of oral methylprednisolone and intratympanic dexamethasone injections. MAIN OUTCOME MEASURES: Pre- and post-treatment audiograms were compared with pure-tone averages (PTAs) in each group. Two treatment groups were also compared. The final hearing assessment was performed 4 weeks after completion of the treatment. RESULTS: The mean PTAs before and after the treatment were 61.86 ±â€Š23.99 and 42.65 ±â€Š32.69 dB in Group 1 (p = 0.001), and 70.07 ±â€Š29.74 and 38.85 ±â€Š32.28 dB in Group 2 (p = 0.001). Pure-tone gain was 20.00 ±â€Š15.02 dB in Group 1, and 31.69 ±â€Š28.29 dB in Group 2. Comparison of two groups for post-treatment PTA and pure-tone gains did not yield any statistically significant differences (p = 0.388 and p = 0.132, respectively). CONCLUSION: Significant hearing improvement may be obtained with use of systemic steroids alone, or simultaneous administration of systemic and intratympanic steroids in pediatric patients with SSHL. Although we did not have a control group, two treatment options appear to offer similar hearing improvements in the pediatric age group higher than the rates obtained with placebo when previous studies in the literature are taken into account.

Efficacy of oral vs. intratympanic corticosteroids in sudden sensorineural hearing loss.

BACKGROUND: The current standard treatment for sudden sensorineural hearing loss (SSNHL) comprises of tapered course of oral corticosteroids. Intratympanic steroids are introduced as another modality of treatment, but management of SSNHL continues to be debatable. The present study was designed to evaluate the efficacy of steroids given orally and by the intratympanic route. METHODS: A prospective, randomized, open-labeled study was conducted involving 42 patients. These were randomly divided into two groups; group I patients received oral prednisone tapered over 14 days, and group II patients were treated with intratympanic methylprednisolone (40 mg/mL). One milliliter of the drug solution containing 40 mg of the drug (40 mg/mL) was injected into the middle ear cavity through the trans-tympanic route. The drug was injected twice a week for 2 weeks. The total duration of the study was 60 days, and hearing outcome was assessed on the basis of change in pure tone average. RESULTS: An improvement of 18.24±8.72 dB was recorded in group I patients treated with oral prednisone in comparison to 14.68±12.88 dB improvement in group II. Statistically significant improvement in hearing was observed in both groups, but it was not significant when group I and group II were compared. CONCLUSIONS: The post-treatment outcomes among patients who receive either oral prednisone or intratympanic methylprednisolone within 2 weeks of onset of symptoms were comparable. The outcomes were affected by degree of hearing loss and association of SSNHL with vertigo.

[Intratympanic injection therapy for therapy refractory acute hearing loss: A safe option for secondary treatment]. / Intratympanale Injektionstherapie bei therapierefraktärem Hörsturz: Eine sichere Therapieoption zur Sekundärtherapie.

BACKGROUND: High-dose corticosteroids are currently recommended for idiopathic sudden sensorineural hearing loss (ISSNHL) treatment. Intratympanic injections (ITI) are of growing importance, especially in cases of therapy resistance. The selection of patients for this procedure in SSNHL has not been adequately examined so far. STUDY DESIGN: A total of 77 patients with ISSNHL after ineffective systemic pretreatment underwent intratympanic administration of dexamethasone and hyaluronic acid. Improvement after treatment was determined by pure tone audiometry for both ears before and of the treated ear after ITI. RESULTS: In this study 34 female and 43 male patients with mean age of 57 years showed a pre-ITI hearing loss of 35 dB in the lower frequencies and 69 dB in the higher frequencies. The mean hearing gain was 10 dB and the response rate was 62%. Absolute hearing gain revealed significant improvements at 500 Hz, 1 kHz and 2 kHz. Under inclusion of contralateral thresholds there were hardly any differences up to 4 kHz. In a detailed analysis of responders moderate improvements could be observed even in higher frequencies. Overall, no relevant adverse events occurred. CONCLUSION: Treatment of ISSNHL resistant to systemic regimens by ITI of steroids provides an option that offers additional prospects of auditory improvement for affected patients. The presented results indicate that these modalities are also valid for patients with pancochlear ISSNHL.

Chemical labyrinthectomy for the worse ear of adult Nigerians with bilateral Meniere's disease: preliminary report of treatment outcomes.

The objective of this study was to assess the effectiveness of variable titration, low-dose intratympanic gentamycin (ITG) into the worse affected ear of patients with bilateral Meniere's disease (MD). It is a prospective analytic case series conducted in a tertiary care referral hospital in a developing economy and a tertiary care otologic private ENT clinic. Patients with MD who failed or are intolerant to medical treatment were recruited based on the criteria of definite MD and bilateral ear involvement. 0.75 cc of low-dose (40 mg/ml) buffered gentamycin was injected into the worse affected ear and patients followed up every 2 months, and the regime repeated only if subjective vertigo persists. The patient's age, sex, duration of MD symptom, ear first affected, ear selected for ITG, pure tone threshold at each visit, duration of caloric response (in seconds) for the injected ear, status of tinnitus in both ipsilateral (injected) and contralateral ears, total number of injections before last follow-up, and time since last follow-up are entered into the study protocol and analyzed. Nine patients with a mean age of 45 years and mean duration of symptoms of 59 months were treated. The mean total number of injections was 2.8 with a mean follow-up period of 34 months. Three cases showed drop in pure tone average threshold (2.5-7.5 dB) while an increase in threshold was noted in six cases (2.5-5 dB). All cases demonstrated decrease in duration of response to iced water caloric stimulation in ipsilateral ear, and 4/9 of contralateral ear. The variable titration method using low-dose intratympanic gentamycin directed at worse ear of adult Nigerians with bilateral Meniere's disease appears to be highly effective. More studies are needed.