The Role of Steroids in the Preservation of Hearing and Vestibular Function in Cochlear Implantation.

OBJECTIVE: Cochlear implant surgery is guided by principles of atraumatic insertion as to protect the inner ear. Previous studies suggest the potential benefit of steroids in patients undergoing cochlear implantation (CI), although the optimal route of administration has yet to be determined. We aim to systematically review the human studies of hearing and vestibular function preservation in patients undergoing CI receiving perioperative steroids and to discuss their role. DATA SOURCES: Search performed in PubMed, EMBASE, and CENTRAL databases in December 2023. REVIEW METHODS: Studies comparing several methods of steroid delivery and conventional management for patients undergoing CI were identified. Primary outcomes included hearing and vestibular function preservation. Secondary outcomes included reported adverse events, routes of steroid administration, and the presence of a control group without steroid administration. RESULTS: A total of 15 studies (N = 659) met inclusion criteria. Methodology, doses, route of steroid administration, and follow-up duration differed between most studies. Audiometric, vestibular, and hearing preservation (HP) results were inconsistent. In 12 studies, perioperative steroids were associated with either increased HP or vestibular function preservation. Only two studies reported adverse events related to oral corticosteroid therapy. CONCLUSIONS: There is a tendency for perioperative steroids to have a positive impact, at least in the short term, on hearing and vestibular function preservation in CI. Topical corticosteroid therapy appears to have a superior risk-benefit profile. There is a need for future carefully designed randomized controlled trials to determine the ideal route of steroid administration and its real impact in the long term. Laryngoscope, 134:3458-3465, 2024.

Relationship between the Presence of Nystagmus in the Fourth Position of the Epley Maneuver and Treatment Efficacy for PSC BPPV: A Prospective Study.

OBJECTIVE: To investigate whether a specific nystagmus observed during the Epley maneuver can enable immediate reassessment of patients, eliminating the need for deferred diagnosis. STUDY DESIGN: Prospective cohort. SETTING: Tertiary center. PATIENTS: Patients with posterior semicircular canal (PSC) benign paroxysmal positional vertigo (BPPV) diagnosed by the Dix-Hallpike test between March 2022 and March 2023. INTERVENTIONS: All patients were treated with the Epley maneuver. The presence and the characteristics of the nystagmus were recorded in each of the four intermediate positions of the maneuver. Fifteen minutes later, all patients were reevaluated with the Dix-Hallpike test to determine the therapeutic success. MAIN OUTCOME MEASURES: Outcome of the Epley maneuver and its relationship with nystagmus characteristics during the four positions of the maneuver. RESULTS: Sixty-six patients (77.3% female) were included in the study, of which 66.7% exhibited right PSC BPPV. Therapeutic success of the first Epley maneuver was 74.2%. Almost one third (30.3%) of patients presented with nystagmus in the second and third positions of the Epley maneuver. All patients with down-beating and torsional nystagmus toward the opposite direction of the diagnostic nystagmus in the fourth position of the Epley maneuver needed a second rehabilitative maneuver. None of the patients without nystagmus in this fourth position remained with active BPPV after the first Epley maneuver. CONCLUSIONS: The presence of nystagmus in the fourth position of the Epley maneuver appears to have a high predictive value, reducing waiting time for a second diagnostic maneuver. Its absence may exempt subsequent reevaluation.