Prevalence of perilymphatic fistula in patients with sudden-onset sensorineural hearing loss as diagnosed by Cochlin-tomoprotein (CTP) biomarker detection: its association with age, hearing severity, and treatment outcomes.

PURPOSE: To determine the prevalence of perilymphatic fistula (PLF) in sudden-onset sensorineural hearing loss (SSNHL) patients by employing the Cochlin-tomoprotein (CTP) detection test, a specific diagnostic marker for perilymph. We also analyzed the clinical characteristics associated with hearing outcomes in this cohort. METHODS: A total of 74 eligible patients were prospectively enrolled. Following myringotomy, middle ear lavage (MEL) samples underwent the CTP test to identify perilymph leakage. Intratympanic dexamethasone (IT-DEX) therapy was administered, and hearing outcomes were assessed. Control groups comprised patients with chronic otitis media (n = 40) and non-inflammatory middle ears (n = 51) with concurrent MEL sample collection. RESULTS: CTP was positive in 16 (22%) patients. No control samples showed positive results. Multiple regression analysis indicated that age and pre-treatment hearing levels significantly contributed to the CTP value. We found a positive correlation between CTP values, age, and pre-treatment pure-tone averages. Notably, CTP values in SSNHL cases aged 60 and above were significantly higher than in those below 60 years. Patients with positive CTP had significantly worse recovery rates after IT-DEX treatment. CONCLUSION: This study is the first prospective investigation demonstrating a positive relationship between CTP values, age, and hearing severity in SSNHL, indicating that PLF might be the essential cause of SSNHL, particularly in the elderly. Our findings suggest that IT-DEX may be less effective for PLF-associated SSNHL. Future research could reveal that PLF repair surgery is a viable treatment strategy for SSNHL. This study was registered under the UMIN Clinical Trials Registry (UMIN000010837) on 30/May/2013.

Intratympanic Dexamethasone Role in Hearing Protection in Cancer Patients.

Introduction The study aims to determine the role of intratympanic dexamethasone (ITD) on the hearing profile of patients with head and neck cancer post-chemoradiotherapy. Study design This study employs a prospective case-control design. Subjects and methods In total 834 patients were evaluated for eligibility. Seven hundred and eleven were excluded because they didn't meet the inclusion criteria. A hundred cases out of 123 were diagnosed with head and neck cancer for which the treatment protocol included cisplatin concurrent to radiotherapy recruited. Before each cisplatin treatment session, ITD was injected into one ear (experimental ear) while the other ear of the same patient served as the control. Pure-tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAE) test results of the baseline and follow-up examinations in the sixth and 12th weeks were compared within and between the study and control ears. Results For pure tone thresholds, significant hearing threshold change was noticed at 8 kHz in the experimental group at six weeks and at ≥ 6 kHz in the control group. At 12 weeks, high frequencies were significantly affected at ≥ 4 kHz in the control group. When the baseline was compared across the groups in the 12th week, for otoacoustic emissions, high frequencies showed a loss in the control group more compared to the experimental side (Wilcoxon signed-rank test). Conclusion ITD functions less effectively at higher frequencies because the basal turn of the cochlea is more susceptible to cisplatin ototoxicity. ITD might have potential in the reduction of cisplatin-induced hearing loss.

Intratympanic dexamethasone in Manières disease and symptom control.

BACKGROUND: Manières disease (MD) is a chronic inner ear disease characterized by recurrent vertigo and fluctuation in auditory symptoms. Vertigo spells have a sudden onset and are difficult for patients to handle. Therefore, treating a patient with MD is still a challenge for clinicians. AIMS: This study aims to analyse the short-term effects of intratympanic dexamethasone (ITD) on the various symptoms of unilateral MD. MATERIALS AND METHODS: The study comprised 27 patients with unilateral MD and severe vertigo who failed medication therapy. Treatment was with ITD as an alternative to destructive therapy. Treatment is evaluated after four months. RESULTS: Significant improvements were measured with Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI), frequency of vertigo attacks longer than 20 min, Functional Level Scale (FLS), and tinnitus sensation measured by the Analog Visual Scale (AVS). Patients with severe symptoms grading with DHI and THI experienced the most improvement. Patients have achieved substantial vertigo control in 73%. CONCLUSION: ITD application shows improvement in controlling vertigo and tinnitus in patients under exacerbation in MD. SIGNIFICANCE: It is a promising non-destructive addition to the 'stepwise treatment concept' in MD and can be used as a first-line treatment in vertigo control.

Combined Intratympanic and Systemic Steroid Therapy in Sudden Sensorineural Hearing Loss.

Sudden sensorineural hearing loss (SSNHL) is a true otological emergency that must be diagnosed and treated immediately. This study aimed to assess the efficacy of treatment with intratympanic dexamethasone (ITD) plus oral prednisolone with that of oral prednisolone or intratympanic dexamethasone alone and to determine factor affecting treatment outcome for SSNHL. Forty-five patients with SSNHL that had been present within 2 weeks of onset of symptoms were included in this prospective case control study. Patients were allocated to three different groups. Patients in group A were treated with oral prednisolone 1 mg/kg/d full dose 14 days then tapered over next 14 days. Patients in group B were treated with ITD 0.5 ml (4 mg/ml) every 7 days for a total 4 weeks along with oral prednisolone 1 mg/kg/d in tapering dose for 4 weeks. Patients in group C were got ITD 0.5 ml (4 mg/ml) every 7 days for a total 4 weeks. Audiogram was performed before each subsequent injection and at completion of treatment course. Among all participants, 22 patients (48.89%) showed improvement in pure tone audiogram to within 50% of pre- sudden hearing loss. On comparing the results of group A, B and C, there were no statistically significant difference with each other (p value 0.185). The mean audiometric gain was 37.71 dB in recovered cases. The combination therapy of intratympanic dexamethasone and oral steroid is more effective in comparison with intratympanic or oral steroid alone in the treatment of SSNHL as the patients benefitted from the therapeutic effects of both local and systemic steroids.

Intratympanic Dexamethasone in Sudden Sensorineural Hearing Loss.

Sudden sensorineural hearing loss can be a frightening experience for the sufferer and needs immediate treatment. Systemic steroid therapy has been the mainstay of treatment of this condition but concerns about their side effects has led to their use by intratympanic injection. We studied the results of intratympanic dexamethasone (IT-Dexa) both as a primary therapy and as salvage treatment after failure of oral steroids. A total of 39 patients of SSNHL were studied prospectively. Of these 23 were given oral steroids. Ten of these showed no response and were treated with IT-Dexa 4 mg/ml twice a week for two weeks. In addition, 16 patients who reported later than two weeks or had concomitant medical disorders like diabetes and/or hypertension were treated with IT-Dexa. While oral steroids showed hearing improvement (≥ 10 dB) in 56.5% patients, the recovery rate was 62.5% and 80% in those treated primarily with IT-Dexa and as salvage therapy respectively. There was a negative correlation of delay in institution of treatment with hearing recovery. Conclusion: intratympanic dexamethasone is a safe and effective treatment and should be offered to patients as a primary treatment modality and also as salvage therapy after failure of oral steroids. For best results the treatment should be started at the earliest.

Tone burst electrocochleography disproves a diagnosis of Meniere's disease treated aggressively.

Reliable confirmation of the presence or absence of endolymphatic hydrops is essential to avoid confusing vestibular migraine with Meniere's disease. MRI inner ear imaging is a promising new method to confirm hydrops, avoiding both unnecessary invasive or destructive inner ear treatments, but it is not universally available. Tone burst electrocochleography is an older simple, quick, safe, and sensitive test that is potentially available, with existing (or minorly upgraded) equipment at most tertiary medical centers. In Meniere's disease hydrops remains after intratympanic treatments. A case is presented of a 45 year-old man with a long history of recurrent vertigo attacks who, due to an erroneous diagnosis of Meniere's disease, was given five intratympanic treatments with no effect. He was subsequently found by tone burst electrocochleography to have no hydrops and was differentially diagnosed with probable vestibular migraine. Response to treatment confirms this diagnosis. This patient's electrocochleographic findings are compared with two other patients with definite Meniere's disease, one of whom had demonstrable hydrops despite intratympanic gentamycin treatments.

Long Term Outcomes of Intratympanic Dexamethasone in Intractable Unilateral Meniere's Disease.

To evaluate the long term effect of Intratympanic dexamethasone in intractable Meniere's disease. 30 patients with refractory Meniere's disease which did not respond to the standard medical management, were treated with Intratympanic dexamethasone injections. Post treatment hearing outcome and dizziness scores were compared with the pretreatment values respectively. The mean dizziness handicap inventory (DHI) score was reduced from 91.58 (range 80-100) to be 31.00 (p = 0.00) at 3 months of treatment. With the successive follow-up periods, the mean DHI scores were reduced to 51.50, 46.6, and 50.90 at the end of, 6, 12, and 24 months (p = 0.04, 0.35, and 0.49 respectively). Again at the end of 24 months, 23.80% of patients were free of vertigo (p = 0.01). No patient had improvement in the hearing (> 10 dB) in any of the follow-up periods and 6.6% demonstrated deterioration in hearing. There were no major intraoperative or postoperative complications detected. Intratympanic injection of steroid is a safe and effective method for treating intractable Meniere's disease. Although short term improvement in the vertigo is well documented, still in 23% of the patients were found to be free of vertigo at even the end of 24 months. There was no significant improvement in hearing noticed, either in short term or in long term.

Intratympanically administered steroid for progressive sensorineural hearing loss in Ménière's disease.

Background: Ménière's disease is characterised by episodic rotational vertigo, sensorineural hearing loss, tinnitus, and vegetative symptoms. Objectives: The aim of our study is to follow-up the effects of the intratympanic steroid treatment of hearing loss in MD. Material and methods: A group of 105 clinically diagnosed MD patients were enrolled in this investigation. Long-term follow-up was carried out, and pure tone speech audiometry results of the subjects before and after application of steroid were contrasted. Statistical analysis was carried out using the IBM SPSS V24 software. Results: Based on the audiograms in this population, all stages of hearing loss were presented (from slight to profound). In most of the cases (68.6%), after intratympanic dexamethasone treatment, stagnation in the hearing profile was achieved. Moreover, there was a smaller group demonstrating hearing improvement after the treatment (12.4%). According to logistic regression [p = .001; Odds ratio: 2.75 (95% CI 1.068-4.442,)], there was a strong correlation between hearing improvement and dexamethasone treatment (all patients were treated with intratympanic dexamethasone, while improvement without steroid treatment could never be attained). Conclusions and significance: Intratympanically administered dexamethasone is a potent agent to prevent the progression of hearing loss in MD.

Intratympanic Injections of Dexamethasone in Delayed Endolymphatic Hydrops: A Prospective Clinical Study.

OBJECTIVE: This study was designed to evaluate the effectiveness of intratympanic dexamethazone (ITD) for the treatment of ipsilateral delayed endolymphatic hydrops (DEH). METHODS: Forty-one patients were diagnosed with ipsilateral DEH. Only 37 patients completed this study. Patients were randomly divided into 2 groups. Group A (n = 16) received oral medication, and group B (n = 21) received ITD once weekly for 4 consecutive weeks. RESULTS: In group A, 6 patients showed improvement in their vertigo. Four patients (25%) showed complete vertigo control, and 2 patients (12.5%) showed substantial vertigo control. In group B, 21 patients showed improvement in their vertigo, 11 patients (52%) showed complete vertigo control, and 10 patients (47%) showed substantial vertigo control. Only 1 case did not show any improvement in their vertigo. CONCLUSION: ITD is proven to be a valuable and promising alternative modality for the management of ipsilateral DEH.

Clinical effect of intratympanic dexamethasone injection in acute unilateral tinnitus: A prospective, placebo-controlled, multicenter study.

OBJECTIVE: The purpose of this study was to investigate the effectiveness of intratympanic dexamethasone injection (ITDI) in acute tinnitus of presumed cochlear origin. STUDY DESIGN: A prospective, randomized, placebo-controlled, double-blinded, multicenter study. METHODS: Between August 2013 and December 2015, 54 patients with unilateral tinnitus were enrolled at four different centers. Patients were assigned either to an ITDI (n = 27) or an intratympanic normal saline injection (ITNI; n = 27) group through block randomization. Intratympanic injections were administered four times over 2 weeks. At 4 weeks after initial injection, we analyzed the improvement rates of tinnitus using the tinnitus handicap Inventory (THI) and visual analogue scale (VAS) for loudness, awareness, and annoyance. We defined improvement as the reduction of more than 7 points or of more than 20% in the final THI score compared to the initial THI score. RESULTS: The initial mean hearing thresholds and VAS and THI scores of the two groups did not differ significantly. At 4 weeks after initial injection, the mean VAS and THI scores of both groups had significantly reduced. However, the improvement rate did not differ significantly between the groups (ITDI, 51.9%; ITNI, 59.3%). CONCLUSION: The results indicate that ITDI might not be more effective than ITNI for the treatment of acute unilateral tinnitus. Therefore, ITDI should not be considered as the main treatment for patients presenting with acute tinnitus as the primary symptom. LEVEL OF EVIDENCE: 1b. Laryngoscope, 128:184-188, 2018.

La importancia del comienzo temprano del tratamiento con corticoide intratimpánico en hipoacusia súbita / The importance of early treatment with intratympanic corticoid for sudden hypoacusia / A importância do começo temporão do tratamento com corticoide intratimpánico em hipoacusia subita

INTRODUCCIÓN: La hipoacusia neurosensorial súbita idiopática se define como la pérdida de audición súbita, de más de 30 dB, en por lo menos 3 frecuencias contiguas de la audiometría tonal, que ocurre dentro de los 3 días de inicio del síntoma, en un paciente sin antecedentes otológicos previos. OBJETIVOS: Evaluar la relación entre el comienzo temprano del tratamiento con corticoide intratimpánico y el grado de recuperación auditiva. MATERIAL Y MÉTODO: Es un estudio observacional, descriptivo y retrospectivo. A través de una revisión de historias clínicas se recolectaron pacientes con diagnóstico de hipoacusia neurosensorial súbita, valorados entre 2016 y 2017. El protocolo terapéutico utilizado fue la inyección de corticoide intratimpánico bajo visión microscópica, del oído afectado. Este procedimiento se realizó una vez por semana, durante 4 semanas. Se solicitó un control audiométrico una vez finalizado el tratamiento para evaluar el grado de recuperación auditiva...

INTRODUCTION: Sudden sensorineural hearing loss surdez neurosensorial subita is defined as a sudden loss of hearing, of more than 30dB, in at least three adjacent frequencies of the tone audiometry, which occurs within the three days after the symptom onset, in patients without previous otologic background. OBJECTIVE: Analyze the relationship between the early beginning of treatment with intratympanic corticoid and the degree of hearing recovery. MATERIAL AND METHOD: This is an observational, descriptive and retrospective study. Medical records of patients with sudden sensorineural hearing loss diagnosis between 2016 and 2017 were gathered. The therapeutic protocol used was injection of intratympanic corticoid in the affected ear under microscopic vision. This procedure was carried out once a week, for 4 weeks. An audiometric control was done after finishing treatment in order to assess the hearing recovery degree…

INTRODUÇÃO: A surdez neurosensorial subita idiopatica define-se como a perda de audição subita, a mais de 30dB, em pelo menos 3 frequências contíguas da audiometria tonal, que ocorre dentro dos 3 dias de início do sintoma, num paciente sem antecedentes otológicos prévios. OBJETIVOS: Avaliar a relação entre o começo temporão do tratamento com corticoide intratimpánico e o grau de recuperação auditiva. MATERIAL E MÉTODO: É um estudo observacional, descritivo e retrospectivo. Através de uma revisão de histórias clínicas colectaram-se pacientes com diagnóstico de hipoacusia neurosensorial súbita, avaliados entre 2016 e 2017. O protocolo terapêutico utilizado foi a injeção de corticoide intratimpánico baixo visão microscópica, do ouvido afectado. Este procedimento realizou-se uma vez por semana, durante 4 semanas. Solicitou-se um controle audiométrico uma vez finalizado o tratamento para avaliar o grau de recuperação auditiva...

Intratympanic dexamethasone injections for refractory Meniere' s disease.

Intratympanic injections or titration is a potential medical therapeutic strategy for patients with incurable inner ear diseases. Dexamethasone represent an attractive steroid source in intratympanic steroids strategies in the treatment of inner ear disorders. Here, we evaluated the effectiveness of intratympanic dexamethasone injections (IDI) in outpatients with refractory Meniere's disease (MD). Vestibular function measured by Vestibular Ocular Reflex (VOR) gain and caloric test revealed that 21 outpatients out of 43 (48.8%) had complete sufficient vertigo control, while 9 (20.9%) of them were attached to fundamental manipulation. Out of the 13 remaining outpatients, 4 (9.3%) had a limit control and 9 had less modification. Therefore, 5 of 9 received re-treatment with IDI and 2 of 9 patients were administered ablative treatment with gentamicin. Meanwhile, audiology data suggested that 3 (7.0%), 4 (9.3%), 32 (74.4%), 4 (9.3%) patients were attached to the level of A, B, C, D, respectively. Furthermore, the symptom of tinnitus in 5 outpatients vanished, 21 (48.8%) diminished, 10 (23.3%) invariable, 7 (16.3%) aggravated. In 4 of 24 cases (16.7%), aural fullness disappeared after IDI, when the aural fullness was alleviated in 11 cases (45.8%) even intensive in 9 patients (37.5%). Together, our results demonstrate that intratympanic dexamethasone injection, as an effective therapeutic strategy for refractory Meniere's disease, could either be used for cascade therapy preoperation or used for patients who couldn't accept the surgery.

Steroid-based treatments for patients with total sudden sensorineural hearing loss.

CONCLUSIONS: In patients with total sudden sensorineural hearing loss (SSNHL), oral prednisone (OP) alone or intratympanic dexamethasone (ITD) alone have comparable results. The addition of salvage ITD following OP does not seem to add over either single modality treatment. OBJECTIVES: To study the effect of steroid-based treatments in patients with total SSNHL. METHODS: The medical charts of 59 patients with total loss of hearing, defined as pure tone thresholds in the profound range (> 90 dB) with an unobtainable speech reception threshold (SRT) that were treated with OP (n = 20), ITD (n = 13), or OP followed by salvage ITD (n = 26) were analyzed. Response to treatment was evaluated by means of pure tone thresholds, SRT, and speech discrimination score (SDS), immediately after treatment and on a follow-up visit. RESULTS: Forty-nine patients (83%) responded to treatment, with mean significant improvements of 36, 34, 31, and 25 dB at 500, 1000, 2000, and 4000 Hz, respectively. The mean improvement in SRT was 33 dB, and SDS improved by 32%. There were no differences in improvement in pure tone thresholds and SRT among the three treatment groups. The late effect of OP was similar to the effect of salvage ITD.

Effect of Intratympanic Dexamethasone on Controlling Tinnitus and Hearing loss in Meniere's Disease [corrected].

INTRODUCTION: We investigated the effect of intratympanic dexamethasone on control of tinnitus and hearing loss in patients with Menier's disease. MATERIALS AND METHODS: 100 consecutive patients with a diagnosis of Menier's disease according to the 1995 criteria of The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) who remained symptomatic despite medical therapy were assigned to receive intratympanic dexamethasone. The results were assessed with respect to changes in hearing symptoms and tinnitus. RESULTS: Hearing improvement and improvement in SDS was observed in 52% and 35% of patients, respectively. Tinnitus score was improved in 57% of patients. There was no relationship between age, sex, duration of disease, unilaterality of disease, or response to therapy. CONCLUSION: Intratympanic dexamethasone may be effective in the symptomatic control of hearing loss and tinnitus in Menier's disease.

Combined intratympanic and systemic steroid therapy for poor-prognosis sudden sensorineural hearing loss.

INTRODUCTION: The aim of this study was to evaluate the efficacy of combined intratympanic and systemic steroid therapy compared with systemic steroid therapy alone in idiopathic sudden sensorineural hearing loss (ISSNHL) patients with poor prognostic factors. MATERIALS AND METHODS: Seventy-seven patients with sudden sensorineural hearing loss (SSNHL) who had at least one poor prognostic factor (age greater than 40 years, hearing loss more than 70 db, or greater than a 2-week delay between the onset of hearing loss and initiation of therapy) were included in this study. Patients were randomized to the intervention group (combined intratympanic and systemic steroid therapy) or the control group (systemic steroid therapy alone). All patients received oral treatment with systemic prednisolone (1 mg/kg/day for 10 days), acyclovir (2 g/day for 10 days, divided into four doses), triamterene H (daily), and omeprazole (daily, during steroid treatment), and were advised to follow a low salt diet. The intervention group also received intratympanic dexamethasone injections (0.4 ml of 4 mg/ml dexamethasone) two times a week for two consecutive weeks (four injections in total). A significant hearing improvement was defined as at least a 15-db decrease in pure tone average (PTA). RESULTS: Among all participants,44 patients(57.14%) showed significant improvement in hearing evaluation. More patients showed hearing improvement in the intervention group than in the control group (27 patients (75%) versus 17 patients (41.4%), respectively; P=0.001). CONCLUSION: The combination of intratympanic dexamethasone and systemic prednisolone is more effective than systemic prednisolone alone in the treatment of poor-prognosis SSNHL.

Effectiveness of intratympanic dexamethasone in otitis media with effusion resistant to conventional therapy.

The aim of this study was to determine the efficiency of intratympanic dexamethasone (ITD) injections as a new treatment modality in otitis media with effusion resistant to conventional therapy. We planned a nonrandomized prospective study to determine the safety and effectiveness of the direct administration of dexamethasone into middle ear cavity with chronic eustachian tube dysfunction. This study was applied on 75 ears of 64 patients aged from 12 to 60 years. ITD received 47 ears of 41 patients who had previously been treated by medical or surgical therapy middle ear effusion without resolution classified as study group. They were taken conventional medical therapy again 28 ears of 23 patients classified as a control group. ITDs were administered 0.5 ml/4 mg per mm directly in antero-superior quadrant of tympanic membrane. These injections were repeated once a week for 4 weeks. Results were evaluated by using audiometric and tympanometric measurements 1 and 3 months after the treatments. Audiometric measurement shows that 9.91 dB improvement in the mean air-bone gap 15.17 dB in air conduction (AC) pure-tone averages (PTA) and 5.25 dB bone conduction (BC) PTA. But the control group data showed only 2 dB improvement in the mean air-bone gap, 3 dB AC-PTA and 1.36 dB BC-PTA. Tympanometric improvement was found. In 28 ears of patients (59.6%) like type B or C converted to type A in study group without complication but only in three ears (10.7%) of control group. ITD administration to the middle ear is safe and effective for the treatment of otitis media with effusion or chronic eustachian tube dysfunction. No complications like tympanic membrane perforation and/or sensorineural hearing loss have occurred.