Gianoli GJ, Li JC. Transtympanic steroids for treatment of sudden hearing loss
To determine whether transtympanic steroid administration may be an effective treatment for sudden onset sensorineural hearing loss (SSNHL) in patients for whom systemic steroid treatment has failed or who were not candidates for systemic steroids.
The standard medical regimen for SSNHL usually involves systemic steroid therapy. Unfortunately, some patients do not respond successfully to or are poorly tolerant of systemic steroids. Transtympanic administration of steroids has been suggested as an alternative to systemic therapy. A prospective study was designed to evaluate the hearing outcomes in SSNHL patients treated with transtympanic steroids. Patients received transtympanic steroids if oral steroids had failed to work or if they were not able to tolerate oral steroids. Transtympanic steroids were administered through a ventilation tube placed with the patient under local anesthesia. Steroid administration was performed on 4 separate occasions over the course of 10 to 14 days. Hearing was assessed immediately before therapy and within 1 to 2 weeks after therapy.
Hearing improvement was documented in 10 of 23 patients (44%) who underwent transtympanic steroid administration. This represents a 44% hearing salvage in patients for whom steroid treatment would otherwise have been considered a failure.
Transtympanic steroid therapy may be an alternative treatment for patients with SSNHL for whom systemic steroid therapy had failed or who could not tolerate systemic steroid therapy.
Available from: Jae Ho Ban
- "Idiopathic sudden sensorineural hearing loss (SSNHL) is commonly associated with tinnitus and ear fullness, and is often accompanied by vertigo. Although some patients recover spontaneously without treatment, therapeutic intervention that includes systemic steroid therapy and intra-tympanic steroid injections is typically used to promote prompt recovery of hearing (1-4). Therapeutic efficacy in patients with SSNHL depends on the treatment regimen and a variety of prognostic factors including age, treatment delay, diabetes mellitus, hypertension, and audiological patterns (5-7). "
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ABSTRACT: The prognostic significance of vertigo in patients with idiopathic sudden sensorineural hearing loss (SSNHL) remains a matter of debate because vertigo is associated with many different vestibular disorders. The purpose of this study is to determine the role of benign paroxysmal positional vertigo (BPPV) as a prognostic factor in patients with SSNHL.
We conducted a retrospective study of 298 patients with SSNHL. Hearing outcomes were evaluated by assessments of pre-treatment hearing and hearing gain. Comparative multivariate analyses between prognostic factors and hearing outcome were conducted.
Thirty-eight (12.7%) SSNHL patients were found to also have BPPV. BPPV showed significant negative prognostic factors in hearing outcome on multivariate analysis (odds ratio, 0.15). In comparison to average pure tone audiometry (PTA), patients diagnosed with SSNHL with BPPV exhibited poorer hearing in pre- and post-treatment PTA compared to SSNHL without BPPV. Old age (>60 years), pre-treatment hearing, and canal paresis were significant outcome predictors.
BPPV in SSNHL patients, representing definitive vestibular damage, was closely related to poor prognosis.
Clinical and Experimental Otorhinolaryngology 12/2010; 3(4):199-202. DOI:10.3342/ceo.2010.3.4.199 · 0.85 Impact Factor
Available from: Rachael T Richardson
- "A very rapid chemical conversion within the cochlea from drug salt to active drug occurs within 15 min [Hargunani et al., 2006] and dexamethasone is completely removed from the inner ear in under 24 h [Parnes et al., 1999; Chandrasekhar et al., 2000; Liu et al., 2004; Hargunani et al., 2006]. Third, transtympanic delivery of steroids is already in otologic practice [Gianoli and Li, 2001; Ho et al., 2004; Gouveris et al., 2005; Selivanova et al., 2005]. Fourth, the round window is accessible during cochlear implant surgery. "
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ABSTRACT: To study electric acoustic stimulation, we have developed a model of guinea pig cochlear implantation via a cochleostomy. Thirty minutes prior to implantation, a hyaluronic acid/carboxymethylcellulose bead, loaded with either dexamethasone or normal saline, was placed upon the round window membrane. Animals that did not receive beads acted as controls. Pure-tone auditory brainstem response thresholds were estimated before and after electrode insertion, and 1 and 4 weeks later. Selected cochlear histology was performed. RESULTS: Dexamethasone could be detected in the cochlea for 24 h after cochlear implantation. Thresholds were elevated across frequencies in all animals immediately after surgery. These thresholds recovered completely at and below 2 kHz, and partially at higher frequencies by 1 week after implantation. At 32 kHz, but not the lower frequencies, the presence of dexamethasone had a significant protective effect upon hearing, which increased in magnitude over time. The protection was greatest in difficult implantations where an intractable resistance to electrode insertion was met. There was a persistent foreign body reaction at the site of implantation of saline-treated implanted ears but not in the dexamethasone-treated implanted ears. CONCLUSION: Short-term preoperative delivery of dexamethasone through the round window can protect residual hearing during cochlear implantation, especially during technically difficult surgery.
Audiology and Neurotology 02/2008; 13(2):86-96. DOI:10.1159/000111780 · 1.71 Impact Factor
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