Roebuck J, Chang CY. Efficacy of steroid injection on idiopathic sudden sensorineural hearing loss

Department of Otolaryngology, University of Texas-Houston, 6410 Fannin Street, Houston, TX 77030-3005, USA.
Otolaryngology Head and Neck Surgery (Impact Factor: 2.02). 09/2006; 135(2):276-9. DOI: 10.1016/j.otohns.2006.03.035
Source: PubMed


To evaluate the effectiveness of transtympanic steroid injection on patients with idiopathic sudden sensorineural hearing loss (ISSNHL) compared with patients who receive oral steroids alone.
Retrospective chart review.
Patients with a history of ISSNHL and failed oral steroid therapy were included. Audiograms were performed and patients were included if SNHL of more than 20 dB occurred over less than 72 hours. Patients who received transtympanic steroid injection were compared with those who received oral steroids alone.
Sixty-one patients met inclusion criteria and were included in the study. The number of patients with improvement in pure tone average in the injection group was 9 (30%) compared with 5 (17%) in the oral group. Twelve (38.7%) of the injected patients did have improvement in speech discrimination scores of greater than 15% compared with only 3 (10%) in the oral steroid group.
Our study revealed that patients with ISSNHL who have failed oral steroid therapy obtain better hearing results with transtympanic steroids in comparison to oral steroids. EBM rating: B-3b.

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    ABSTRACT: A sudden onset of hearing loss due to disease of the organ of hearing is a medical emergency and requires prompt recognition and treatment. In addition to the hearing impairment, patients may also suffer from symptoms of tinnitus (background ringing noise), a sensation of ear fullness and dizziness. In many instances medical specialists are able to find the cause and treat the hearing impairment. However, in a large proportion of patients, no known cause of the sudden hearing loss can be found. Steroids are commonly used to treat patients with sudden hearing loss of an unknown origin. The specific action of the steroids in the hearing apparatus is uncertain. It has been postulated that the steroid treatment improves hearing because of its ability to reduce inflammation and oedema (swelling) in the hearing organs. The review of the trials showed a lack of good quality evidence for the effectiveness of steroids in the treatment of sudden hearing loss of an unknown origin. The quality of the trials was generally low and more research is needed.
    Cochrane database of systematic reviews (Online) 02/2006; 7(1):CD003998. DOI:10.1002/14651858.CD003998.pub2 · 6.03 Impact Factor
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    ABSTRACT: We sought to describe our experience with intratympanic steroid treatment of sudden sensorineural hearing loss after failure of intravenous steroid treatment. We conducted a nonrandomized prospective clinical trial. Fifty patients presenting with sudden onset idiopathic hearing loss were treated intravenously over five days. After this period, patients with treatment failure (18 cases) were offered intratympanic steroid treatment. Nine patients refused, whereas the other nine patients received three weekly injections of methylprednisolone. Recovery of hearing was reported as improvement of more than 15 dB in pure tone average. Intratympanic steroid treatment improved hearing loss in five patients (55%). This is significant compared with those patients who refused intratympanic treatment, who showed no further improvement (P < 0.05). No serious adverse effects were observed. Intratympanic steroids significantly improve the recovery outcome of sudden hearing loss that had not recovered after intravenous steroid treatment. Intratympanic steroids are an effective and safe therapy in sudden sensorineural hearing loss cases that are refractory to standard treatment.
    Otolaryngology Head and Neck Surgery 08/2007; 137(1):74-8. DOI:10.1016/j.otohns.2007.01.022 · 2.02 Impact Factor
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    ABSTRACT: Local application of dexamethasone-21-dihydrogen-phosphate (Dex-P) to the round window (RW) membrane of guinea pigs produces a substantial basal-apical concentration gradient in scala tympani (ST) perilymph. In recent years, intratympanically applied glucocorticoids are increasingly being used for the treatment of inner ear disease. Although measurements of intracochlear concentrations after RW application exist, there is limited information on the distribution of these drugs in the inner ear fluids. It has been predicted from computer simulations that substantial concentration gradients will occur after RW application, with lower concentrations expected in apical turns. Concentration gradients of other substances along the cochlea have recently been confirmed using a sequential apical sampling method to obtain perilymph. Dexamethasone-21-dihydrogen-phosphate (10 mg/ml) was administered to the RW membrane of guinea pigs (n = 9) in vivo for 2 to 3 hours. Perilymph was then collected using a protocol in which 10 samples, each of approximately 1 mul, were taken sequentially from the cochlear apex into capillary tubes. Dexamethasone-21-dihydrogen-phosphate concentration of the samples was analyzed by high-performance liquid chromatography. Interpretation of sample data using a finite element model allowed the longitudinal gradients of Dex-P in ST to be quantified. The Dex-P content of the first sample in each experiment (dominated by perilymph from apical regions) was substantially lower than that of the third and fourth sample (dominated by basal turn perilymph). These findings qualitatively demonstrated the existence of a concentration gradient along ST. After detailed analysis of the measured sample concentrations using an established finite element computer model, the mean basal-apical concentration gradient was estimated to be 17,000. Both absolute concentrations of Dex-P in ST and the basal-apical gradients were found to vary substantially. The existence of substantial basal-apical concentration gradients of Dex-P in ST perilymph were demonstrated experimentally. If the variability in peak concentration and gradient is also present under clinical conditions, this may contribute to the heterogeneity of outcome that is observed after intratympanic application of glucocorticoids for various inner ear diseases.
    Ontology & Neurotology 05/2008; 29(3):401-6. DOI:10.1097/MAO.0b013e318161aaae · 1.79 Impact Factor
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