Intratympanic steroid use for idiopathic sudden sensorineural hearing loss: current otolaryngology practice in Germany and Austria

Sutton, Liam; Schartinger, Volker Hans; Url, Christoph; Schmutzhard, Joachim; Lechner, Daniel; Kavasogullari, C.; Sandhu, Jaswinder S.; Shaida, Azhar; Laszig, Roland; Loehler, J.; Plontke, Stefan K.; Riechelmann, Herbert; Lechner, Matt

doi:10.1007/s00405-018-4958-8

Cited by 20 publications

(25 citation statements)

References 35 publications

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“…However, published protocols differ in the kind of steroid used, drug concentration and applied volume, number of injections and intervals between injections, total duration of treatment and starting time after the onset of ISSNHL. It becomes difficult to compare the results and subsequently to find clear recommendations for primary or secondary IT steroid treatment [5,6,10,11].…”

Section: Introductionmentioning

confidence: 99%

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Roßberg

Goetz

Timm

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose To evaluate temporal bone cone-beam CT in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) being treated with primary and secondary intratympanic (IT) triamcinolone and to possibly correlate these results to the clinical outcome. Methods Retrospective analysis of patients treated with IT triamcinolone for ISSNHL at our department in 2018. Pre-and post-therapeutic audiologic examinations included four-tone average (FTA) at 0.5, 1, 2 and 3 kHz. Using a clinical questionnaire, pre-therapeutic CBCT scans were re-evaluated looking at items, which might interfere with adequate drug diffusion into the inner ear (e.g. bony overhangs or secondary membranes at the round or oval window). Results Thirty-one patients were included. Twenty-four (77%; group A) had experienced ineffective systemic steroid therapy before and seven (23%; group B) received primary IT injections. Four group A-patients (21%) and two group B-patients (33%) showed a post-therapeutic FTA improvement of more than 15 dB HL. Bony overhangs at the round window niche (RWN) were present in seven cases (26%), a secondary membrane at the RWN in four (15%) and soft tissue in eight (30%) cases, respectively. Conclusion Most patients present radiological findings in CBCT imaging, which might interfere with drug diffusion through the RW membrane. Interestingly, soft or bony tissue obstructing the RWN or the OWN was found in 50% of patients, who showed improvement of hearing. We conclude that radiologic 'tiny' findings are either clinically irrelevant or improvement in hearing is independent from intratympanic drug delivery.

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Section: Introductionmentioning

confidence: 99%

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Roßberg

Goetz

Timm

et al. 2020

Eur Arch Otorhinolaryngol

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“…There is a wide range of steroids used in UK practice, with the most common (28%) being dexamethasone at a concentration of 3.3 mg/ml. This is in contrast to practice in Germany and Austria, which has a majority use (81%) of dexamethasone at a concentration of 4 mg/ml, 22 which is also the favored concentration being used in America. 23 The most common volume injected is 0.5 ml.…”

Section: Discussionmentioning

confidence: 80%

“…The criteria used for the diagnosis of ISSNHL show little consensus within different countries; similar studies to the one reported were carried out in Germany and Austria 22 as well as America, 23 to establish their practices. These found that 31.2% of German/Austrian clinicians used a range of different definitions for ISSNHL compared to 18% of the surveyed British doctors.…”

Section: Discussionmentioning

confidence: 95%

“…We found that approximately two-thirds of surgeons used intratympanic steroids for SSNHL in some aspect of the patients’ management. This provides an interesting comparison to the current uptake of 49.1% in practice within Germany and Austria 22 and 100% in the United States. 23 The point in the disease process when intratympanic steroids should be used was variable.…”

Section: Discussionmentioning

confidence: 96%

“…The use of a tympanic ventilation tube and the duration of time the patient was left in a supine position also displayed very little homogeneity within this study. There is a trend between UK, continental European, 22 and American 23 practice having a majority (52.4%-76%) preferring a supine position for 30 minutes postprocedure.…”

Section: Discussionmentioning

confidence: 99%

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Intratympanic Steroid Use for Sudden Sensorineural Hearing Loss: Current Otolaryngology Practice

Lechner

Sutton

Ferguson

et al. 2019

Ann Otol Rhinol Laryngol

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Objective: To investigate the current practice of intratympanic steroid (ITS) injection for sudden sensorineural hearing loss (SSNHL) in the United Kingdom and link the data with data from the United States and continental Europe. Methods: A survey of 21 questions was distributed to members of the British Society of Otology using an online survey platform via ENT UK. Data obtained from UK otolaryngologists (n = 171) were integrated with previously published data from other countries, including the United States (n = 63) and continental Europe (n = 908). Results: In the United Kingdom, 62% of responding otolaryngologists use ITS injection for SSNHL, while 38% do not. Of those using ITS, 59% use it as first-line treatment, either using it in conjunction with oral steroids (51%) or using it as monotherapy (8%). Of those that use ITS, a majority (83%) use it as salvage therapy when primary treatment with systemic steroids has failed, and similar results are found in the continental Europe and US surveys. The most commonly used preparation is dexamethasone. Responses to questions regarding treatment regimes used are enlightening and show considerable variation in the treatment regimes used within and between countries. Conclusions: There is a wide variation in practice with regards to ITS for SSNHL hearing loss in the United Kingdom, United States, and continental Europe. In the absence of protocols or definitive guidance from published literature, knowledge of contemporary practice may help guide or encourage reevaluation of clinical practice and will help guide the design of future clinical trials.

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Residual Perforation Risk Assessment of Intratympanic Steroids via Tympanostomy Tube Versus Transtympanic Injections

et al. 2021

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Objectives/Hypothesis To investigate the risk of residual tympanic membrane (TM) perforation after intratympanic (IT) steroidal treatment administered via transtympanic injection compared with trans‐tympanostomy tube (TyT). Study Design Case series, systematic review and meta analysis. Methods Data were retrieved from the medical files of an original cohort of all consecutive patients with sudden sensorineural hearing loss necessitating IT steroidal treatment in a tertiary medical center between January 1, 2016 and November 20, 2020. A systematic literature search of “MEDLINE” via “PubMed,” “Embase,” and “Web of Science” on comparable published cases was performed and meta‐analysis was established. Results Eighteen studies describing 818 ears were included in the quantitative meta‐analysis in addition to a local cohort of 140 ears. The proportion of residual TM perforation was 1.11% and 1.14% (95% confidence interval: 0.01%–3.27% and 0.028%–2.38%) in the TyT and trans‐tympanic groups, respectively, suggesting no significant difference in residual TM perforation risk between these techniques. Conclusion IT steroid therapy via trans‐TyT is not associated with more residual perforations than IT steroid therapy via transtympanic injections. Level of Evidence NA Laryngoscope, 131:E2583–E2591, 2021

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Intratympanic steroid use for idiopathic sudden sensorineural hearing loss: current otolaryngology practice in Germany and Austria

Cited by 20 publications

References 35 publications

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Intratympanic Steroid Use for Sudden Sensorineural Hearing Loss: Current Otolaryngology Practice

Residual Perforation Risk Assessment of Intratympanic Steroids via Tympanostomy Tube Versus Transtympanic Injections

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