Can Intratympanic Dexamethasone Added to Systemic Steroids Improve Hearing Outcome in Patients With Sudden Deafness?

Ahn, Joong Ho; Yoo, Myung Hoon; Yoon, Tae Hyun; Chung, Jong Woo

doi:10.1097/mlg.0b013e3181585428

Cited by 115 publications

(135 citation statements)

References 18 publications

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“…152 Another study combining oral and IT corticosteroids did not show a difference in hearing recovery compared with corticosteroids alone. 153 A recent study proposed IT treatment as the sole initial treatment. 154 The protocol consisted of early injections for 3 consecutive days, with only 3 of 34 patients failing to improve.…”

Section: Intratympanic Corticosteroidsmentioning

confidence: 99%

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Clinical Practice Guideline

Stachler

Chandrasekhar

Archer

et al. 2012

Otolaryngol.--head neck surg.

780

361

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Objective. Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL.Purpose. The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients.Results. The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals,...

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Section: Intratympanic Corticosteroidsmentioning

confidence: 99%

“…9,153,155,157,[198][199][200][201][202] One critical problem in the individual trials is how an improvement in hearing was defined. Most authors used a 10-dB HL improvement in the PTA or an improvement in WRS of 15% or 20% as indicative of successful treatment.…”

Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline

Stachler

Chandrasekhar

Archer

et al. 2012

Otolaryngol.--head neck surg.

780

361

View full text Add to dashboard Cite

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“…In a randomized, prospective study, Arslan et al [20] reported that SS+IT methylprednisolone (0.5 mL, every other day, 5 injections) may increase the healing ratios. On the other hand, in a study of Ahn et al [21] comparing 0.3 mL IT dexamethasone application on1, 3, and 5 days concomitant with SS with only SS treatment, they reported that ITS treatment concomitant with SS does not cause significant improvement. In a prospective, randomized, controlled trial of Park et al [22] , IT dexamethasone treatment concomitant with SS was compared with ITS administration after SS treatment and was …”

Section: Discussionmentioning

confidence: 99%

Evaluation of Adjuvant Intratympanic Dexamethasone Administration in the Treatment of Sudden Sensorineural Hearing Loss

Şahin¹,

Göde²,

Öztürk³

et al. 2015

Int Adv Otol

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“…However, a combination of a high-dose prednisone taper with IT steroids resulted in partial or complete hearing recovery in 14 of 16 patients [15]. Another study combining oral and IT corticosteroids did not show a difference in hearing recovery compared with corticosteroids alone [16]. A recent study proposed IT treatment as the sole initial treatment [17].…”

Section: Discussionmentioning

confidence: 99%

Intratympanic Steroids in Sudden Sensorineural Hearing Loss: Myth or Magic?

Taneja

Tatavarty

Gupta

2017

JOENTR

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Sudden Sensorineural hearing loss (SSNHL) is a medical emergency inwhich etiopathogenesis and consensus on treatment are still largely debatable. SSNHL has been defined as 30 dB or more sensorineural hearing loss over at least three contiguous audiometric frequencies occurring within 3 days or less. Although several vascular, inflammatory, viral and neoplastic causes exist, no specific etiology can be confirmed; thereforeit is considered idiopathic. Steroids form the mainstay of treatment; however, recent experience with transtympanic steroid injections has been very encouraging. The exact number of injections, dosage, steroid form and window of application is still to be determined conclusively. We report a rare case of idiopathic SSNHL with profound hearing loss treated by 6 shots of transtympanic injections which normalised the hearing. We also review the methods and improvement of transtympanic injections from other studies.

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Can Intratympanic Dexamethasone Added to Systemic Steroids Improve Hearing Outcome in Patients With Sudden Deafness?

Abstract: The addition of ITD to systemic steroids did not result in significant improvements in the treatment of idiopathic sudden HL.

Cited by 115 publications

References 18 publications

Clinical Practice Guideline

Clinical Practice Guideline

Evaluation of Adjuvant Intratympanic Dexamethasone Administration in the Treatment of Sudden Sensorineural Hearing Loss

Intratympanic Steroids in Sudden Sensorineural Hearing Loss: Myth or Magic?

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