Impact of Perioperative Oral Steroid Use on Low-frequency Hearing Preservation After Cochlear Implantation

Sweeney, Alex D.; Carlson, Matthew L.; Zúñiga, M. Geraldine; Bennett, Marc; Wanna, George B.; Haynes, David S.; Rivas, Alejandro

doi:10.1097/mao.0000000000000847

Cited by 47 publications

(27 citation statements)

References 30 publications

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“…The results of the preliminary study described in this chapter suggested that combined glucocorticoid administration (according to scheme of administration in the second subgroup) is beneficial in preserving and stabilizing hearing thresholds in patients undergoing cochlear implantation surgery. The findings of this study are supported by the results of similar studies [1,17]. However, the present study adds to the findings of previous studies by having a relatively long follow-up period, of 12 months after activation, with study analysis conducted during six different follow-up periods.…”

Section: Final Conclusionsupporting

confidence: 90%

“…Hearing preservation (HP) was calculated by comparing hearing thresholds in the 1-year postoperative period with the preoperative hearing thresholds, according to the hearing preservation (HP) formula (below) and converted to three levels: minimal, partial, and complete hearing preservation. (1) In this equation, P TApre is the pure tone average measured preoperatively, PTApost is the pure tone average measured postoperatively, and P TAmax is the maximal sound intensity generated by a standard audiometer, usually 120 dB hearing level (HL), and HP is the rate of hearing preservation in percentage [19].…”

Section: Methodology Of the Study: Primary And Secondary Outcomes Andmentioning

confidence: 99%

“…Regardless of surgical technique for cochlear implantation (cochleostomy or an approach through the round window), specialized centers have now introduced the comprehensive analysis of the nonsurgical factors that could contribute to improve rates of hearing preservation in preoperative, during surgery, or in postoperative period in patients who suffer from partial deafness. One of the approaches of many leading research centers is using pharmacotherapy (glucocorticoids) as a factor which may improve hearing functions following cochlear implantation [1,2]. Glucocorticoids play an important role in pharmacotherapy of many different otorhinolaryngological diseases, such as Meniere's disease, sudden sensorineural hearing loss (SSNHL), and tinnitus, and as a part of otorhinolaryngological procedures in surgeries (e.g., cochlear implantation) [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Role of Glucocorticoids in Hearing Preservation in Partial Deafness Treatment

Skarżyńska¹

2020

The Human Auditory System - Basic Features and Updates on Audiological Diagnosis and Therapy

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During the last 15 years, cochlear implantation became available as a method of treatment for different types of hearing impairment. Leading, specialized centers have now introduced the analysis of the nonsurgical factors that could contribute to improve rates of hearing preservation in preoperative period, during surgery, or in postoperative period in patients who suffer from partial deafness. One of the approaches is using pharmacotherapy (glucocorticoids) as a factor that may improve hearing functions. Preservation of hearing in patients who suffered from partial deafness and underwent cochlear implantation by using two different regimes of corticosteroid therapy was the aim of the study carried out by the World Hearing Center (WHC). Forty-six patients were enrolled in the trial and divided into three subgroups. Hearing preservation (HP) was evaluated using pure tone audiometry (PTA) (11 frequencies ranging from 125 to 8000 Hz). The impact of administrated substances was evaluated by pure tone audiometry during six different periods: before cochlear implant surgery, during activation of audio processor, and 1, 6, 9, and 12 months after activation of audio processor in comparison with control group. According to hearing preservation (HP) classification, patients from the second group, to whom combined glucocorticoid therapy was administrated, achieved the best HP results. The complete hearing preservation index was observed in the highest percentage of patients from the second subgroup. The dispersion of measured values was lesser than in other subgroups. According to the results, administration of glucocorticoids (dexamethasone and prednisone or dexamethasone only) to the patients, who suffered from partial deafness and underwent cochlear implantation surgery, may be important in stabilization of hearing thresholds and in protection of hearing.

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Section: Final Conclusionsupporting

confidence: 90%

Section: Methodology Of the Study: Primary And Secondary Outcomes Andmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of Glucocorticoids in Hearing Preservation in Partial Deafness Treatment

Skarżyńska¹

2020

The Human Auditory System - Basic Features and Updates on Audiological Diagnosis and Therapy

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“…Other studies have therefore concentrated on the use of prolonged steroid therapy using combined oral and intravenous steroids to stabilize and preserved hearing in cochlear implantation (6). Another approach proven more effective than single-dose steroids was the use of a perioperative oral steroid taper on low frequency hearing preservation (7). Hence, it has already been shown clinically that a perioperative steroid application has, to some extend, a positive effect on residual, low frequency hearing (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Dose-Dependent Transient Decrease of Impedances by Deep Intracochlear Injection of Triamcinolone With a Cochlear Catheter Prior to Cochlear Implantation–1 Year Data

et al. 2020

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Administration of low-dose steroids via a catheter inserted into the cochlea to apply pharmaceuticals to more apical regions was previously shown not to be sufficient for long-term reduction of electrode impedances. The aim of the present study was to investigate the effect of intra-cochlear high-dose triamcinolone application on impedances in cochlear implant recipients. Patients received low-dose (4 mg/ml; n = 5) or high-dose (20 mg/ml; n = 5) triamcinolone via a cochlear catheter just prior to the insertion of a Med-El Flex28 electrode. Impedances were measured at defined time points from intra-operatively up to 12 months after first fitting and retrospectively compared with a control group (no steroid application). Patients who received a high-dose application of crystalloid triamcinolone showed significantly reduced impedances in the first fitting measurements compared to the control group. This effect was no longer detectable in patients of the low-dose group at that time. Looking at the different regions of the electrode, the impedance values were lowered significantly only at the basal and medial contacts. At later time points, there were no significant differences between any of the groups. This is the first study to demonstrate a dose-dependent reduction of impedances by deep intra-cochlear injection of triamcinolone in cochlear implant patients. With a high-dose, single application of triamcinolone using a cochlear catheter prior to insertion of a Flex28 electrode, the impedances can be significantly reduced up to and including the first fitting. Although the effect was longer lasting than when compared to low-dose triamcinolone, it was also not permanent.

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“…One of the approaches to improving hearing function following cochlear implantation has been the use of corticosteroids, such as dexamethasone [ 8 , 9 ]. Dexamethasone is a synthetic glucocorticoid, or corticosteroid, that differs from prednisolone only by the positioning of a fluorine atom in the compound [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Preservation of Hearing Following Cochlear Implantation Using Different Steroid Therapy Regimens: A Prospective Clinical Study

et al. 2018

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BackgroundA prospective clinical study was conducted to assess different regimens of steroid therapy and preservation of hearing following cochlear implantation.Material/MethodsStudy participants were ≥18 years-of-age, with a cochlear duct length ≥27.1 mm measured by computed tomography (CT), with hearing sound levels in the range of 10–120 decibels (dB) and sound frequencies of 125–250 hertz (Hz); sound levels of 35–120 dB and frequencies of 500–1,000 Hz; sound levels of 75–120 dB and frequencies of 2,000–8,000 Hz. Study exclusion criteria included diseases with contraindications for steroid therapy or medications that increased the effects of steroids. Patients had cochlear implantation and were divided into three treatment groups: intravenous (IV) steroid therapy (standard steroid therapy): combined oral and IV steroid therapy (prolonged steroid therapy); and a control group (cochlear implantation without steroid therapy). Hearing preservation was established by pure tone audiometry based on the pre-operative and postoperative average hearing thresholds according to the formula developed by the HEARRING Network.ResultsThere were 36 patients included in the study. In all cases, the cochlear implant electrode was inserted via the round window approach with a straight electrode length of 28 mm. Patients with combined oral and IV steroid therapy (prolonged steroid therapy) had better results when compared with patients with intravenous (IV) steroid therapy (standard steroid therapy) and the control group.ConclusionsProlonged steroid therapy using combined oral and IV steroids stabilized hearing thresholds and preserved hearing in adult patients following cochlear implantation.

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Impact of Perioperative Oral Steroid Use on Low-frequency Hearing Preservation After Cochlear Implantation

Abstract: A 2-week oral prednisone taper beginning before surgery may positively affect the incidence and degree of low-frequency hearing preservation after cochlear implantation.

Cited by 47 publications

References 30 publications

Role of Glucocorticoids in Hearing Preservation in Partial Deafness Treatment

Role of Glucocorticoids in Hearing Preservation in Partial Deafness Treatment

Dose-Dependent Transient Decrease of Impedances by Deep Intracochlear Injection of Triamcinolone With a Cochlear Catheter Prior to Cochlear Implantation–1 Year Data

Preservation of Hearing Following Cochlear Implantation Using Different Steroid Therapy Regimens: A Prospective Clinical Study

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