Intratympanic Methylprednisolone for Sudden Sensorineural Hearing Loss

Kılıç, Rahmi; Şafak, Mustafa Asım; Oğuz, Haldun; Kargin, Selda; Demirci, Münir; Samim, Erdal; Özlüoğlu, Levent N.

doi:10.1097/mao.0b013e31802fba7a

Cited by 49 publications

(36 citation statements)

References 16 publications

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“…In reviewing the SSNHL studies in tables 2 and 3, 13 studies had controls [4,23,24,25,26,27,28,29,30,31,32,33,34]; however, the controls were all some form of systemic steroids. None of the studies had placebo as their control.…”

Section: Resultsmentioning

confidence: 99%

Intratympanic Steroids for Inner Ear Disorders: A Review

Parnes

2009

Audiol Neurotol

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Background/Aim: The use of intratympanic steroids (ITS) has proliferated over the past 10–15 years to include treatments for inner ear disorders, like Ménière’s Disease (MD) and sudden sensorineural hearing loss (SSNHL). The aim of this study was to review the clinical trials of ITS for inner ear disorders. Methods: PubMed and Ovid Medline databases were searched from 1966 to present for clinical trials on ITS in the treatment of MD and SSNHL. Studies were evaluated based on comparability and internal and external validity. Results: Thirty-eight studies were identified in total, 13 studies on MD and 25 studies on SSNHL. Most studies lacked placebo controls. Only 3 studies were double-blinded randomized prospective trials. Overall, there were heterogeneous steroid doses, treatment protocols, previous treatments, and definitions of disease and improvement. Conclusion: There are no good studies on ITS that meet the criteria of comparability, internal validity, and external validity. It is difficult to compare studies due to the heterogeneous nature of the data. More rigorously designed studies are required to determine the efficacy of this treatment, the optimal steroid to use, and the best treatment regimen.

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Section: Resultsmentioning

confidence: 99%

Intratympanic Steroids for Inner Ear Disorders: A Review

Parnes

2009

Audiol Neurotol

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“…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.

772

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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“…The treatment results in these reports vary considerably and the evidence provided is modest since most of the clinical reports are case series (3). Few studies compared their findings with a control group (4)(5)(6)(7)(8)(9)(10) and only one randomized trial has so far been published (11).…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone Concentration Gradients Along Scala Tympani After Application to the Round Window Membrane

Plontke¹,

Biegner²,

Kammerer³

et al. 2008

Otology &Amp; Neurotology

174

129

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Hypothesis-Local application of dexamethasone-21-dihydrogene-phosphate (Dex-P) to the round window membrane (RWM) of guinea pigs produces a substantial basal-apical concentration gradient in scala tympani (ST) perilymph.Background-In recent years, intratympanically-applied glucocorticoids are increasingly being used for the treatment of inner ear disease. Although measurements of intracochlear concentrations after round window (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 with lower concentrations expected in apical turns after RW application. Concentration gradients of other substances along the cochlea have recently been confirmed using a sequential apical sampling method to obtain perilymph.

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Intratympanic Methylprednisolone for Sudden Sensorineural Hearing Loss

Cited by 49 publications

References 16 publications

Intratympanic Steroids for Inner Ear Disorders: A Review

Intratympanic Steroids for Inner Ear Disorders: A Review

Clinical Practice Guideline

Dexamethasone Concentration Gradients Along Scala Tympani After Application to the Round Window Membrane

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