Therapy of Idiopathic Sudden Sensorineural Hearing Loss: Antiviral Treatment of Experimental Herpes Simplex Virus Infection of the Inner Ear

Stokroos, Robert J.; Albers, F. W. J.; Schirm, J

doi:10.1177/000348949910800501

Cited by 92 publications

(94 citation statements)

References 16 publications

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“…Many authors report that spontaneous recovery happens in 45 to 60% of the patients 4,6,9,10 . In a more detailed fashion, it is estimated that about 25% of patients have total spontaneous recovery; 50%, partial and 25% present no recovery at all 2 .…”

Section: Introductionmentioning

confidence: 99%

Surdez súbita idiopática: aspectos etiológicos e fisiopatogênicos

Lazarini¹,

Camargo²

2006

Rev. Bras. Otorrinolaringol.

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Several factors have been postulated to elicit the etiology of idiopathic sudden sensorineural hearing loss. Through a bibliographic review, we made a critical analysis of the different etiopathogenic aspects of its clinical manifestation. The most recent studies concerning the possible causes of sudden hearing loss suggest vascular disorders, rupture of the inner ear membrane and autoimmune diseases; however, viral infections have received a great deal of attention in recent years. Little is known about the mechanism of sudden hearing loss. Viruses can cause sudden hearing loss in an acute infection, however the latent form, and its possible reactivation have also been considered as explanations of the cochlear injury mechanism. Even though hearing loss can be explained by a blood viscosity change, experimental and clinical studies do not show any evidence of labyrinthine fibrosis and new bone formation, or labyrinthine membrane breaks. These findings are not in agreement with vascular and rupture membrane factors, respectively. The eventual presence of antibodies against the inner ear suggests that sudden hearing loss pathogenesis may be of autoimmune nature, but the difficulty in establishing the correlation of its morphological and clinical aspects to the hearing loss also do not help to support this statement. Sudden hearing loss is still a controversial and obscure subject in several aspects.

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Section: Introductionmentioning

confidence: 99%

Surdez súbita idiopática: aspectos etiológicos e fisiopatogênicos

Lazarini¹,

Camargo²

2006

Rev. Bras. Otorrinolaringol.

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“…7 Both adrenocorticoid and glucocorticoid receptors are found in the inner ear, though the precise mechanism of action is not known. 8 The main role of steroids is to protect the cochlea from inflammatory mediators released like TNA-a and NFK b. 9 Steroids increase the blood flow to the cochlea and regulate protein synthesis in cochlea.…”

Section: Discussion: Sudden Sensorineural Hearing Loss Is One Of the mentioning

confidence: 99%

“…5 Silverstein et al quoted that intra tympanic steroids are safe and do not produce histological changes in the cochlea. 8 The main clinical presentation is sudden hearing loss, which is also attributed to common ear fullness by the patients. The fullness in the ear can be due to wax impaction or congestion of Eustachian tube as in URTI.…”

Section: Discussion: Sudden Sensorineural Hearing Loss Is One Of the mentioning

confidence: 99%

A Clinical Study on Intratympanic Methyl Prednisolone as Primary and Rescue Therapies Versus Oral Prednisolone in the Treatment of Ssnhl: A Study on 90 Patients

A¹,

Ravishankar²,

S³

et al. 2015

jemds

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INTRODUCTION:Sudden Hearing Loss is a real emergency requiring a fixed protocol in every hospital to help the patient recover his lost hearing ability. Diagnostic tools including pure tone and speech audiometry, Hematological tests and MRI scan will guide the physician to identify the etiology of deafness to a certain extent, but in majority of the patients it is difficult. Oral steroid therapy with Prednisolone or Methyl Prednisolone over a period of 19 days is the most common choice. It also seems to be the best treatment option. Recently intratympanic steroids have become an attractive choice either as a primary therapy or as an adjuvant therapy, in patients showing no or little improvement with oral steroids. It is also useful in patients in whom steroids are contraindicated. OBJECTIVE: To observe and analyze the result of improvement in hearing following Intratympanic steroids used as a primary treatment and rescue therapy versus results in the patients on oral steroids alone taken as a control group; To evolve a treatment protocol in the management of SSNHL in our Hospital. MATERIALS AND METHODS: In this prospective study 90 patients are divided into three groups and the effect of Oral Prednisolone therapy on improving hearing is compared with primary and rescue therapy with Intratympanic steroid injections. Pre and post therapy audiograms of pure tone (PTA) and speech audiometry (SRT) of the three groups are analyzed to formulate a meaningful solution. RESULTS: Intratympanic steroids as a primary therapy showed effective recovery of hearing, observed by reduction in PTA of more than 15dB and improved SRT scoring of more than 15%. This study showed statistical significance when compared with systemic steroids therapy and failed systemic steroid therapy (less than expected P value <0.05) Intratympanic injections as a rescue therapy also showed recovery of hearing with fall in PTA to <15dB and improved SRT scoring >15%. CONCLUSIONS: Four injections of Steroids into the middle ear used as primary or rescue therapies, improved hearing thresholds as recorded on pure tone average and speech discrimination. The additional advantage of avoiding systemic side effects is established once again in this study.

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“…2,4,8 The precise mechanism by which steroids may improve hearing remains unknown; both glucocorticoid and mineralocorticoid receptors may be found in the inner ear. 28 A few studies have shown that the main roles of steroids in the treatment of SHL are to protect the cochlea from the harmful effects of inflammatory mediators such as the tumor necrosis factor (TNF-a and NFK-b), which is elevated in infection and inflammation, 29 to increase cochlear blood flow 30 thereby avoiding cochlear ischemia, 31 to avoid noise-induced hearing loss, 32 and to regulate protein synthesis in the inner ear. 33 Studies have shown that the vascular stria, which regulates Na/K secretion for maintaining the endocochlear potential, is a site of injury in SHL.…”

Section: Discussionmentioning

confidence: 99%

Metilprednisolona intratimpânica como terapia de resgate na surdez neurossensorial súbita

Raymundo¹,

Bahmad²,

Filho³

et al. 2010

Braz. j. otorhinolaryngol. (Impr.)

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Treat ment in sudden sensorineural hearing loss is a contentious issue, today, oral steroids are the most common choice and considered the best treatment option, but the use of intratympanic steroids has become an attractive alternative, especially in cases when systemic therapy fails, or to avoid the side effects of the systemic use of steroids. Aim:To describe the results of intratympanic methylprednisolone in idiopathic sudden sensorineural hearing loss after failure of oral prednisolone.Methods: In a prospective study fourteen patients with idiopathic sudden sensorineural hearing loss were treated with intratympanic methylprednisolone after failing in the treatment with systemic steroids. Pretreatment and post-treatment audiometric evaluations including pure tone average (PTA) and speech reception thresholds (SRT) were analyzed. Results:Ten from 14 patients treated with intra-tympanic methylprednisolone presented with hearing recovery > 20 dB in PTA or 20% in SRT. Conclusion:Three intratympanic injections of methylprednisolone improved pure-tone average or speech discrimination scores for a subset of sudden hearing loss subjects that failed to benefit from oral steroids. Braz J Otorhinolaryngol. 2010;76(4):499-509. ORIGINAL ARTICLE BJORL

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Therapy of Idiopathic Sudden Sensorineural Hearing Loss: Antiviral Treatment of Experimental Herpes Simplex Virus Infection of the Inner Ear

Cited by 92 publications

References 16 publications

Surdez súbita idiopática: aspectos etiológicos e fisiopatogênicos

Surdez súbita idiopática: aspectos etiológicos e fisiopatogênicos

A Clinical Study on Intratympanic Methyl Prednisolone as Primary and Rescue Therapies Versus Oral Prednisolone in the Treatment of Ssnhl: A Study on 90 Patients

Metilprednisolona intratimpânica como terapia de resgate na surdez neurossensorial súbita

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