Transtympanic corticoid therapy for acute profound hearing loss

Abstract

The prognosis of idiopathic sudden hearing loss depends on its severity; acute complete deafness, for example, has a particularly bad prognosis. The treatment of acute deafness is based on a systemic application of corticosteroids. Corticoid concentrations in the cochlea are higher after transtympanic application in comparison to systemic application. We therefore investigated whether an additional transtympanic corticoid therapy gives an advantage over systemic standard therapy. We report on 27 patients with sudden idiopathic profound hearing loss or deafness who were treated in the Department of Otorhinolaryngology, University of Essen, Germany. Fourteen patients were treated with a rheologic infusion therapy with systemic prednisolone. Thirteen patients were treated additionally with methylprednisolone (Urbason) transtympanically through a ventilation tube. In the first group of patients who were treated with infusion therapy and corticoids systemically, three patients had good recovery of hearing. Another five patients had a partial recovery of hearing. The average hearing gain from 0.5-4 kHz was 15 dB. In the group of patients who were treated additionally with local corticoids, two patients reported a good recovery of hearing and another two patients only had a partial recovery of hearing. The average hearing gain in the above-mentioned frequency range was 11 dB. In our patients the additional transtympanic application of corticoids did not result in a significantly improved recovery of hearing in comparison to the patients treated with the standard therapy alone.

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

“…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).…”

Cochlear microdialysis for quantification of dexamethasone and fluorescein entry into scala tympani during round window administration

“…There are a growing number of clinical reports with regard to local treatments with corticosteroids in cases of acute hearing loss of various causes (Chandrasekhar, 2001;Gian-oli and Li, 2001;Gouveris et al, 2005;Ho et al, 2004;Lautermann et al, 2005;Lefebvre and Staecker, 2002;Plontke et al, 2005;Silverstein et al, 1996;Parnes et al, 1999), of Meniere's disease (Itoh and Sakata, 1991;Sennaroglu et al, 2001;Shea and Ge, 1996;Silverstein et al, 1998) and of tinnitus (Cesarani et al, 2002;Coles et al, 1992;Sakata et al, 1997;Shulman and Goldstein, 2000;Silverstein et al, 1996). In addition, a number of investigational drugs show promising results with respect to protection when locally applied to the RWM Chen et al, 2003b;Hight et al, 2003;Keithley et al, 1998).…”

Metilprednisolona intratimpânica como terapia de resgate na surdez neurossensorial súbita

“…Other authors have also described the use of intratympanic corticosteroids for the treatment of SHL. 9,[12][13][14][15][16][17][18][19][20][21][23][24][25][26][27] Although its efficacy alone has not been proved definitively, intratympanic corticosteroid therapy for SHL is becoming more widely used. The variability among treatment protocols for SHL also applies to intratympanic corticosteroid therapy.…”

“…Administration modes also differ: transtympanic needle injection, 9,13,15,19,20,17,[24][25][26][27] myringotomy, 13,14 myringotomy with a ventilation tube, 12,23 myringotomy with a special perfusion needle (Micromedics, Eagan, MN), 18,21 and implantable infusion pumps in the middle ear (Round Window m-Cath; Durect Corp., Cupertino, CA) for continuous steroid release. 16,17,21 The duration of treatment, the interval between injections, and the number of injections also differs among authors, ranging from a single dose to weekly transtympanic injections, 9,12,14,15,18,20,23 steroid solutions as drops applied by patients during several weeks, 18,21 transtympanic injections several times a week, 19,23,25,26 or implantable infusion pumps. 16,17,21 Reported complications are rare, and include pain, 13 vertigo, 13,16,17,20,21 otitis media, 13 perforated tympanic membrane, 9,21 acne, 20 dysgeusia, …”

“…23,24 In most of these studies, the addition of intratympanic therapy to oral therapy had no significant effect on the recovery of hearing. Lauterman 23 compared patients that were given intratympanic corticosteroids and systemic corticosteroid therapy with another group treated only with oral corticosteroid therapy and found no benefit from adding intratympanic corticosteroids. Battista 24 reported a minor improvement following intratympanic corticosteroids in SHL patients in a study of 25 patients with profound sensorineural hearing loss (90-dB PTA).…”