Transtympanic Steroids as a Salvage Therapy in Sudden Hearing Loss: Preliminary Results

Abstract

Purpose: To understand the real efficacy of transtympanic steroid therapy for sudden sensorineural hearing loss (SSHL) in patients in whom traditional therapies have failed. Procedures: A prospective study was designed in order to evaluate hearing improvement in SSHL patients treated with transtympanic therapy. A solution of methyl-prednisolone (MP) and sodium bicarbonate was administered via a transtympanic injection to 8 patients. Hearing level was evaluated before therapy and at days 1, 7 and 30. Results: Hearing improvement was obtained in 75% of the patients. The patients in this category are usually considered untreatable. Conclusion: Transtympanic steroid therapy is an efficacious solution for patients affected by SSHL in whom traditional therapies have failed. Further studies will be required to identify the most favourable dosage, route of administration and type of steroid. Transtympanic steroid application is safe, inexpensive, easy to perform and efficacious in cases of SSHL not responsive to traditional therapy.

Metilprednisolona intratimpânica como terapia de resgate na surdez neurossensorial súbita

“…9 Dallan et al (2006) treated 8 patients with intratympanic methylprednisolone in a prospective study; there was a 75% improvement rate after a single injection. 26 Choung et al reported a 38% improvement rate in a group of patients treated with intratympanic and systemic therapy; another group treated only with systemic therapy had a 6.1% improvement rate. 25 As the natural history of SHL suggest high recovery rates, it is rather difficult to establish whether interventions really increase those rates.…”

“…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.…”

“…13,15,16 Most studies about intratympanic corticosteroids for treating SHL report having attempted this mode of therapy after systemic corticosteroid therapy has failed. 9,[12][13][14][15][16][17][18][19][20][21][25][26][27] Two studies evaluated the effects of intratympanic corticosteroids as adjuvant therapy to systemic corticosteroids in SHL patients. 23,24 There are several advantages of using intratympanic corticosteroids (see Frame I).…”

“…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, …”

New Prognostic Parameters of Sudden Hearing Loss: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio

“…Ani işitme kaybı (AİK) üç gün içinde veya daha kısa zamanda aniden gelişen, art arda üç frekansı tutan, 30 dB ve üzerindeki sensorinöral işitme kaybıdır (1) . Genellikle 30-60 yaşlar arasında ortaya çıkmakta ve %90 tek taraf tutulmaktadır.…”