Intratympanic infliximab is a safe and effective rescue therapy for refractory immune-mediated hearing loss.

Abstract

To determine the efficacy and safety of the intratympanic infiltration of infliximab at the hearing threshold of patients in follow-up for refractory immune-mediated hearing loss. 17 patients were collected with relapses, despite maintenance treatment with oral azathioprine associated or not with oral prednisone at low doses (between 5 and 7.5ml/day) or refractory relapses to previous intratympanic corticoid treatment being 19 affected ears infiltrated. We measured the hearing threshold by Pure-Tone Average (PTA) 500-3000Hz, 125-8000Hz and 250-8000Hz in pre-infiltration (baseline) and follow-up 3weeks post-infiltration with auditory threshold at frequencies 125-8000Hz. The average age was 50.68years (±15.23years). After the administration of intratympanic infliximab, an improvement of the hearing threshold was showed in the Pure-Tone Average (PTA) calculated at 500-3000Hz (p = 0.004), 125-8000Hz (p = 0.001) and 250-8000Hz (p = 0.006). An immediate improvement in low frequencies also was observed: 125, 250 and 500Hz (p = 0.009, p = 0.002 and p < 0.001 respectively) also at 1000Hz (p = 0.004) and a persistence of the effect at 3months in the low frequencies: 125Hz (p = 0.020), 250Hz (p = 0.006) and 500Hz (p = 0.002). Infliximab intratympanic infiltration improves the hearing threshold in patients with immune-mediated hearing loss. The effect of improving the hearing threshold is higher in low frequencies and persists within 3months of the infiltration. The administration of intratympanic infliximab is an effective and safe technique.