Intratympanic Injection Research Articles

A PROSPECTIVE STUDY ON APPLICATION OF ENDOSCOPIC INTRATYMPANIC INSTILLATION OF PRP V/S STEROID INJECTION IN SUDDEN SENSORINEURAL HEARING LOSS

Background and Aim: Sudden Sensorineural Hearing Loss (SSNHL) is characterized by a sudden decline in auditory function. While traditional treatments like corticosteroids focus on facilitating hearing recovery, emerging therapies, such as intratympanic platelet-rich plasma (PRP), have demonstrated potential in improving treatment outcomes.This study aimed to evaluate and compare the effectiveness of intratympanic PRP injections and intratympanic steroid therapy in the treatment of SSNHL. Methodology: After receiving approval from the IEC, 100 patients diagnosed with SSNHL were randomly assigned to two groups: Group A (PRP) and Group B (steroids). Pre- and post-treatment pure tone audiometry (PTA) assessments were performed on all patients, and the results were analyzed to assess the effectiveness of the treatments. Results: Both groups demonstrated a statistically significant reduction in PTA values after treatment (p < 0.05). Pre-operatively, Group B had higher PTA values [44.165 (36.900-57.325) Hz] compared to Group A [40.0 (33.3225-48.3) Hz]. Post-treatment, PTA values improved to [30.0 (25.0-40.0) Hz] in Group A and [38.665 (28.3-45.4) Hz] in Group B. While intra-group improvements were significant, inter-group differences post-treatment were not statistically significant (p > 0.05). Conclusion: Intratympanic PRP and steroid therapies are both effective in improving hearing in patients with SSNHL. However, intratympanic steroids remain the preferred first-line treatment. PRP may serve as a secondary option in cases where steroids fail to deliver satisfactory results.

Efficacy analysis of intratympanic injection of dexamethasone at different concentrations for the treatment of unilateral idiopathic sudden sensorineural hearing loss.

Our study tried to evaluate and compare the therapeutic efficacy of intratympanic injection of dexamethasone (DEX) at different concentrations for the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). A prospective randomized controlled study was conducted on 203 patients with unilateral ISSNHL. Patients were divided into four groups: the control group (n=47, systemic treatment only), the high-concentration group (n=51, intratympanic injection of DEX 20mg/ml), the medium-concentration group (n=55, 10mg/ml), and the low-concentration group (n=50, 5mg/ml). Pure tone audiometry (PTA) thresholds were measured before treatment and on the 10th day post-treatment, with a follow-up period of 2months. Hearing gains and efficacy rates were compared among the groups. Significant differences were observed in PTA thresholds before and after treatment in all four groups (P<0.05), indicating that both systemic therapy and intratympanic injection were effective. The overall efficacy rate and hearing gain were higher in the intratympanic injection groups compared to the control group, but the differences were not statistically significant. Specifically, the control group achieved an efficacy rate of 57.4% with a hearing gain of 11.25±10.00dB HL. The intratympanic injection groups showed an overall efficacy rate of 67.3% and a hearing gain of 12.50±10.94dB HL, with subgroup results as follows: low-concentration group (62.0%, 12.50±11.56dB HL), medium-concentration group (69.1%, 11.25±13.75dB HL), and high-concentration group (70.6%, 12.50±8.75dB HL). Among patients with severe or profound hearing loss, the high-concentration group exhibited significantly greater hearing gains compared to the control group, while no significant differences were observed in efficacy rates. Combined intratympanic injection of DEX with systemic treatment for SSNHL provides higher hearing gains and efficacy rates compared to systemic treatment alone, though the differences were not statistically significant. In patients with severe or profound hearing loss, intratympanic injection of high-concentration DEX resulted in significantly greater hearing improvement, suggesting a potential therapeutic advantage in this subgroup.

Local injections of glucocorticoids at different regions in the treatment of sudden sensorineural hearing loss: a Meta-analysis

Objective: To compare the efficacy and safety of postauricular injection (PI) and intratympanic injection (II) of glucocorticoids (GC) in the initial treatment of sudden sensorineural hearing loss (SHL). Methods: Electronic databases retrieval (PubMed, Web of Science, CNKI, VIP, WANFANG) was performed to identify all randomized controlled trials about PI and II of GC in the initial treatment of SHL between 2015 and 2024. Meta-analysis was performed on the studies met the inclusion criteria by RevMan5.4. Results: A total of 971 articles were retrieved, and 23 Chinese articles were included after screening. Meta-analysis found that the total effective rate of PI was significantly higher than that of II (OR=1.37, 95%CI:1.15-1.65, P=0.000 6), with higher recovery of the hearing threshold (SMD=1.24, 95%CI:0.01-2.46, P=0.05) and a lower incidence of adverse reactions and complications (OR=0.20, 95%CI:0.15-0.28, P<0.000 01). Conclusions: Compared with II, PI has a better efficacy and safety. Nonetheless, whatever topical administration of GC that can be regarded as the first choice of initial therapeutic schedules to SHL requires further studied.

Hyperbaric Oxygen Therapy for Sudden Sensorineural Hearing Loss – A Comorbidity Lens

Leder Macek AJ, Wang RS, Cottrell J, Kay-Rivest E, McMenomey SO, Roland Jr. T, Ross FL. Hyperbaric Oxygen Therapy for Sudden Sensorineural Hearing Loss – A Comorbidity Lens. Undersea Hyperb Med. 2024 Fourth Quarter; 51(4):393-402. Objective: To determine the outcomes of patients receiving hyperbaric oxygen therapy for sudden sensorineural hearing loss and the impact of patient comorbidities on outcomes. Study Design: Retrospective chart review. Setting: Tertiary referral center. Methods: All patients over 18 diagnosed with sudden sensorineural hearing loss between 2018 and 2021 who were treated with hyperbaric oxygen therapy were included. Demographic information, treatment regimens and duration, and audiometric and speech perception outcomes were recorded and analyzed. Results: 19 patients were included. The median age was 45 years. 53% were female and 21% had pre- existing rheumatologic disorders. The mean duration between hearing loss onset and physician visits was 9.6 days. All patients received an oral steroid course, while 95% also received a median of 3 intratympanic steroid injections. Patients began hyperbaric oxygen therapy an average of 34.2 days after the hearing loss onset for an average of 13 sessions. No significant relationships were found between patient comorbidities and outcomes. Of those who reported clinical improvement, 57% demonstrated complete recovery per Siegel’s criteria. There was significant improvement after hyperbaric oxygen therapy for pure tone averages (50.3dB vs. 36.0dB, p&lt;0.01) and word discrimination scores (73% vs 79%, p&lt;0.05) for all patients regardless of reported clinical improvement. Conclusion: Hyperbaric oxygen therapy, as an adjunct to steroids, significantly improves recovery from sudden sensorineural hearing loss. The Charlson comorbidity index was not significantly associated with patient outcome, but patients with rheumatologic disorders were less likely to respond. Differentiating the natural history of the disease from hyperbaric oxygen therapy-associated improvements remains a challenge. Keywords: Charlson Comorbidity Index; ENT; salvage therapy; sudden sensorineural hearing loss

Comparison between intratympanic injection of dexamethasone and methylprednisolone in idiopathic sudden sensorineural hearing loss: A randomized clinical trial.

To compare the hearing outcomes of patients with idiopathic sudden sensorineural hearing loss after intratympanic (IT) injection of methylprednisolone and dexamethasone. Randomized case-controlled clinical trial. Seventy-five patients diagnosed with idiopathic sensorineural hearing loss were randomly divided into two groups based on therapy. Both groups received oral prednisolone (10 mg/kg; maximum of 60 mg) for 10 days without tapering and received IT injections two times a week for 2 weeks (four injections in total). One group received an IT injection of a 40 mg/mL solution of methylprednisolone, and the other one, 4 mg/mL dexamethasone. Three comparisons between the initial and third-month hearing tests were made to assess the degree of hearing change: (1) pure tone improvement in each individual tone (0.5, 1, 2, 3, and 4 kHz); (2) word-recognition score improvement; and (3) complete, partial, and no recovery of hearing calculated (as defined by American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines). The study was completed with 69 of the 75 patients-34 in the methylprednisolone group and 35 in the dexamethasone group. The groups' differences in frequency-specific hearing improvement were not statistically significant. There was no statistically significant difference in the word recognition score improvement between the two groups. Additionally, there was no discernible difference between the two groups' hearing recovery rates. Methylprednisolone and dexamethasone IT injection therapy had similar hearing outcomes. 2.

Sudden sensorineural hearing loss in diabetes mellitus patients receiving intra-tympanic steroid injections.

Sudden sensorineural hearing loss is an acute hearing disorder typically managed using steroids. However, prognostic factors of diabetes mellitus (DM) patients undergoing intra-tympanic steroid injections (ITSIs) are unclear. We explored the prognostic factors for ITSI in DM patients with unilateral SSNHL. This retrospective study enrolled 89 DM patients with unilateral SSNHL from July 2016 to June 2022. All patients received ITSIs, and their clinical and audiological data were analyzed. The patients' mean age was 49.31±16.26years. After ITSI, the mean hearing level gain was 14.91±20.28dB, the mean speech reception threshold (SRT) gain was 15.78±32.16dB, and the mean speech discrimination score (SDS) gain was 16.94±35.06%. Based on Siegel's criteria, 8 patients (8.98%) had complete recovery, 14 (15.73%) had partial recovery, 16 (17.98%) had slight recovery, and 51 (57.31%) had no improvement. Older age (odds ratio [OR]=0.970, 95% confidence interval [CI]: 0.941-0.999, p=0.043) and profound hearing loss on pure-tone audiometry (PTA; OR=0.058, 95% CI: 0.007-0.462, p<0.001) were adverse prognostic factors in univariate analyses. Older age (OR=0.963, 95% CI: 0.932-0.994, p=0.023) and profound hearing loss (OR=0.048, 95% CI: 0.005-0.395, p=0.004) were independent negative prognostic factors in a multivariate analysis. ITSI is effective and avoids side effects of high-dose steroids in patients with SSNHL and DM. Among 89 DM SSNHL patients who underwent ITSI, older age and profound hearing loss were negative prognostic factors. Prompt and active management is necessary for DM patients with these risk factors.

Harvest of Vestibular End-Organs under Physiologic Conditions during Labyrinthectomy.

The living human inner ear is challenging to study because it is encased within dense otic capsule bone that limits access to biological tissue. Traditional temporal bone histopathology methods rely on lengthy, expensive decalcification protocols that take 9-10 months and reduce the types of tissue analysis possible due to RNA degradation. There is a critical need to develop methods to access fresh human inner ear tissue to better understand otologic diseases, such as Ménière's disease, at the cellular and molecular level. This paper describes a technique for the harvest of human vestibular end organs from a living donor under physiologic conditions. An individual with Ménière's disease and 'drops attacks' that were refractory to intratympanic gentamicin injection underwent labyrinthectomy. A traditional mastoidectomy was first performed, and the horizontal and superior semicircular canals (SCC) were identified. The mastoid cavity was filled with a balanced salt solution so that the labyrinth could be opened under more physiologic conditions to preserve cellular integrity. A zero-degree endoscope fit with a lens-cleaning sheath irrigation system was used to visualize the submerged mastoid cavity, and a 2 mm diamond burr was used to skeletonize and open the horizontal and superior SCCs, followed by the vestibule. The ampullae and portion of the canal ducts for the superior and lateral SCCs were harvested. The utricle was similarly harvested. Harvested tissue was immediately placed in an ice-cold buffer and then fixed for one hour in 4% paraformaldehyde in phosphate-buffered saline (PBS). The tissue was rinsed several times in 1x PBS and stored for 48 h at 4 °C. The tissue samples underwent immunostaining with a combination of primary antibodies against tenascin-C (Calyx), oncomodulin (streolar hair cells), calretinin (Calyx and Type II hair cells), synaptic vesicle protein 2 (efferent fibers and boutons), β-tubulin 1 (Calyx and afferent boutons), followed by incubation with fluorophore-conjugated secondary antibodies. The tissue samples were then rinsed and mounted for confocal microscopy examination. Images revealed the presence of ampullar and macular hair cells and neural structures. This protocol demonstrates that it is possible to harvest intact, high-quality human inner ear tissue from living donors and may provide an important tool for the study of otologic disease.

Improved intracochlear biopolymeric drug delivery system: an in vivo study

Background The delivery of drugs into the inner ear is a challenging field of study due to the complex cochlear anatomy and physiology. The creation of an intracochlear device that allows for short- and long-term intracochlear delivery of the drugs with a minimal invasive technology is needed to prevent or treat conditions that can potentially prevent the development of permanent hearing loss. Aim This study intends to test the efficacy of DXM-infused PLGA microneedles created in our laboratory in an in vivo animal model of acute ototoxic injury. Material and Methods Twenty-four male Norway Brown rats were randomized into four groups, three of which groups received an intratympanic injection of ethacrynic acid and kanamycin. Two of these groups underwent the placement of an intracochlear microneedle blended or not with dexamethasone, and two groups underwent implantation of a plain microneedle, one of without prior exposure to the ototoxic agent to confirm in vivo biocompatibility. Animals were then followed with a weekly auditory brainstem response testing until day 28 after surgical intervention. Result and Conclusion Our intracochlear device demonstrated biocompatibility and produced no hearing changes after its implantation in the control group. Inserted DXM-blended microneedles prevented hearing deterioration in those animals exposed to an ototoxic environment.

Intratympanic injections made from eutectic liquid (camphor and menthol)-based oil-less emulsions containing morin hydrate-lipoid E80 complex: An approach to augment drug permeation into inner ear region in a healthy rabbit model

Morin hydrate (MH, flavonols of plants, family-Moraceae) promotes inner ear stem cell survival and differentiation process to preserve the healthy hearing function. However, round window membrane (RWM) of inner ear provides a barrier for MH to reach an adequate amount at inner ear region. Since MH possesses a low aqueous solubility (28.72 ± 0.97 μg/ml), intratympanic (IT) injections of camphor-menthol eutectic liquid-based oil-less emulsions containing MH-Lipoid E80 complex was developed to promote MH ferrying action across RWM. At 360 min post-dissolution time point, the MH solution displayed 92.88 ± 6.26 % drug release, but the drug-Lipoid E80 complex-loaded oil-less emulsions showed 58.05 ± 11.62 % only. The MTT assay results indicate the possible non-toxicity of oil-less emulsions to L-929 cells up to 100 μg/ml concentration. Significant differences were seen between the Cmax and AUC0-t values observed at 90 min in the perilymph after the IT injections of MH solution (14.13 ± 0.33 × 103 ng/ml & 429.55 ± 9.20 × 103 ng min/ml) and MH-Lipoid E80 complex-loaded oil-less emulsions (117.93 ± 4.24 × 103 ng/ml & 5529.46 ± 37.65 × 103 ng min/ml) into the healthy albino rabbits. Hence the IT injections of eutectic liquid-based oil-less emulsions could facilitate the drugs crossing over of RWM in the inner ear regions.

Increasing Utilization of Intratympanic Injections among Medicare Fee-for-Service Providers.

To characterize national practice patterns and geographic variations in intratympanic injections among Medicare providers. Retrospective cross-sectional analysis of intratympanic injections performed in the Medicare fee-for-service population from 2013 to 2021. Center for Medicare & Medicaid Services Physician and Other Practitioners database. Providers performing outpatient intratympanic injections, documented by Current Procedural Terminology code 69801. Intratympanic injections. The number of intratympanic injections performed by individual providers, states, and geographic regions, as well as reimbursements, was analyzed annually. A total of 159,236 in-office intratympanic injections were performed. The Center for Medicare & Medicaid Services reimbursed $25,407,086; out-of-pocket patient costs were $6,591,514. The mean Medicare reimbursement rate and out-of-pocket cost per injection were $159.56 and $41.38, respectively. From 2013 to 2021, the number of intratympanic injections increased from 13,117 to 20,711 injections, representing a 57.9% increase. On linear regression, an additional 989.9 injections were performed each year (95% CI 766.4-1,213.4, p < 0.001). The number of providers performing injections also increased from 1,828 to 2,834 from 2013 to 2021 ( b = 125.6 [95% CI 111.3-140.0], p < 0.001). The population-controlled annual mean number of injections varied substantially across the United States, ranging from 12.0 injections per 100,000 beneficiaries in Oklahoma to 255.2 injections per 100,000 beneficiaries in Alabama. The number of intratympanic injections administered in the Medicare population has increased from 2013 to 2021. There is variability in practice patterns and utilization of intratympanic injections among otolaryngologists in the United States.

An International Survey of the Diagnosis and Management of Ménière's Disease Amongst Otolaryngology Consultants.

Ménière's Disease (MD) is a disease that may be difficult to diagnose and manage. Our UK survey showed variability in the practice of UK Otolaryngology consultants. We hence surveyed Otolaryngology consultants internationally, to assess their confidence levels in diagnosing MD, their use of the AAO-HNS guidelines and current diagnostic and treatment modalities. An online questionnaire was distributed internationally over four weeks. The questionnaire asked respondents to anonymously rank their confidence in diagnosing MD, identify the minimum investigations required to make a diagnosis, describe their use of the AAO-HNS criteria, share their preferred treatment modalities for acute attacks, and state their 1st and 2nd-line preventative treatment options. A total of 173 responses were collected with 77% of respondents reporting high levels of confidence in diagnosing MD. Most respondents stated the minimum tests required were "History, Otoscopy, Clinical Vestibular testing, and Pure Tone Audiometry" although some chose as few as 1 test. Regarding the use of the AAO-HNS criteria, responses ranged from "always" (20.2%) to "never" (22.5%). Cinnarizine was the first-line treatment for acute attacks followed by betahistine. Betahistine (30.1%) and dietary restrictions (28.3%) were recommended almost equally as first-line preventative measures. The most popular second-line measure was intratympanic steroids injection (30.1%). Our survey revealed disparities in the diagnosis of MD and its management, like the results of our previously conducted UK survey. This suggests the need for an international consensus regarding the diagnosis and subsequent management strategies for this disease.

The Effectiveness of Steroids and Antioxidants in the Management of Cisplatin-induced Ototoxicity: A Comprehensive Systematic Review of the Literature and Network Meta-Analysis

Abstract Background: Cisplatin efficacy in cancer therapy is hindered by dose-dependent toxicities, including ototoxicity. Its mechanisms involve cochlear damage and oxidative stress. Gender and age affect susceptibility, with limited treatment options for adults. Objective: To assess the effectiveness of steroids compared to antioxidants (AOs) in preventing and managing cisplatin-induced ototoxicity. Materials and Methods: Data were collected from multiple sources including Medline, CENTRAL, PubMed, and Springer Nature Journals. Adults and pediatrics with the clinical diagnosis of cisplatin-induced ototoxicity, interventional studies (including single-arm studies) were included. Studies with a focus on chemotherapy agents other than cisplatin were excluded. Results: The study encompassed 10 randomized controlled trials spanning 2004–2023 across Canada, Israel, The Netherland, Spain, Turkey, Greece, Italy, and Iran. It aimed to evaluate interventions for preventing cisplatin-induced ototoxicity, including intratympanic injections and oral dietary supplements. Based on the results of this systematic review, thiosulfate-hyaluronate gel showed a 1.3 dB reduction in hearing loss; dexamethasone injections had minimal efficacy; L-N-acetylcysteine (L-NAC) offered significant otoprotection with daily infusion; and transtympanic L-NAC showed no significant benefit. Salicylate usage yielded no decrease in hearing loss. AO dietary supplements showed no difference in results between groups. However, based on the network meta-analysis results, it appears that steroids perform best in reducing cisplatin-induced ototoxicity at higher frequencies (8000 Hz), followed by placebo and then AO. Conclusion: A further molecular and targeted therapy is needed to target the cyto/ototoxic activity and further prevent such deterioration in hearing and promote chemotherapy regime without ototoxic effects.

Perfusion Steroid via Ventilation Tube as Salvage Treatments for Sudden Sensorineural Hearing Loss.

Objectives: Intratympanic steroid injection (ISI) for sudden sensorineural hearing loss (SSNHL) is a relatively popular and effective method, but there is no standardized method for intratympanic steroids for the treatment of SSNHL and no consensus on how to deliver steroids to the middle ear. The purpose of this study was to compare 2 means of intratympanic steroid delivery as therapy for SSNHL. Methods: A retrospective chart review was performed for the period from November 2018 to October 2022 at our Department of Otorhinolaryngology-Head and Neck Surgery. Sixty patients with profound SSNHL who have failed initial steroid therapy were divided into the continuously transtympanic steroid perfusion (TSP) therapy and the intermittent ISI therapy. Results: Posttreatment pure-tone average was 60.3 ± 18.2 dB in the TSP group and 67.5 ± 22.6 dB in the ISI group, 70.0% of subjects in the TSP group, and 46.7% of subjects in the ISI group had improved by 15 dB or more after the therapy. The increased hearing threshold of the TSP group (24.6 ± 14.1 dB) was better than the ISI group (16.6 ± 14.9 dB), and the hearing recovery was significantly different (P < .05) in the 2 groups. Besides the hearing improvement was most obvious in low-frequency areas in the TSP group, the most significant hearing improvement was at 250 Hz, reaching 30.8 ± 3.3 dB. Conclusions: In SSNHL patients who have failed initial steroid therapy, TSP therapy via a ventilation tube can achieve good hearing outcomes and serve as a salvage therapy for patients with SSNHL.

Intratympanic injection of MSC-derived small extracellular vesicles protects spiral ganglion neurons from degeneration

Sensorineural hearing loss is one of the most prevalent sensory deficits. Spiral ganglion neurons (SGNs) exhibit very limited regeneration capacity and their degeneration leads to profound hearing loss. Mesenchymal stem cell-derived small extracellular vesicles (MSC-sEV) have been demonstrated to repair tissue damage in various degenerative diseases. However, the effects of MSC-sEV on SGN degeneration remain unclear. In this study, we investigated the efficacy of MSC-sEV for protection against ouabain-induced SGN degeneration. MSC-sEV were derived from rat bone marrow and their components related to neuron growth were determined by proteomic analysis. In primary culture SGNs, MSC-sEV significantly promoted neurite growth and growth cone development. The RNA-Seq analysis of SGNs showed that enriched pathways include neuron development and axon regeneration, consistent with proteomics. In ouabain induced SGN degeneration rat model, MSC-sEV administration via intratympanic injection significantly enhanced SGN survival and mitigated hearing loss. Furthermore, after ouabain treatment, SGNs displayed evident signs of apoptosis, including nuclei condensation and fragmentation, with numerous cells exhibiting TUNEL-positive. However, administration of MSC-sEV effectively decreased the number of TUNEL-positive cells and reduced caspase-3 activation. In conclusion, our findings demonstrate the potential of MSC-sEV in preventing SGN degeneration and promoting neural growth, suggesting intratympanic injection of MSC-sEV is a specific and efficient strategy for neural hearing loss.

The effectiveness of intratympanic injections with methylPREDnisolon versus placebo in the treatment of vertigo attacks in MENière’s disease (PREDMEN trial): a study protocol for a phase-3 multicentre, double-blinded, randomised, placebo-controlled trial

IntroductionIntratympanic corticosteroids are commonly used in the treatment of Menière’s disease (MD). However, few and small randomised controlled trials (RCT) on the effectiveness of intratympanic corticosteroids have been performed. A...

The Optimal Head Position Following Intratympanic Injection: A Research Based on HRCT Reconstruction.

Objective: This study aimed to investigate the optimal head position (OHP) following intratympanic injection, a critical intervention in treating inner ear disorders. Identifying OHP is essential to maximize drug retention in the middle ear, thereby significantly enhancing the therapeutic efficacy by mitigating the significant issue of injectate leakage through the eustachian tube (ET). Exploratory various positions of ET orifice and round window (RW) were investigated and associated with head movements. Methods: Twenty-two (10 males and 12 females) anonymized high-resolution computed tomography (HRCT) datasets of patients without structural ear disease were selected from January 2022 to December 2022 in the study. The subjects were categorized into two groups: children (≤18 years) and adult group (>18 years). The reconstruction of the ET orifice and RW from HRCT were analyzed using Mimics software and the distances from the center point of ET orifice or the center point of RW to the reference plane were defined as distance of ET orifice (DET) and distance of RW (DRW). Results: In the supine position, the OHP for intratympanic injection was 23°of pronation and 24° of posterior extension, and the maximum distance between the ET orifice and RW (DET-RW) was 9.29 ± 2.13 mm. As the head position extended posteriorly beyond 43°, DET was relatively high compared with DRW, resulting in the OHP a fully posteriorly extended 90° of the head being the optimal position with DET-RW of 2.13 ± 1.60 mm in the supine position, however, it is not realized in human beings. Moreover, the OHP had no obvious relevance corresponding to age following intratympanic injections. Conclusion: Our study suggested that OHP after intratympanic injections treatment consists of supine position, along with a slight pronation and posterior extension.

Intratympanic Platelet-Rich Plasma Therapy for Sudden Sensorineural Hearing Loss: A Preliminary Prospective Study.

Sudden Sensorineural Hearing Loss (SSNHL) is a distressing condition with limited treatment options. This prospective study aimed to investigate the effectiveness of intratympanic Platelet Rich Plasma (PRP) as a salvage treatment for SSNHL. 56 consecutive patients with unilateral SSNHL, unresponsive to conventional treatments, were administered two intratympanic injections of autologous PRP 10 days apart and hearing threshold evaluated after one month. Audiometric data before and after PRP injections revealed a significant mean hearing gain of 11.99 dB which was more in lower frequencies (250, 500, 1000Hz) reaching upto 13.88dB. Notably, improvement was observed in patients with amino glycoside-induced hearing loss, even after prolonged symptom duration. Additionally, 8 out of 17 patients reported subjective improvement in tinnitus. No serious adverse events were noted, and patients tolerated the procedure well. Intratympanic PRP holds promise as a salvage treatment for SSNHL, particularly in cases where conventional treatments have failed. Further research with larger sample sizes and comparative studies is warranted to establish PRP's role as a primary therapy for SSNHL and explore its long-term benefits. Its role in treatment of tinnitus also needs to be explored.

Investigating the Effect of Coenzyme Q10 in the Treatment of Sudden Sensorineural Hearing Loss

Background and Objective: Sudden sensorineural hearing loss (SSNHL) is a complication that is usually unilateral and can be accompanied by tinnitus and vertigo. Although various infectious, vascular, and immune etiologies have been proposed for SSNHL, the cause is unknown in most cases. Therefore, this study aimed to determine the effect of coenzyme Q10 in the treatment of SSNHL. Materials and Methods: This study was a double-blind, randomized, controlled clinical trial, which was conducted using the available sampling method. A total of 60 patients with SSNHL (18-70 years old) lasting less than one month were divided into two groups: intervention and control. The routine treatment of both groups included weekly injections of dexamethasone in the middle ear for 3 weeks. The intervention group also received 100 mg of coenzyme Q10 per day for 4 weeks, while the control group received a placebo. Patients were evaluated by basic audiological tests at the baseline and third and sixth months after the treatment. Statistical analysis of findings was done in SPSS26 software. Results: The difference in the mean pure tone hearing thresholds of the intervention and control groups was significant in the third month (29.33±15.96 dB and 35.34±12.24 dB; P=0.02) and sixth month (dB 28.00±16.27 and dB 34.33±11.87; P=0.01). Conclusion: In patients with SSNHL, combined treatment with oral coenzyme Q10 at the rate of 100 mg per day, along with intratympanic injection of dexamethasone for four weeks, can improve pure tone hearing thresholds and facilitate the treatment

Dexamethasone nanocrystals-embedded hydroxypropyl methylcellulose hydrogel increases cochlear delivery and attenuates hearing loss following intratympanic injection

Herein, dexamethasone (DEX) nanocrystalline suspension (NS)-embedded hydrogel (NS-G) was constructed using a hydroxypropyl methylcellulose (HPMC) polymer to enhance cochlear delivery and attenuate hearing loss following intratympanic (IT) injection. Hydrophobic steroidal nanocrystals were prepared using a bead milling technique and incorporated into a polysaccharide hydrogel. The NS-G system with HPMC (average molecular weight, 86,000 g/mol; 15 mg/mL) was characterized as follows: rod-shaped drug crystalline; particle size <300 nm; and constant complex viscosity ≤1.17 Pa·s. Pulverization of the drug particles into submicron diameters enhanced drug dissolution, while the HPMC matrix increased the residence time in the middle ear cavity, exhibiting a controlled release profile. The IT NS-G system elicited markedly enhanced and prolonged drug delivery (> 9 h) to the cochlear tissue compared with that of DEX sodium phosphate (DEX-SP), a water-soluble prodrug. In mice with kanamycin- and furosemide-induced ototoxicity, NS-G markedly enhanced hearing preservation across all frequencies (8–32 kHz), as revealed by an auditory brainstem response test, compared with both saline and DEX-SP. Moreover, treatment with NS-G showed enhanced anti-inflammatory effects, as evidenced by decreased levels of inflammation-related cytokines. Therefore, the IT administration of DEX NS-loaded HPMC hydrogels is a promising strategy for treating hearing loss.

Prognostic Factors in Idiopathic Sudden Sensorineural Hearing Loss: The Experience of Two Audiology Tertiary Referral Centres.

Background and Objectives: Although different hypotheses have been proposed over time, there is a dearth of information on factors able to predict the response to treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) and hearing recovery. The aim of this study was to apply univariate and multivariate statistical models in a retrospective clinical setting of patients given therapy for ISSNHL at our tertiary academic audiological centers to investigate the prognostic value of clinical signs, symptoms, and comorbidities in relation to hearing recovery. Materials and Methods: The inclusion criteria were: history of ISSNHL diagnosed and treated at the Padova or Modena tertiary academic audiological centers; age ≥ 18 years; availability of clinical and audiological outcome data. The exclusion criteria were: hearing loss in acoustic schwannoma, endolymphatic hydrops, meningitis, trauma (head trauma, temporal bone fracture, acoustic trauma), barotrauma, perilymphatic fistula; exposure to noise levels ≥ 80 dB in the work environment; any unilateral or bilateral hearing loss (except for presbycusis) prior to ISSNHL diagnosis; any disorders affecting the external or middle ear; any previous ear surgery; refusal to make medical data available for research purposes. Eighty-six consecutive patients (38 females, 48 males; median age: 58 years; interquartile range: 47.00-69.00 years) were included. A systemic steroid therapy was administered to all patients, either orally with prednisone or intravenously with methylprednisolone. Second-line therapy included intratympanic steroid injections and/or hyperbaric oxygen therapy. Results: A multivariate logistic regression model was used, including the non-multicollinear clinical and audiological variables, which showed a p-value < 0.10 at the univariate analyses (namely age at diagnosis, time to diagnosis, oral steroid dose, and PTA on the affected side). Only PTA on the affected side retained its statistical significance (OR: 1.0615, 95% CI: 1.0185-1.1063, p = 0.005). Conclusions: The analysis of our data showed an association between the hearing threshold before treatment and the recovery from ISSNHL. Further studies on larger cohorts (especially in a prospective setting) are needed to shed more light on the prognostic role of clinical parameters in patients with ISSNHL. In a correct counseling setting, with regard to the patient's concern about not being able to recover hearing, it is important to offer perspectives of appropriate hearing rehabilitation approaches.