Intratympanic Dexamethasone Injection Research Articles

Alternative methods of delivering steroids to the middle ear in treatment of sudden sensorineural hearing loss

Introduction. Sudden sensorineural hearing loss is the most common pathology of polyethological sound perception. Systemic glucocorticosteroid therapy has long been considered the main treatment method. In recent years, topical therapy has been of great interest. However, intratympanic injections cause considerable discomfort to the patient and require about 1 hour per day to perform the procedure.Materials. In order to modernize and reduce the time spent on delivering steroids into tympanic cavity, this article considers the experience of managing 41 patients with sudden unilateral sensorineural hearing loss. Patients of the first group received dexamethasone 4 mg / ml in a volume of 1 ml by catheterization of the auditory tube, followed by introduction into the tympanic cavity. Patients of the second group were divided into 2 subgroups: in the first subgroup, dexamethasone 4 mg / ml in a volume of 0.5 ml was administered into tympanic cavity through a pre-imposed hole in the eardrum using a radio-wave device, and patients of the second subgroup received a classic intratympanic injection of dexamethasone 4mg / ml 0.5 ml after application anesthesia of the eardrum. The audiometry was performed before treatment, after 1, 2 weeks, 1 and 6 months.Results. The average time spent in the clinic of patients of the first group was 30 minutes, while patients of the first subgroup of the second group had 20 minutes a day. The longest time in the clinic was 2 subgroup of patients from 2 groups-about 1 hour.Conclusions. Radio-wave myringotomy is the safest and most convenient method. The smallest amount of time spent on the patient was observed in the subgroup of intratympanic injections that performed radio-wave miringotomy. It has been proved that the methods of topical treatment are not inferior in efficiency to each other.

Should air travel be avoided shortly after an idiopathic sudden sensorineural hearing loss?

Introduction: The effect of air travel on the recovery rate after idiopathic sudden sensorineural hearing loss (ISSNHL) has not been established. The advice to avoid flights is essentially based upon conjecture.Objectives: To analyze the recovery rate of patients who traveled by air shortly after they were treated for ISSNHL.Materials and methods: The hospital records of 115 newly diagnosed adult patients with unilateral ISSNHL were retrospectively collected. Included were patients who traveled by air within 90 days since the ISSNHL occurrence. The treatment protocol included oral prednisone and intratympanic dexamethasone injection when indicated. Audiograms performed upon presentation and 90 days later were compared.Results: Twelve patients were included (median age 45.5 years). The median treatment delay was 3 days. The average time from the ISSNHL to air-travel was 37 days, and the average air-travel distance was 13,362 km. The degree of HL was moderate, moderately severe, and severe (4 patients each). Seven patients (58%) underwent full recovery. No patients experienced further deterioration of their audiometric results after air-travel.Conclusions: This study does not support the avoidance of air-travel after ISSNHL.Significance: This study is the first to investigate the effect of air-travel on ISSNHL recovery rates, a clinical question that rises commonly.

Potential benefits of salvage intratympanic dexamethasone injection in profound idiopathic sudden sensorineural hearing loss.

To compare hearing recovery levels after initial treatment or salvage intratympanic dexamethasone injection (ITDI), and to find the prognostic factor on salvage ITDI therapy in profound ISSNHL. We retrospectively reviewed 115 patients with profound ISSNHL. All patients were treated with combination or systemic steroid therapy as the initial treatment. Next, we used salvage ITDI therapy on patients who showed slight or no improvement according to Siegel's criteria. To find the prognostic factors for the effectiveness of salvage ITDI therapy, we analyzed clinical data, such as, age, sex, vertigo, symptom duration, diabetes, hypertension, initial PTA, pre-salvage PTA, and treatment methods, using multiple regression analyses. The rate of serviceable hearing recovery were 10.4% (12/115) in the initial-treatment group and 20.4% (21/103) in the salvage group. The difference was statistically significant (p = 0.041). Pre-salvage PTA, diabetes mellitus, and symptom duration were affective factors for the effectiveness of salvage ITDI therapy in profound ISSNHL refractory to initial treatment, with odds ratios of 1.169 (95% confidence interval, 1.088-1.256), 0.069 (95% confidence interval, 0.005-0.889), and 9.242 (95% confidence interval, 1.079-79.146). Salvage therapy should be considered for profound ISSNHL, which is expected to result in poor prognosis or hearing recovery: ITSI therapy might be an effective treatment as salvage therapy.

Adjuvant Migraine Medications in the Treatment of Sudden Sensorineural Hearing Loss.

To examine the hearing outcomes of patients with sudden sensorineural hearing loss (SSNHL) treated with oral and intratympanic (IT) steroid only or a combination of steroid and migraine treatment. Our hypothesis was that adjuvant migraine medications may improve outcomes in SSNHL. A retrospective chart review at a tertiary otology center was conducted to identify patients with SSNHL who received oral steroid and IT dexamethasone injection(s) with or without migraine medications (a combination of nortriptyline and topiramate). A total of 47 patients received oral steroid and IT dexamethasone injection(s) only, and 46 patients received oral steroid and IT dexamethasone injection(s) as well as migraine lifestyle changes plus a combination of nortriptyline and topiramate. There were no significant differences in demographics and baseline audiometric data between the two groups. Both groups demonstrated improvements in pure tone average (PTA) and hearing thresholds at 250 Hz and 8000 Hz posttreatment. However, compared to steroid-only group, the adjuvant migraine medications group had significantly greater improvements in hearing thresholds at the lower frequencies (250 Hz, 500 Hz, 1000 Hz). Patients in the latter cohort also had greater improvement in PTA (P = .01) and received fewer IT injections (P = .04) PTA improvement of ≥ 10 dB was observed in 36 patients (78%) in the adjuvant migraine medications group and 22 patients (46%) in the control group (P < .001). In multimodal treatment of SSNHL, supplementing oral and IT steroid with migraine medications may result in greater improvements in lower frequency hearing thresholds and PTA. Furthermore, adjuvant migraine treatment can lead to decrease in number of IT injections, thus reducing procedure-related risks and complications. 3 Laryngoscope, 131:E283-E288, 2021.

A study on efficacy of injection of intratympanic dexamethasone in treatment of sudden sensorineural hearing loss

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Sudden sensorineural hearing loss is a common otologic emergency which occurs due to various etiologies affecting the inner ear. Majority of treatment protocols are focussed on glucocorticoids either systemically or through intratympanic route due to their antioxidant and anti-inflammatory properties.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a pre and post observational clinical study conducted in patients visiting Rajarajeswari medical college between December 2015 to December 2016 with a history of sudden hearing loss (30 patients). 6 of these patients presented with bilateral hearing loss, and we considered each ear as a separate case, giving us a total of 36 cases. A diagnosis of idiopathic sudden sensorineural hearing loss was made based on the patient’s history and audiological evaluation. All the patients were treated with 3 doses of Intratympanic injections of Dexamethasone (4 mg/ml), on alternate days. Pure tone audiometry (PTA) and brain stem evoked response audiometry (BERA) was done pre-treatment, at 1 and 6 months after treatment. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean age of our patients was 44.8. 80% of our patients were male. The average PTA gain, 1 month after treatment was 27.917 and 6 months after treatment was 29.639 with a p value of &amp;lt;0.001, which correlated with BERA. At the end of 6 months after treatment, 15 cases had complete recovery (41.7%), 9 cases showed slight recovery (25%), 6 cases had marked recovery and 6 cases (16.7%) had no recovery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intratympanic dexamethasone injections can be used as the first line of treatment with minimal side effects. &lt;/p&gt;

Effect of tympanic dexamethasone injection in the treatment of different types of sudden deafness

Objective:The aim of this study is to explore the best administration, timing and efficacy of dexamethasone and Mison in the treatment of different types of sudden deafness. Method:242 cases of sudden deafness first diagnosed in our department were selected. According to the guidelines（2015）, the patients were divided into low frequency descending type （49 cases）, high frequency descending type （66 cases）, flat descending type （71 cases） and total deafness （56 cases）. Different types of patients were randomly divided into tympanic injection group and systemic administration group on the basis of routine treatment. Tympanic injection group was further divided into initial injection group and delayed injection group. Tympanic injection was performed under ear endoscope, once every other day, three times for low frequency descending deafness, and five times for other types of deafness. Result:In comparison of total effective rate, there were significant differences among the three treatments in 49 cases of low frequency descending type, 71 cases of flat descending type and 56 cases of total deafness type （P<0.05）. In 66 cases of high frequency descending type, there was no significant difference among the three treatments （P>0.05）. In the comparison of cure rate, the difference of cure rate among the three treatment methods was also significant in low frequency descending type （P<0.05）. In the other three types of deafness, there was no significant difference among the three treatment methods （P>0.05）. There was no significant difference in the effective rate between men and women （P>0.05） in all patients treated by tympanic injection. There was significant difference in the effective rate of tympanic injection within 7 days of onset and 7 days after onset （P<0.05）. Conclusion:Intratympanic injection of dexamethasone is safe, effective, and easy to use as an initial treatment for low frequency descent, flat, and full deafness, and the sooner the better.

Effects of an Intratympanic Injection of Dexamethasone Combined with Gentamicin on the Expression Level of Serum P0 Protein Antibodies in Patients with Meniere's Disease

OBJECTIVES:To investigate the effects of an intratympanic injection of dexamethasone combined with gentamicin on the expression level of serum P0 protein antibodies in patients with Meniere’s disease (MD).METHODS:A total of 136 patients with MD treated in our hospital were enrolled in this study. Among them, 68 patients were treated with an intratympanic injection of dexamethasone combined with gentamicin (observation group). Another 68 patients were treated with gentamicin alone (control group).RESULTS:After treatment, the expression levels of IgG and IgM in the two groups significantly decreased (p<0.05); the levels in the observation group were significantly lower than those in the control group (p<0.05). The incidences of vertigo, tinnitus, and gait instability in the observation group were significantly lower than those in the control group (p<0.05). Vestibular symptom index (VSI) scores in the observation group were significantly lower than those in the control group (p<0.05). We observed no significant difference between the two groups in the number of vertigo attacks 6 months after treatment (p>0.05).CONCLUSION:For patients with MD, dexamethasone combined with gentamicin can reduce the incidence of vertigo, tinnitus, and gait instability, but it has no effect on the efficacy or number of vertigo attacks 6 months after treatment. Therefore, the levels of myelin P0 protein antibodies after treatment can be used as predictors of vertigo at 6 months after treatment.

Comparison of Treatment Outcomes Following Either Prefrontal Cortical-only or Dual-site Repetitive Transcranial Magnetic Stimulation in Chronic Tinnitus Patients: A Double-blind Randomized Study.

We evaluated treatment outcomes following single-site repetitive transcranial magnetic stimulation (rTMS) in the dorsolateral prefrontal cortex (DLPFC) and dual-site rTMS in the auditory cortex (AC) and DLPFC (AC + FC). This prospective randomized double-blind trial initially included 19 patients with chronic tinnitus and 17 of these patients received rTMS on the left AC and left DLPFC or only the left DLPFC. The subjects were randomly allocated to either the dual-site rTMS (AC + FC) protocol (Group 1, n = 9) or the singlesite rTMS (DLPFC) protocol (Group 2, n = 8). Group 1 received daily treatments with 2,000 pulses applied to the AC and 1,000 pulses applied to the DLPFC for 4 days (total of 12,000 pulses) and Group 2 received daily treatments with 3,000 pulses applied the DLPFC for 4 days (total of 12,000 pulses). The severity of tinnitus was assessed before rTMS treatment using the Tinnitus Handicap Inventory (THI) and the self-rated Visual Analog Scale. These measures were used to determine the awareness, loudness, annoyance, and effects of tinnitus on daily life at 1, 2, 4, and 12 weeks after treatment. The improvement in THI score was significantly better in Group 1 than in Group 2, even after controlling for the between-group differences in pretreatment THI score. In terms of psychological factors, Group 1 exhibited significant improvements in scores on the State-Trait Anxiety Inventory (STAI) for both state anxiety (STAI-X1) and trait anxiety (STAI-X2) at 12 weeks posttreatment and scores on the Pittsburgh Sleep Quality Index at 4 weeks posttreatment. Group 2 showed an improvement in only the STAI-X2 score at 12 weeks posttreatment. The rTMS protocol effectively suppressed tinnitus in the dual-site rTMS (AC+FC) group but not in the single-site rTMS (DLPFC) group. Although recent evidence has shown that non-auditory cortices in the tinnitus network play an important role in the generation of tinnitus, our findings indicate that rTMS on non-auditory cortical sites alone may not be sufficient for treatment. Thus, dual-site rTMS in the AC and DLPFC may be preferable for controlling this condition.

Effect of Intratympanic Dexamethasone in Idiopathic Sudden Sensorineural Hearing Loss

Introduction&#x0D; Oral steroids currently represent the standard treatment for idiopathic sudden sensorineural hearing loss The aim of this study is to assess the effectiveness of intratympanic dexamethasone injection for treating ‘Idiopathic sudden sensori-neural hearing loss’ (ISSNHL) not improved with conventional oral steroid.&#x0D; Materials and Methods&#x0D; A prospective study was conducted on 30 patients refractory to oral steroid therapy between June 2017 to May 2018. ‘Intratympanic dexamethasone injection’ (ITDI) was given every week for 3 consecutive weeks. Hearing was assessed by performing pure tone audiogram before every ITDI and also 1 week after the completion of treatment.&#x0D; Results&#x0D; Hearing improvement was found in 19 out of the 30 cases (63.3%).&#x0D; &#x0D; Conclusions&#x0D; Intratympanic dexamethasone significantly improves the prognosis of ISSNHL and is a safe, inexpensive and effective treatment.

Therapeutic Effect of Intratympanic Injection of Dexamethasone plus Hyaluronic Acid on Patients with Meniere's disease.

Intratympanic therapy, as a widely used treatment for inner ear diseases, is regarded as a therapeutic method in controlling the vertigo of the patients with Meniere's disease. This study was designed to evaluate the effect of the Intratympanic dexamethasone-hyaluronic acid combination on patients suffering from Meniere's disease. This study was a clinical trial on patients with Meniere's disease during 2016-2017. Patients received two Intratympanic injections of dexamethasone plus hyaluronic acid as a mixture within a month. Before and 2 weeks after the intervention, pure tone average (PTA) at 0.5, 1, 2, and 4 KHz frequencies, speech discrimination score (SDS), dizziness handicap inventory (DHI), and tinnitus handicap inventory (THI) scores were evaluated for each patient. The obtained scores were statistically analyzed. This study was conducted on a total number of 25 patients with Meniere's disease. The mean age of participants in this study was 44.71±4.92 years. Gender distribution among participants revealed that 36% of patients were male. The mean values of PTA, SDS, and THI were not significantly different before and after the intervention. However, the mean score of DHI decreased significantly after the intervention (P<0.001). Intratympanic dexamethasone/hyaluronic acid had a positive effect on the vertigo of the investigated patients without any significant improvement in hearing impairment and tinnitus in the short term.

Efficacy of intratympanic injection of dexamethasone in the treatment of subjective idiopathic tinnitus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To study the efficacy of intratympanic injection of dexamethasone in cases of subjective idiopathic tinnitus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective interventional study at the Department of ENT, JSS Medical College and Hospital, Mysore, in which 45 patients diagnosed clinically as subjective idiopathic tinnitus, for a duration of 2 years from October 2016 were included in the study. The patients were subjected to 3 intratympanic injections of dexamethasone once in a week for 3 weeks. They received a 0.5 ml intratympanic injection of 4mg/ml dexamethasone solution. After topical anaesthesia, using a 2 ml syringe and a spinal needle no. 22, the assigned solution was administered under direct vision using an endoscope in the postero- inferior quadrant of the tympanic membrane. They were followed up at the end of 1 and 3 months from the last injection. Tinnitus handicap inventory was repeated during the follow up and was compared to the value at presentation. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There was a statistically significant improvement in the THI at the first follow up compared with the baseline THI. Whereas there was no statistically significant change in improvement rate from the 1st follow up to the 2nd follow up (p=0.7), however there is decrease in the improvement, which means the improvement is temporary, and starts reverting by the second visit to some extent.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It was observed that the improvement in the tinnitus was for a short term after intratympanic injection of dexamethasone.&lt;/p&gt;

Effectiveness of intratympanic injection of dexamethasone in treatment of acute sensorineural hearing loss

Acute sensorineural hearing loss is a common pathology in the human population due to impaired sound perception. Along with the widespread systemic use of glucocorticosteroids in recent years, there has been a keen interest in their local delivery via intratympanic injections or through a previously installed shunt in the eardrum. The experience of treating 40 patients with ASNHL is presented. Patients of the 1st group received a systemic course of dexamethasone, and patients of the 2nd group received dexamethasone through the superimposed perforation in the eardrum using a current frequency of 4 MHz. Audiological examination was performed before treatment, 1, 2 weeks, 1 and 6 months after treatment. Local treatment of ASNHL is as effective as their systemic use and can be used as the main one. The method of radiofrequency myringotomy is safe and convenient in treatment by intra-implantation of glucocorticosteroids into the tympanic cavity.

The Efficacy of Concurrent or Sequential Intravenous and Intratympanic Steroid for Idiopathic Sudden Sensorineural Hearing Loss

Objective: The purpose of this retrospective study was to investigate the difference in treatment outcomes for patients with idiopathic sudden sensorineural hearing loss (SSNHL) undergoing concurrent or sequential intravenous (IV) and intratympanic (IT) steroid therapies. Methods: Patients with idiopathic SSNHL admitted to Taipei Veterans Hospital from August 2011 to August 2012 were enrolled. Patients were treated with both IV dexamethasone 5 mg b.i.d. for 5 days, then tapered over 6 days, and IT injections of dexamethasone 5 mg daily. The administration of IV and IT steroids was given either concurrently or sequentially (IV steroid was administered from days 1–5 followed by IT steroid treatment starting on day 4 or day 5). The hearing outcomes of the concurrent and sequential groups were analyzed. Results: Overall, after ≥2 months following treatment, across frequencies ranging from 250 to 8,000 Hz and pure-tone average (PTA) assessments, hearing improvements were similar between treatment groups, except at the frequencies of 4,000 and 8,000 Hz where the concurrent treatment group had greater hearing gain than the sequential group (4,000 Hz: 30.68 ± 28.96 vs. 14.52 ± 24.06 dB, respectively, p = 0.042; 8,000 Hz: 22.62 ± 23.59 vs. 7.67 ± 21 dB, p = 0.030). Across frequencies and PTA assessments, a similar percentage of patients had ≥20-dB gains in hearing compared with patients treated sequentially, except at 8,000 Hz where a greater percentage of patients in the concurrent group (57.1%) than the sequential group (23.3%) (p = 0.014) had ≥20-dB hearing gains. Conclusion: The findings suggest that both concurrent and sequential treatment improve hearing in patients with idiopathic SSNHL, and that concurrent treatment may show greater benefit than sequential therapy, particularly at high frequencies.

Significance of 1 kHz Pure-tone Threshold in Acute Low-frequency Sensorineural Hearing Loss.

To analyze risk factors for acute low-frequency hearing loss (ALFHL), and compare treatment outcomes in the presence or absence of such risk factors. A case series featuring retrospective chart review. An academic university hospital. We included 170 ALFHL patients without vertigo. All of the patients received one of four treatments: low-dose steroid (LD-steroid), high-dose steroid (HD-steroid), LD-steroid and diuretics (LD-combination therapy), and ITDI (intratympanic dexamethasone injection) and diuretics (ITDI-combination therapy). To identify risk factors, we reviewed the clinical features of patients such as age, sex, chief complaint, accompanying symptoms, diabetes, hypertension, time from disease onset, the extent of hearing loss, treatment methods, and 1 kHz involvement. ALFHL was diagnosed based on the average hearing loss >30 dB at 250 and 500 Hz. The overall rates of hearing recovery were 70-80% in the four treatment groups. In terms of the prognosis of ALFHL patients, we found that a longer time from disease onset and 1 kHz involvement were independent risk factors for poor prognosis. In addition, we compared treatment outcomes of four treatment methods in the presence or absence of risk factors. In ALFHL patients with risk factors, we found statistically significant differences (p = 0.042) among treatment methods; effectiveness ranged in the order if ITDI-combination therapy, LD-combination therapy, HD-steroid, and LD-steroid. Risk factors for poor hearing recovery in ALFHL included longer symptom duration and 1 kHz involvement. In ALFHL with such risk factors, combination therapy was more effective than oral steroid therapy.

Analysis of the treatment effects of refractory sudden total frequency deafness with steroid from different topical administration routes

Objective:To compare the efficacy between intratympanic dexamethasone and postauricular injection of methylprednisolone treatment for refractory sudden total frequency deafness. Method:Forty-eight cases of refractory sudden total frequency deafness were randomly divided into A group and B group (n=24 in each group). A group received intratympanic injection of dexamethasone 0.5 ml, and B group received postauricular injection of methylprednisolone 40 mg. Both treatments were performed once every other day for 2 weeks. The hearing was reviewed 2 weeks after the treatment. Result:In A group, 1 case was cured, 2 cases were markedly effective, 6 cases were effective, 15 cases were ineffective, the total effective rate was 37.5%; in B group, 0 cases were cured, 1 case was markedly effective, 4 cases were effective, 19 cases were ineffective, the total effective rate was 20.8%. There was no significant difference between the two groups in the total effective rate (P>0.05). The average PTA of patient in the A group and B group were respectively increased by (15.13±11.77) dB and (8.71±9.72) dB, and the difference was statistically significant (t=2.059, P<0.05). Conclusion:Both topical injection treatments of glucocorticoids can be recommended for patients with refractory sudden total frequency deafness, while intratympanic dexamethasone may be more advantageous in improving hearing threshold.

A novel use of intratympanic dexamethasone for intractable posterior canal benign paroxysmal positional vertigo: report of two cases

Benign paroxysmal positional vertigo is a common inner-ear pathology, characterised by episodic vertigo lasting for a few seconds that is associated with sudden change in the head position. Benign paroxysmal positional vertigo is treated with canalolith repositioning manoeuvres. Intractable vertigo describes a small group of patients who either do not improve with canalolith repositioning manoeuvres (persistent cases) or who relapse after improvement of initial symptoms (recurrent cases). These cases are difficult to treat and may have to be treated surgically.Case reportsThis paper reports two cases of intractable posterior canal benign paroxysmal positional vertigo that were treated with intratympanic dexamethasone injections on an interval basis. Both patients showed good control of their vertiginous symptoms, with negative Dix-Hallpike test findings following the intervention. The findings support an underlying inflammatory pathology in intractable benign paroxysmal positional vertigo; intratympanic steroids should be considered as an intermediate option before proceeding to a definitive surgical intervention.

Intratympanic Dexamethasone Injection in Chronic Tinnitus Associated with SNHL

AbstractBackground: Tinnitus is a common distressing complain characterized by perceived sensation of sound without an external stimulus. Intra-tympanic (IT) dexamethasone injection is used for the treatment of tinnitus associated with sensory neural hearing loss (SNHL) by introducing dexamethasone through the tympanic membrane, leading to decreasing sys-temic toxicity and a higher perilymph steroid level.Aim of the Study: The aim of this study was to express our experience in evaluation the effect of IT dexamethasone injection for controlling idiopathic chronic tinnitus of cochlear origin associated with SNHL.Patients and Methods: A prospective interventional study of eighty patients with subjective idiopathic tinnitus associated with SNHL for at least 1 year were treated by IT injection of dexamethasone, once per week for 4 weeks. Improvement in tinnitus was assessed using pure-tone audiometry, speech audiometry, tinnitus matching test, and Tinnitus Handicap Inventory by comparing the results before and after therapy. Follow-up after the end of the four injections, 1 and 3 months later.Results: Pure-tone audiometry did not show significant improvement. However, there was a significant improvement in speech audiometry, tinnitus loudness, and Tinnitus Handicap Inventory after the end of the four injections and in the subsequent evaluations 1 and 3 months later.Conclusion: IT dexamethasone injection could be a simple and effective method for controlling subjective idiopathic chronic tinnitus. The tinnitus may not disappear, but could be markedly decreased and easily tolerated.

Intratympanic injection of dexamethasone after failure of intravenous prednisolone in simultaneous bilateral sudden sensorineural hearing loss

PurposeThis study aimed to analyze outcomes of intratympanic injection of dexamethasone after failure of intravenous prednisolone in simultaneous bilateral sudden sensorineural hearing loss (SSNHL). Materials and methodsThe cases of simultaneous bilateral SSNHL treated in our hospital from March 2007 to March 2018 were retrospectively analyzed. During the earlier period (March 2007 to February 2012), the cases were treated by intravenous prednisolone only, and classified into group A. During the late period (February 2012 to March 2018), intratympanic injection of dexamethasone after failure of intravenous prednisolone therapy was employed to treat simultaneous bilateral SSNHL, and these patients were enrolled in group B. Effective rates of the two treatment modalities in groups A and B were compared. ResultsIn group A, 3 of 40 ears obtained complete recovery, and 4 ears achieved partial recovery after intravenous prednisolone treatment, with the effective rate of only 17.5% (7/40 ears). In contrast, 6 of 44 ears in group B achieved complete recovery, and 10 ears got partial recovery, with the effective rate of 36.4% (16/44 ears). There was significant difference in the effective rate between the two groups. ConclusionIntratympanic injection of dexamethasone after failure of intravenous prednisolone therapy was a better choice for simultaneous bilateral SSNHL compared to traditional intravenous prednisolone therapy.

Long Term Outcomes of Intratympanic Dexamethasone in Intractable Unilateral Meniere's Disease.

To evaluate the long term effect of Intratympanic dexamethasone in intractable Meniere's disease. 30 patients with refractory Meniere's disease which did not respond to the standard medical management, were treated with Intratympanic dexamethasone injections. Post treatment hearing outcome and dizziness scores were compared with the pretreatment values respectively. The mean dizziness handicap inventory (DHI) score was reduced from 91.58 (range 80-100) to be 31.00 (p = 0.00) at 3months of treatment. With the successive follow-up periods, the mean DHI scores were reduced to 51.50, 46.6, and 50.90 at the end of, 6, 12, and 24months (p = 0.04, 0.35, and 0.49 respectively). Again at the end of 24months, 23.80% of patients were free of vertigo (p = 0.01). No patient had improvement in the hearing (> 10dB) in any of the follow-up periods and 6.6% demonstrated deterioration in hearing. There were no major intraoperative or postoperative complications detected. Intratympanic injection of steroid is a safe and effective method for treating intractable Meniere's disease. Although short term improvement in the vertigo is well documented, still in 23% of the patients were found to be free of vertigo at even the end of 24months. There was no significant improvement in hearing noticed, either in short term or in long term.

Intratympanic Dexamethasone as First-Line Treatment for Selected Patients With Hearing Loss

There is no consensus among ENT (ear, nose and throat) physicians on the causes, diagnosis and especially therapeutic approach in sensorineural hearing loss (SSHL). The present paper describes our experience with intratympanic dexamethasone injection as initial treatment for selected patients with the sudden sensorineural hearing loss. The results obtained were fully encouraging. The sustained and coherent approaches of the national ENT society through his section of otoneurology, can lead to a diagnostic and therapeutic consensus in the sensorineural hearing loss. Further, the National Health Insurance House must introduce in the methodological norms the therapeutic variants and the concrete conditions for their realisation, in order to have a common medical practice.