Intratympanic Steroid Treatment Research Articles

Intratympanic Steroid Treatment for Sudden Hearing Loss after Failure of Systemic Steroid Therapy

Intratympanic Steroid Treatment for Sudden Hearing Loss after Failure of Systemic Steroid Therapy

Intratympanic Steroids for Sudden Sensorineural Hearing Loss

To determine the evidence for efficacy of intratympanic (IT) steroid treatment for the management of idiopathic sudden sensorineural hearing loss through a systematic review of the existing literature. Online databases consisting of PubMed, Medline, OVID, Google Scholar, Cochrane Review, and collected additional publications cited in bibliographies. Literature search by both authors with structured criteria to select studies evaluated for systematic review. The authors identified 176 articles, of which 32 represented studies of initial or salvage intratympanic steroid injections for sudden hearing loss that included 6 randomized trials and only 2 randomized controlled trials. Despite the paucity of well-executed trials, the vast majority of studies of intratympanic steroids for salvage treatment in all tiers demonstrated a benefit of intratympanic steroid therapy. A limited meta-analysis of the higher quality studies revealed a mean difference in improvement of 13.3 dB (95% confidence interval [CI], 7.7-18.9; P < .0001). Although statistically significant, it is still unclear if this difference is clinically significant. Initial intratympanic therapy was equivalent to standard therapy in the existing literature of all qualities. Intratympanic steroid treatment as primary treatment for sudden sensorineural hearing loss appears equivalent to treatment with high-dose oral prednisone therapy. As salvage therapy, intratympanic steroids offer the potential for some degree of additional hearing recovery, although it remains uncertain if this improvement is clinically significant and what percentage of patients is likely to show benefit.

Incidence of Tympanic Membrane Perforation after Intratympanic Steroid Treatment through Myringotomy Tubes

Intratympanic (IT) steroids are often used to treat inner ear disorders such as sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, and Ménière disease. Administration of corticosteroids via IT injection, via application with a pledget to the round window, or via catheter has been used for this purpose. The frequency of adverse events related to the IT injection of steroids is low, with pain, short-lasting vertigo, otitis media, and tympanic perforations being the most common complications. However, the safety of IT steroid therapy has not yet been established in a randomized clinical trial. In this article, we discuss a group of 11 patients with sensorineural hearing loss who underwent myringotomy and tube placement for home-based dexamethasone instillation and subsequently developed the complication of tympanic membrane perforation. It appears that there is a significantly increased incidence of tympanic membrane perforations in this population.

Efficacy of intratympanic steroid treatment on idiopathic sudden sensorineural hearing loss

Efficacy of intratympanic steroid treatment on idiopathic sudden sensorineural hearing loss

Comparison of intratympanic steroid treatment versus hemodilution and vasoactive treatment combination in sudden hearing loss

Gerec ve Yontem: Bu prospektif calismaya, 2005 ile 2010 yillari arasinda klinigimize ani isitme kaybi sikayeti ile basvuran 49 hasta dahil edildi. Bu hastalardan 25’i intratimpanik steroid grubuna, 24’u hemodilusyon ve vazoaktif kombinasyon tedavi grubuna dahil edildi. Intratimpanik steroid grubuna toplam 5 kez 20 mg/ml dozunda metilprednizolon enjeksiyonu uygulandi. Kombinasyon grubuna ise primer tedavi olarak intravenoz dekstran ve oral pentoksifilin verildi. Tedaviden sonra hastalarin saf ses ortalamalari, her iki grup icin istatistiksel olarak karsilastirildi.

Early Posttreatment Audiometry Underestimates Hearing Recovery after Intratympanic Steroid Treatment of Sudden Sensorineural Hearing Loss

Objective. To review our experience with intratympanic steroids (ITSs) for the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL), emphasizing the ideal time to perform follow-up audiograms. Methods. Retrospective case review of patients diagnosed with ISSNHL treated with intratympanic methylprednisolone. Injections were repeated weekly with a total of 3 injections. Improvement was defined as an improved pure-tone average ≥20 dB or speech-discrimination score ≥20%. Results. Forty patients met the inclusion criteria with a recovery rate of 45% (18/40). A significantly increased response rate was found in patients having an audiogram >5 weeks after the first dose of ITS (9/13) over those tested ≤5 weeks after the first dose of ITS (9/27) (P = 0.03). Conclusions. Recovery from ISSNHL after ITS injections occurs more frequently >5 weeks after initiating ITS. This may be due to the natural history of sudden hearing loss or the prolonged effect of steroid in the inner ear.

Intratympanic Methylprednisolone Improves Hearing Function in Refractory Sudden Sensorineural Hearing Loss: A Control Study

Objective: The aim of this study was to describe our experience with intratympanic (IT) steroid treatment of sudden sensorineural hearing loss (SSNHL) after the failure of intravenous (IV) steroid treatment and to examine the efficacy of this treatment. Methods: We recruited 65 patients with SSNHL who did not respond to IV treatment with prednisolone. These patients were randomized into 3 groups: treatment with IT steroid, treatment with steroid in ear drops, and blank control. The 24 patients in the IT group received an IT injection of methylprednisolone and the 21 patients in the ear drop group received methylprednisolone that was directly dropped onto the tympanic membrane through the ear canal. The 20 patients in the blank control group did not receive any treatment after the completion of the IV prednisolone injection. Audiograms were performed at the beginning of the study and 2 months after the end of the study. Results: In the IT treatment group, audiogram results showed that the average of the pure tone speech frequencies (500–4000 Hz) was 64.8 (range 40–101 dB) at baseline, 60.7 (range 35–92 dB) at the end of systemic treatment, and 52.9 (range 35–73 dB) at the end of IT treatment. The improvement in the IT group was significantly better than that in the other two groups, with 37% of the IT patients having significant improvement in their hearing (baseline to after systemic treatment). During IT treatment, only 1 patient developed a persistent tympanic membrane perforation, and no serious complications such as chronic otitis media, disequilibrium, and dysgeusia developed. Conclusions: IT steroid therapy can improve hearing function in patients with SSNHL after the failure of systemic steroid treatment.

Surgical management of common peripheral vestibular diseases

To review the latest developments in the surgical management of common peripheral vestibular disorders. Although surgery is indicated mainly for patients with Meniere's disease, other less common disorders such as benign paroxysmal positional vertigo, semicircular canal dehiscence, perilymphatic fistulae, fistulae of semicircular canals, VIII nerve vascular compression, chronic vestibular neuronitis, and dizziness following sudden sensorineural hearing loss may require surgical intervention when conservative management has failed. Surgery for vestibular disorders is less often indicated at present. Office-administered intratympanic gentamicin and steroid treatment have been found to be effective for control of vertigo in Meniere's disease. Side-effects of this treatment are overall acceptable. Surgery may be considered for Meniere's disease patients with good hearing who have failed intratympanic steroid treatment. Surgery is indicated for patients with debilitating dizziness associated with benign paroxysmal positional vertigo, semicircular canal dehiscence, vascular loop compression, and perilymphatic fistulae.

Intratympanic Steroid Prevents Long-Term Spiral Ganglion Neuron Loss in Experimental Meningitis

Intratympanic steroid treatment prevents hearing loss and cochlear damage in a rat model of pneumococcal meningitis. Sensorineural hearing loss is a long-term complication of meningitis affecting up to a third of survivors. Streptococcus pneumoniae is the bacterial species most often associated with a hearing loss. Rats were randomly assigned to 3 treatment groups: a group treated with intratympanic betamethasone and 2 control groups treated with either intratympanic or systemic saline. Treatment was initiated 21 hours after infection and repeated once a day for 3 days. Hearing loss and cochlear damage were assessed by distortion product otoacoustic emissions, auditory brainstem response at 16 kHz, and spiral ganglion neuron density. Fifty-six days after infection, auditory brainstem response showed no significant differences between groups, and distortion product otoacoustic emissions showed significant hearing loss at the low frequencies in animals treated with intratympanic steroid compared with animals treated with systemic saline (p < 0.05; Mann-Whitney test). However, intratympanic steroid significantly increased the number of viable neurons in the spiral ganglion compared with both intratympanic and systemic saline (p = 0.0082 and p = 0.0089; Mann-Whitney test). Histology revealed fibrosis of the tympanic membrane and cavity in steroid-treated animals, which plausibly caused the low-frequency hearing loss. Intratympanic betamethasone treatment prevents long-term spiral ganglion neuron loss in experimental pneumococcal meningitis. This finding is clinically relevant in relation to post-meningitic hearing rehabilitation by cochlear implantation. However, the drug instillation in the middle ear induced local fibrosis and a concurrent low-frequency hearing loss.

Clinical efficacy of initial intratympanic steroid treatment on sudden sensorineural hearing loss with diabetes

Objective The purpose of this study is to compare the efficacy of intratympanic steroid injection (ITSI) with that of systemic steroids as an initial treatment of sudden sensorineural hearing loss (SNHL) with diabetes. Study Design Prospective, nonrandomized multicenter clinical trial. Setting Multicenter study in Busan and Masan, South Korea. Subjects and Methods A total of 114 sudden SNHL patients who were diagnosed with diabetes were divided into peroral (PO) group (n = 48), intravenous (IV) group (n = 32), and intratympanic (IT) group (n = 34). In the PO group, prednisolone was used orally for 10 days, per schedule. In the IV group, prednisolone was administered intravenously for seven days, followed by oral administration of tapered doses for another several days. In the IT group, dexamethasone was injected into the tympanic cavity four times within a two-week period. Hearing outcome was assessed before and after the treatment. Results All groups showed significant improvement with criteria of 15 dB ( P < 0.05). However, there was no significant difference in hearing gain and recovery rate among groups ( P > 0.05). Systemic steroid treatment was stopped for two patients in the IV group and for one in the PO group due to uncontrolled hyperglycemia. However, in the IT group, there were no patients who failed to control their blood sugar level. Conclusion ITSI is as effective as systemic steroid treatment for sudden SNHL patients with diabetes and it can avoid undesirable side effects. Therefore, we consider ITSI to be a more reasonable alternative as an initial treatment for sudden SNHL patients with diabetes.

Sudden Sensorineural Hearing Loss: Otolaryngologic and Audiologic Options

Sudden Sensorineural Hearing Loss: Otolaryngologic and Audiologic Options

Intratympanic steroids for treatment of sudden hearing loss after failure of intravenous therapy

We sought to describe our experience with intratympanic steroid treatment of sudden sensorineural hearing loss after failure of intravenous steroid treatment. We conducted a nonrandomized prospective clinical trial. Fifty patients presenting with sudden onset idiopathic hearing loss were treated intravenously over five days. After this period, patients with treatment failure (18 cases) were offered intratympanic steroid treatment. Nine patients refused, whereas the other nine patients received three weekly injections of methylprednisolone. Recovery of hearing was reported as improvement of more than 15 dB in pure tone average. Intratympanic steroid treatment improved hearing loss in five patients (55%). This is significant compared with those patients who refused intratympanic treatment, who showed no further improvement (P < 0.05). No serious adverse effects were observed. Intratympanic steroids significantly improve the recovery outcome of sudden hearing loss that had not recovered after intravenous steroid treatment. Intratympanic steroids are an effective and safe therapy in sudden sensorineural hearing loss cases that are refractory to standard treatment.

Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: A control study

Although systemic steroids in sudden sensorineural hearing loss (SSHL) appears to be the most effective and the most widely accepted treatment today, a significant number of patients do not respond to steroid treatment or they cannot receive steroids for medical reasons. Intratympanic (IT) administration of steroids appears to be an alternative or additional method of management without the side effects of intravenous steroids. The aim of this study is to investigate the effectiveness and safeness of IT administration of steroids in patients who had not responded to IV treatment and to compare treatment efficacy with controls. Our study consisted of 37 patients with SSHL who, at the end of 10 days of therapy with intravenous steroids as a 1st line treatment, had pure-tone 4-frequency (0.5, 1, 2, and 4 kHz) average (PTA) of worse than 30 dB or worse than 10 dB from the contralateral ear (defined as failed intravenous treatment). They were randomized into 2 groups, treatment and control. The 19 patients of the treatment group received approximately 0.5 mL sterile aqueous suspension of methylprednisolone acetate in a concentration of 80 mg/2 mL by direct injection. The procedure was carried out 4 times within a 15-day period. An audiogram was performed before each injection and approximately 1.5 months after the last session. All patients tolerated the procedure well. No perforation or infection was noticed in any of the patients at their last visit. With regard to the 19 patients who received intratympanic treatment, in 9 patients, the PTA threshold improved more than 10 db, in 10 patients there was no change greater than 10 db, and no patients deteriorated more than 10 db. In the control group, none of the patients showed any change greater than 10 db. The difference was statistically significant (P = 0.002). The treatment group showed an improvement in mean PTA of 14.9 dB, whereas the control group showed a deterioration of 0.8 dB, and this difference also was statistically significant (P = 0.0005). IT treatment (P = 0.0001), better post-IV PTA (P = 0.0008), and absence of vertigo (P = 0.02) were good predictors of the outcome. In contrast, sex, age, affected ear, days to admission, and pattern of the initial audiogram showed no significant influence on the outcome. IT steroid administration after failed intravenous steroids is a safe and effective treatment in sudden sensorineural hearing loss.

Intratympanic Corticosteroids for Sudden Idiopathic Sensorineural Hearing Loss

To determine whether instillation of intratympanic steroids is effective in the treatment of sudden idiopathic sensorineural hearing loss. A retrospective chart review of all patients who underwent intratympanic steroid treatment (methylprednisolone and/or dexamethasone) between 1996 and 2002 at a tertiary care university otology clinic. Thirty-three patients were identified, of which 26 met inclusion criteria for having an idiopathic hearing loss. Pretreatment and posttreatment pure-tone audiograms and speech discrimination scores were compared. Overall, there was a 27.2 +/- 5.7 dB improvement in the pure-tone thresholds and a 25.4 +/- 6.2% improvement in speech discrimination scores. Those treated within 10 days of onset had a statistically significant better outcome than those treated after 10 days. No adverse reactions or complications were reported. Instillation of intratympanic steroids represents a safe and potentially effective treatment of sudden idiopathic sensorineural hearing loss.

Intratympanic Steroid Treatment: A Review

To review published literature regarding the use of intratympanic steroids in the treatment of Meniere's disease and sudden sensorineural hearing loss and to make recommendations regarding their use based on the literature review. Literature review from 1996 to 2003, PubMed, Medline Plus, and Web of Science. Retrospective case series and uncontrolled prospective cohort studies were the only types of studies available for review. On the basis of the available literature, a weak recommendation is made to use intratympanic steroid treatment of sudden hearing loss if oral steroid therapy fails or is contraindicated. The available studies regarding intratympanic steroid treatment of Meniere's disease and tinnitus are inadequate to answer the question of the efficacy of this treatment for these conditions. Higher quality studies are needed.

Intratympanic Steroid Treatment of Inner Ear Disease and Tinnitus (Preliminary Report)

Intratympanic instillation of Depo-Medrol (80 mg/cc), dexamethasone ophthalmic solution (1 mg/cc), or dexamethasone intravenous (4 mg/cc) solution produces improvement of cochlear function in certain patients with Meniere's disease, autoimmune inner ear disease and sudden sensorineural deafness. Tinnitus improved in 47%, most often in patients with Meniere's disease (9 of 15; 60%). The SRT improvement of greater than 10 dB or SD greater than 15% was documented in 41% (average improvement in SRT: 15 dB; SD: 24%). Patients with tinnitus and bilateral sensorineural hearing loss (i.e., presbycusis) did not benefit from the treatment. Prior to treatment with intratympanic medication, laser assisted tympanostomy with middle ear exploration, using otoendoscopy to determine the status of the round window niche and remove mucosal folds, helps in making the round window membrane accessible to local application of drops. Placing Gelfoam into the round window niche under direct vision, and using a Venturi Bobbin tube in the tympanic membrane, appears to be a satisfactory method for delivering medication to the inner ear fluids. The medication can be injected by the physician through the tube into the middle ear, or the patient can perform self-treatment at home, placing medication in the external auditory canal. A double-blind, cross-over study in patients with Meniere's disease is now in progress with Institutional Review Board (IRB) approval, which will be reported at a later date. This preliminary study has shown that intratympanic steroids may affect the symptoms of hearing loss and tinnitus in patients with various inner ear problems. Patients with Meniere's disease appear to respond in the highest percentage of cases. Hopefully, additional research will suggest the appropriate drugs which can be used to treat inner ear disease. Direct application of the drug to the round window membrane may increase the concentration in the inner ear fluids, thus avoiding the systemic effects.