mL Of Dexamethasone Research Articles

Addition of dexamethasone to local infiltration analgesia in elective total hip arthroplasty: a double-blind, randomized control trial

Background and objectivesPain following total hip arthroplasty is significant, and effective analgesia is associated with an improvement in functional outcomes. Dexamethasone may facilitate the action of local anesthesia, but its...

Dexamethasone concentration affecting rocuronium-induced neuromuscular blockade and sugammadex reversal in a rat phrenic nerve-hemidiaphragm model: An ex vivo study.

The concentration range of dexamethasone that inhibits neuromuscular blockade (NMB) and sugammadex reversal remains unclear. To evaluate the effects of dexamethasone on rocuronium-induced NMB and sugammadex reversal. Ex vivo study. Asan Institute for Life Sciences, Asan Medical Center, Korea, from July 2015 to November 2015. One hundred sixty male Sprague-Dawley rats. We assessed the effect of four concentrations of dexamethasone [0, 0.5, 5 (clinical concentrations) and 50 μg ml (experimental concentration)] on partial NMB on 40 phrenic nerve-hemidiaphragm preparations (n=10 per concentration). Once the first twitch of train-of-four (TOF) had been depressed by 50% with rocuronium, dexamethasone was administered. To assess the effect of dexamethasone on sugammadex reversal, 120 phrenic nerve-hemidiaphragm preparations were used in three subexperiments (n=40 per experiment), using three administration regimens of rocuronium-equimolar sugammadex: a single dose, a split-dose (split and ) and a reduced split-dose (split and ). After complete NMB was achieved, dexamethasone and sugammadex were administered. The change in the first twitch height, the recovery time to a TOF ratio at least 0.9, and the TOF ratio at 30 min were evaluated. There were no significant differences in the first twitch height among groups (P = 0.532). With a single dose of sugammadex, dexamethasone did not affect the recovery time to a TOF ratio at least 0.9 (P = 0.070). After using a split-dose of sugammadex, the recovery time to a TOF ratio at least 0.9 was delayed only at a concentration of 50 μg ml of dexamethasone. With a reduced split-dose of sugammadex, the TOF ratio at 30 min was lowered only by a concentration of 50 μg ml of dexamethasone (P < 0.010). Acute bolus administration of dexamethasone at clinical concentrations had no effect on NMB or on sugammadex reversal.

Can Hyaluronidase Be an Alternative Postoperative Anti-edema Agent to Dexamethasone? Preliminary Results of an Animal Study

Recombinant human hyaluronidase (rHuPH20) is widely used as a spreading factor, which enhances the absorption of subcutaneously injected medicines. The anti-inflammatory and anti-edema effects of the enzyme were demonstrated in previous studies. In the present study, the anti-edema effect of rHuPH20 was compared with that of dexamethasone in a traumatic rat paw edema model. Twenty-four Sprague-Dawley rats (weight 200 to 450g) were divided into 3 groups: control (group 1), rHuPH20 (group 2), and dexamethasone (group 3). Traumatic edema was induced in the right hind paws of the rats using Feeney's weight-drop model. After edema induction, 0.4mL of rHuPH20 (100 U/kg=0.88μg/kg dose) and 0.4mL of dexamethasone (0.5mg/kg dose) were injected into the right hind paws of the rats in groups 2 and 3. The paw volumes were measured before edema induction and at 3, 6, 12, 24, 48, and 72hours after induction using a plethysmometer. The Mann-Whitney U test was used for the statistical analyses. Probabilities<.05 were accepted as statistically significant. The between percentage change in the edema mean values of groups 1 and 3 showed no significant difference at all time points; however, group 2 showed significantly less change in the edema mean values at 3, 6, 12, 24, and 48hours after edema induction (P<.05) compared with group 1. The change in the edema mean value for group 2 was significantly less than that for group 3 at 3, 6, 12, 24, and 48hours after edema induction (P<.05). Local rHuPH20 injection more effectively reduced the edema that was induced traumatically in rat paws than did dexamethasone. However, further clinical studies are needed regarding the use of rHuPH20 as a postoperative anti-edema agent in place of dexamethasone.

Effects of Intracordal Estradiol and Dexamethasone Injection on Wound Healing in Vocal Fold Injuries

The aim of this study was to investigate the effects of intracordal estradiol and dexamethasone injection on wound healing in vocal fold injuries. A prospective controlled animal study was carried out. This study was conducted at a tertiary center. Ten rabbits were randomly divided into two groups. As surgical procedure, cordotomy technique was performed in the middle third of the vocal folds bilaterally. In the first group, 0.1 mL of dexamethasone was injected into the right side, and 0.1 mL of saline was injected into the left side. In the second group, 0.1 mL of estradiol was injected into the right side, and 0.1 mL of saline was injected into the left side. Animals were sacrificed after 1 month and laryngeal specimens were evaluated histopathologically. No statistically significant difference was observed in terms of inflammatory response, epithelial thickness, type I and III collagen, and hyaluronic acid parameters in dexamethasone and estradiol injections compared to the saline injection. In terms of elastin level, estradiol injection demonstrated statistically higher values compared to the saline injection. Elastin level of dexamethasone injected vocal folds was not statistically different compared to the saline injection. No significant differences were observed in terms of inflammatory response, epithelial thickness, type I and III collagen, and hyaluronic acid parameters between the estradiol and dexamethasone injected vocal folds. It is thought that the effects of estradiol or dexamethasone injections may have similar effects on wound healing in vocal fold injuries. Intracordal estradiol injection has positive effects on tissue elastin levels.

Effect of epidural levobupivacaine with or without dexamethasone soaked in gelfoam for postoperative analgesia after lumbar laminectomy: A double blind, randomised, controlled trial

Background and Aims:Postoperative pain results in prolonged hospital stay and delayed return to normal activity. This study was conducted with the aim of evaluating the analgesic efficacy of gelfoam soaked in levobupivacaine with or without dexamethasone placed in the epidural space in patients undergoing lumbar laminectomy.Methods:Ninety adult patients were randomised into three groups. Gelfoam was soaked in 12 mL of 0.9% sodium chloride in Group P, 10 mL of 0.25% levobupivacaine + 2 mL of 0.9% sodium chloride in Group L, and 10 mL of 0.25% levobupivacaine + 2 mL of dexamethasone in group LD. The primary outcome was time to first request for rescue analgesia. Total 24-h tramadol consumption, and postoperative visual analog scale (VAS) scores were recorded. Chi-square test and analysis of variance test were used, and P < 0.05 was considered significant.Results:75 patients completed the study. Time to first rescue analgesia was longer in group LD [10.11 ± 3.10 h] compared with group L [6.48 ± 2.36 h] and group P [1.76 ± 1.13 h]. Total 24-h tramadol consumption was lower in group LD (88 ± 66.58 mg) and group L (120 ± 70.7 mg) compared with group P (280 ± 64.5 mg). Postoperative VAS scores were lower in group LD and group L compared with group P, both at rest and on movement.Conclusion:Epidural gelfoam soaked in levobupivacaine and dexamethasone prolongs the duration of analgesia and decreases rescue analgesic consumption and VAS score postoperatively, in patients undergoing lumbar laminectomy.

Determination of the quantity and topography dynamics of the LCA+-dendritic cells in rat thymus in early postnatal period in norm and after the prenatal administration of the dexamethasone

Purpose was to study the dynamics of LCA + -dendritic thymus cells in newborn rats in the postnatal period after administration of dexamethasone in the intrauterine period. Materials and methods. The study was performed on 144 white nonlinear rats on the 1 st –3 rd , 5 th , 9 th , 14 th , 21 st , 30 th days after birth. There are 3 groups with 48 rats in each group: 1 – intact group; 2 – experimental group of rats, who received peritoneal injection of 0.05 ml of dexamethasone (in dilution 1:40) on the 18 th day of the prenatal period, and a control group of rats receiving 0.05 ml of 0.9 % NaCl according to M. A. Voloshyn. To study the dynamics of dendritic cells in the thymus carrying the α-D mannose receptors, LCA-lectin was used. Results . It has been established that the maximum content of LCA + -dendritic thymus cells in the intact (3.92 ± 0.65), experimental (3.41 ± 0.49) and control (4.07 ± 0.53) groups occurs on the 1 st day after birth. The minimum number of LCA + -dendritic cells was detected on the 5 th day in the intact (1.88 ± 0.37) and control (1.73 ± 0.34) groups, and their minimum in the experimental group (2.35 ± 0.48) was determined on the 30 th day after birth. In the experimental group from the 5 th day to the 9 th day a significantly higher number of LCA + -dendritic cells than in the comparison groups was detected. Conclusions. The introduction of dexamethasone in the prenatal period leads to the significant increase in the LCA + -dendritic cell content in the experimental group from the 5 th to the 9 th day of life, which indirectly coincides with the increase in the number of peripheral and mitotic dividing lymphocytes in the thymus of rats in the postnatal period.

A study to assess the effects of a single preoperative dose of steroid on thyroidectomy

Background: On thyroidectomy, incidence of postoperative nausea and vomiting, severe pain with local inflammation and voice impairment was very common. These effects can be manipulated by the use of steroids. Hence the present study, was conducted with the objective to evaluate the effects of a single preoperative dose of dexamethasone on thyroidectomy in terms of postoperative nausea and vomiting (PONV), pain and voice improvement.Methods: The present study was conducted between October 2010 and March 2011 at the Department of General Surgery, Government Medical College, Kottayam, Kerala, India. A total of 72 patients were included in the study after meeting requirements of inclusion criteria. They were divided into two groups. 37 were under Group C and received normal saline and remaining 35 served as Group D and received 8 mg/2 mL of dexamethasone preoperatively. Post-operative incidences of nausea and vomiting, pain scores, and the improvement of vocal function were compared in both groups.Results: Out of 72 patients, most of the patients participated were under the age group of 40-50 years (30.6%). Of them 9 were males and 63 were females. The incidence and severity of PONV and pain was significantly reduced in Group D compared to Group C with P values of 0.001 and 0.056 respectively. Significant protection of dexamethasone towards vocal function was not observed in the study (p =0.245).Conclusions: From the results obtained in the study, it was concluded that preoperative single dose administration of dexamethasone seemed to be safe in healthy patients undergoing thyroidectomy.

Prospective randomized study of interscalene brachial plexus block using 0.5% bupivacaine HCl with or without dexamethasone in shoulder surgery

Background Interscalene brachial plexus block is one of the commonly performed techniques for regional anesthesia of the upper extremity. The aim of this study was to compare the analgesic efficacy and duration of 5 ml versus 10 ml of 0.5% bupivacaine HCl with and without 1 ml of dexamethasone in patients undergoing shoulder surgery. Materials and methods This prospective randomized blinded study was carried on 75 American Society of Anesthesiology I and II patients. Patients were assigned randomly to one of the three groups: group A received 10 ml of bupivacaine HCl 0.5%; group B received 5 ml of bupivacaine HCl 0.5%; and group C received 4 ml of bupivacaine HCl 0.5%+1 ml of dexamethasone. Results There was no significant difference between the three groups in the total dose of intraoperative fentanyl dose. A statistically significantly high visual analog scale value was found in group B in comparison with groups A and C at 12 h postoperatively, and a statistically significant low visual analog scale was found in group C after 36 h. There was statistically significant earlier timing of first rescue analgesia requisite in group B and there was a significant difference between group C and the other two groups studied in the total amount of nalbuphine consumed. The incidence of block-related complications was significantly higher in group A compared with the other groups. Conclusion High volume of bupivacaine HCl 0.5% provides perioperative analgesia comparable to low volume, but low volume is safer in terms of the incidence of complications. Addition of dexamethasone to bupivacaine led to prolonged analgesic duration and was accompanied by a lower consumption of postoperative opioids.

A clinical comparison between 0.5% levobupivacaine and 0.5% levobupivacaine with dexamethasone 8 mg combination in brachial plexus block by the supraclavicular approach.

Background and Aims:Dexamethasone as an adjuvant to bupivacaine for supraclavicular brachial plexus (SCBP) block prolongs motor and sensory blockade. However, the effect of dexamethasone (8 mg) when added to levobupivacaine has not been well studied. This study was conducted to find out analgesic efficacy of dexamethasone as adjuvant to levobupivacaine in SCBP block.Methods:Ultrasound- guided SCBP block was given to sixty patients, randomly assigned into two groups. Group S (thirty patients) received 2 mL normal saline with 25 mL levobupivacaine (0.5%) and Group D (thirty patients) received 2 mL of dexamethasone (8 mg) with 25 mL of levobupivacaine (0.5%), respectively. Time for the first rescue analgesia, number of rescue analgesics required in 24 h and different block characteristics was assessed. Chi-square test and Student's t-test were used for statistical analysis.Results:Time for request of the first rescue analgesia was 396.13 ± 109.42 min in Group S and 705.80 ± 121.46 min in Group D (P < 0.001). The requirement for rescue analgesics was more in Group S when compared to Group D. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S.Conclusion:The addition of dexamethasone to levobupivacaine in SCBP blockade prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block.

Dexamethasone added to levobupivacaine prolongs ultrasound-guided interscalene brachial plexus blockade: a prospective, randomized, controlled study

Objectives This study aimed to evaluate the effect of the addition of dexamethasone to levobupivacaine on the duration of analgesia in forearm surgeries under ultrasound-guided interscalene brachial plexus block. Patients and methods This prospective randomized controlled, double-blind clinical trial was conducted on 60 patients who underwent elective forearm surgeries under ultrasound-guided interscalene brachial plexus block. Patients in the levobupivacaine group (group L) received 25 ml of 0.5% levobupivacaine plus 2 ml of normal saline 0.9%. Patients in the levobupivacaine dexamethasone group (group LD) received 25 ml of 0.5% levobupivacaine plus 2 ml of dexamethasone (8 mg). The onset of sensory and motor block, duration of the sensory block, time to first analgesic request, the number of failed block, total morphine consumption, side effects, and complications were recorded and compared. Results Onset of sensory block and motor block was significantly earlier in group LD compared with group L. Duration of sensory block and time to first analgesic request were significantly longer in group LD compared with group L. Total morphine consumption was significantly lower in group LD in comparison with group L. The number of failed blocks was nonsignificantly lower in group LD. The incidence of side effects and complications was low and comparable in both groups. Conclusion Addition of dexamethasone to levobupivacaine significantly shortens the onset of sensory and motor block, prolongs the duration of analgesia, decreases the 24 h morphine consumption, and prolongs the time to first analgesic request with minimal side effects.

Prospective randomized double blind comparison of analgesic efficacy of single shot epidural bupivacaine with or without dexamethasone in patients undergoing lower abdominal surgeries

Background: Epidural block with local anaesthetic with or without additives is being used for perioperative analgesia. Various additives have been used to enhance the effect of regional blocks including epidural blocks. This study aimed to investigate the effect of adding a single shot epidural dexamethasone to bupivacaine on postoperative analgesia and dose of rescue analgesics used.Methods: A prospective, randomized, double blinded study was conducted in 90 adult patients undergoing lower abdominal surgery. The patients were randomized into two groups. Group 1 received 9ml of 0.5% bupivacaine plain with 1 ml of normal saline. Group 2 received 9ml of 0.5% bupivacaine plain 9 ml with 1 ml of dexamethasone (4mg). After standard balanced anesthesia technique, patients were observed in postoperative period for pain and hemodynamic variables accordingly.Results: Our study showed significantly longer duration of analgesia of 468 minutes (almost 8 hours) when dexamethasone was added to bupivacaine for single shot epidural injection compared to 271 minutes (approximately 4 and half hours) when bupivacaine alone was used (p&lt;0.001). Consumption of rescue analgesic, Tramadol, was significantly lower in dexamethasone group in 24 hours (169.31±50.82 mg in Group 1 and 114.77±60.59mg in Group 2, p&lt;0.001). No adverse events were noted.Conclusion: Addition of dexamethasone to bupivacaine for single shot epidural block almost doubled the duration of analgesia. Single shot epidural block using bupivacaine with addition of dexamethasone provides effective post operative analgesia and significantly reduced the postoperative rescue analgesic requirement.Journal of Society of Anesthesiologists of Nepal 2015; 2(2): 46-51

Assessment of the efficacy of dexamethasone, lignocaine or placebo in the prevention of post intubation sore throat

Objective: To assess the incidence of sore throat and hoarseness caused by endotracheal intubation.To observe if lignocaine or dexamethasone throat spray would alter the incidence of sore throat Materials and methods : Adult patients of either sex who underwent general anaesthesia with endotracheal intubation were included in this randomised double blind study. Three hundred patients who had general anaesthesia with endotracheal intubation were randomly allocated into three groups – Group A, Group B and Group C following block randomisation. Nature of the study was explained to the patient and verbal consent obtained. Group A – 2ml of dexamethasone (8mg) was sprayed Group B – 2ml of 4% lignocaine was sprayed in this group.Group C – 2ml of normal saline was used in this group.Postoperatively between 12-24 hours patients were invited to find out if any sore throat or hoarseness of voice was present. Verbal analogue scoring system was used. Results: Postoperatively sore throat was present in 26% in group A, 33% in group B and 28% in group C. Hoarseness was present in 20% in group A, 23% in group B and 18% in group C. Sore throat and hoarseness were present in 37% in group A, 45% in group B and 39% in group C. Conclusion : Neither dexamethasone nor lignocaine throat spray were useful in reducing postoperative sore throat and hoarseness.

Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomised, double-blind study

Background:Different additives have been used to prolong brachial plexus block. We performed a prospective, randomised, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of supraclavicular brachial plexus block as this is the most common type of brachial block performed in our institute.Methods:Sixty American Society of Anaesthesiologist's physical status I and II patients undergoing elective hand, forearm and elbow surgery under brachial plexus block were randomly allocated to receive either 1.5% lidocaine (7 mg/kg) with adrenaline (1:200,000) and 2 ml of normal saline (group C, n=30) or 1.5% lidocaine (7 mg/kg) with adrenaline (1:200,000) and 2 ml of dexamethasone (8 mg) (group D, n=30). The block was performed using a nerve stimulator. Onset and duration of sensory and motor blockade were assessed. The sensory and motor blockade of radial, median, ulnar and musculocutaneous nerves were evaluated and recorded at 5, 10, 20, 120 min, and at every 30 min thereafter.Results:Two patients were excluded from the study because of block failure. The onset of sensory and motor blockade (13.4±2.8 vs. 16.0±2.3 min and 16.0±2.7 vs. 18.7±2.8 min, respectively) were significantly more rapid in the dexamethasone group than in the control group (P=0.001). The duration of sensory and motor blockade (326±58.6 vs. 159±20.1 and 290.6±52.7 vs. 135.5±20.3 min, respectively) were significantly longer in the dexamethasone group than in the control group (P=0.001).Conclusion:Addition of dexamethasone to 1.5% lidocaine with adrenaline in supraclavicular brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade.

Is an intratympanic injection of corticosteroids effective in the treatment of otitis media with effusion?

EnAbstract Objectives Chronic otitis media with effusion (OME) is a worldwide major health problem for both children and adults. The aim of this study is to test the effectiveness of intratympanic injection of corticosteroid in the treatment of chronic OME. Study The study was applied on 14 patients (24 ears) who had failed medical treatment and had recurrence after surgery or patients who refused surgical treatment. Methods These patients received 4 intratympanic injections of dexamethasone. Approximately 0.5 ml of dexamethasone was injected in each time. Subjective assessment for symptomatic improvement was done and objective assessment was done by pure tone audiometry and tympanometry 3 months after the last injection. Results At the end of follow up period, no patient had noticeable improvement in hearing, aural fullness nor tinnitus. Also, pure tone audiometry and tympanometry revealed no noticeable improvement in any patient. Conclusion It was found that intratympanic injection of dexamethasone is not effective in management of chronic OME.

Dexamethasone prophylaxis before thyroidectomy to reduce postoperative nausea, pain, and vocal dysfunction: A randomized clinical controlled trial

The objective of this 2-arm, double-blind, randomized, controlled study was to assess the effects of a preoperative single dose steroid on postoperative nausea and vomiting (PONV), pain, and vocal function after thyroidectomy for benign disease. We randomized 102 patients into 2 groups from January to December 2009: (1) treatment with 8 mg/2 mL of dexamethasone and (2) treatment with 2 mL NaCl 0.9%, both administered intravenously before anesthesia. The severity of nausea and the need for antiemetic drugs were reduced in patients receiving dexamethasone (p = .0001). Dexamethasone patients reported significantly less pain (p = .008); the need for analgesic drugs was lower in the dexamethasone group (p = .048). No differences were noted with regard to subjective voice analysis (p = .693). Dexamethasone (8 mg IV) is a safe and effective method to reduce PONV and pain after thyroid resection and should be used routinely.

Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade

Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of axillary brachial plexus block. Sixty patients scheduled for elective hand and forearm surgery under axillary brachial plexus block were randomly allocated to receive either 34 mL lidocaine 1.5% with 2 mL of isotonic saline chloride (control group, n = 30) or 34 mL lidocaine 1.5% with 2 mL of dexamethasone (8 mg) (dexamethasone group, n = 30). Neither epinephrine nor bicarbonate was added to the treatment mixture. We used a nerve stimulator and multiple stimulations technique in all of the patients. After performance of the block, sensory and motor blockade of radial, median, musculocutaneous, and ulnar nerves were recorded at 5, 15, and 30 min. The onset time of the sensory and motor blockade was defined as the time between last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory and motor blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain and complete recovery of motor functions. Sixteen patients were excluded because of unsuccessful blockade. The duration of surgery and the onset times of sensory and motor block were similar in the two groups. The duration of sensory (242 +/- 76 versus 98 +/- 33 min) and motor (310 +/- 81 versus 130 +/- 31 min) blockade were significantly longer in the dexamethasone than in the control group (P < 0.01). We conclude that the addition of dexamethasone to lidocaine 1.5% solution in axillary brachial plexus block prolongs the duration of sensory and motor blockade.

Diagnostic and Management Dilemma of Sudden Hearing Loss

Sudden SNHL continues to present a diagnostic and management dilemma to otolaryngologists. This otologic entity should be considered a syndrome with various causes, including acoustic neuromas. Diagnosis is hindered mainly by the limited availability of in vivo evaluation techniques for inner-ear disorders. Despite these challenges, recent animal studies and clinical research have increased our knowledge regarding the effect of corticosteroids on sudden hearing loss. Rarey and Curtis first reported the presence of glucocorticoid receptors in the spiral ligament and in other parts of the human inner ear. Hearing improvement following administration of glucocorticoids might be due to (1) their anti-inflammatory effect; (2) increasing stria vascularis synthesis of Na -K adenosine triphosphatase, which decreases vascular permeability (particularly to circulating immune mediators); and (3) increasing cochlear expression of aquaporin 1 and 3. The pharmakokenetics of the glucocorticoids have been studied by Parnes et al, who demonstrated a much higher penetration of corticosteroids into the cochlear fluids following IT application than with systemic administration. The frequent spontaneous recovery of hearing and the hearing improvement following treatment with corticosteroids are both suggestive of a reversible inner-ear process rather than hair-cell degeneration. Such a reversible process can result from ion-homeostatic disturbances caused by stria vascularis dysfunction that can lead to loss of the endocochlear potential and hearing loss. This might represent a common final pathway of many causes of sudden hearing loss, including viral or bacterial infections, metabolic abnormalities, and vascular and autoimmune disorders. Marzo has done a comprehensive and very informative literature review on the topic of IT steroid treatment for sudden SNHL. He was able to identify 7 such studies, of which 1 was randomized and controlled. The results of these studies are encouraging, and his conclusion that this modality of treatment should be considered when oral steroid treatment fails is reasonable. Since severe and profound sudden SNHL has a very poor prognosis, it is tempting to consider treatment with synchronous administration of systemic steroids and IT perfusion in an effort to improve outcomes. At our institution this option is presented to such patients. For IT perfusions, we use 0.3 to 0.4 mL of dexamethasone (24 mg/ mL) administered with a 30-gauge needle attached to a tuberculin syringe. Three treatments are given at weekly intervals. At present, 24mg/mL dexamethasone is available only in a compounded form prepared by pharmacists. Some of the failures of IT perfusion might be caused by inhibition of steroid absorption by a pseudomembrane covering the round window niche. In a study of 202 temporal bones from 117 patients, 11% of the ears were found to have fibrous tissue or a fat plug, and 21% had an extraneous (false) round-window membrane. Office endoscopy and removal of any obstructive lesions may be warranted in such cases. Our preliminary results with IT steroid perfusion for severe and profound sudden SNHL are not very encouraging at this point. We will be reporting our experience in the near future. As new diagnostic techniques are developed, our ability to treat sudden SNHL will improve. Until then, systemic and IT steroids should be considered the treatment of choice. Prospective and controlled studies should be conducted to determine which corticosteroid is most effective, its optimal dose, and the optimal number of treatments. They also should determine if the use of sustained-release delivery vehicles of corticosteroids to the inner ear is more effective than the repeated intratympanic injections. Finally a standardized method of reporting hearing results would be very helpful.

Corticosteroids to Prevent Recurrent Obstruction after Vaginal Urethrolysis

Background Urethral obstruction may occur after anti-incontinence surgery. We describe the use of steroids to prevent recurrent obstruction after vaginal urethrolysis. Case A 22-year-old woman with a history of a Burch procedure complicated by obstruction and a failed vaginal urethrolysis is now 6 months from a second urethrolysis for outlet obstruction and without complaints. Postoperatively, she received periurethral injections of 10 mg of dexamethasone and 1% lidocaine without epinephrine (2.5 mL of dexamethasone and 1 mL of lidocaine) every 2 weeks for a total of 8 visits. The injections were given around the bladder neck, directed toward the symphysis. Conclusion Steroids should be considered in the prevention of outlet obstruction after vaginal urethrolysis.

NEUTROPHILS ARE ASSOCIATED WITH A FASTER RECOVERY AFTER MUSCLE INJURY

One of the first observed events after skeletal muscle injury is acute inflammation, which is thought to affect functional recovery. PURPOSE To determine whether neutrophils (PMN) are correlated with functional recovery after muscle injury. METHODS Male Sprague-Dawley rats (n=47, 314±60g) were subjected to an eccentric injury of the tibialis anterior (TA) by stimulating the peroneal nerve while plantar flexing the ankle through a 90° arc. The TA was then immediately injected with either 0.1 mL of dexamethasone (DM) (0.08mg/kg), saline, nandrolone decanoate (ND) (2mg/kg), or sesame oil. Maximal tetanic tension (Po) was used to measure muscle function on days 1 and 3. To quantify PMN accumulation, a muscle extract was obtained and assayed for myeloperoxidase (MPO) activity and results were calculated as U/mg protein. To visualize PMNs, we performed immunohistochemistry (IH) using antibodies against MPO. The data were analyzed by a one-way ANOVA. RESULTS In a preliminary study, our TA injury led to an immediate decrease in Po from 7.88±1.88N to 5.05±0.85N. As expected, Po continued to drop in all four groups one day after injury. By day 3, however, the DM-treated muscles showed a significant increase in Po (5.68±2.37N) compared to the control group (p = 0.02), while the ND-treated muscle continued to deteriorate (1.56±1.08N) compared to controls (p = 0.03). One day after TA injury both our vehicle-control groups had a doubling of MPO specific activity compared to non-injured muscle. Treatment with DM led to a 55\% increase above controls, while ND treatment led to a 35\% decrease of MPO specific activity compared to controls. By Day 3 the MPO activity had returned to the pre-injury level in all groups. IH showed a similar trend. CONCLUSIONS Contrary to our expectations, we observed a relationship between increased amount of intramuscular PMN on day 1 and the recovery of function after muscle injury on day 3. The data suggest that PMNs may prime the muscle to achieve a faster recovery after injury. Funded in part by NIH (K01HD01165) and a grant from NFL Charities to PGDD

Bursitis: A factor in the differential diagnosis of orofacial neuralgias and myofascial pain dysfunction syndrome

A woman had pain on swallowing and talking when initially seen. Previous diagnoses of glossopharyngeal, neuralgia and myofascial pain dysfunction syndrome had been made. Appropriate treatment for these conditions failed to produce any improvement. Palpation revealed two tender areas bilaterally, overlying the hamulus. Treatment with an injection of 1 ml of dexamethasone (Decadron) 4 mg/ml into each area of tenderness resulted in a dramatic improvement. An anatomic review disclosed the presence of a bursa on the hamulus to protect the tendon of tensor veli palatini. A diagnosis of bursitis was made because of the dramatic improvement in the patient's condition as the result of corticosteroid therapy. Bursitis should therefore be considered in the differential diagnoses of orofacial neuralgias, temporomandibular joint dysfunction, and myofascial pain dysfunction syndrome.