Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy

  • Haralampos Gouveris
  • Oksana Selivanova
  • Wolf Mann
Otology

Abstract

The purpose of this prospective study was to test whether intratympanic application of dexamethasone/hyaluronic acid improves hearing outcome in patients with pantonal idiopathic sudden sensorineural hearing loss (ISSHL), in patients with sudden deafness or sudden profound SHL and in patients with predominant high-frequency ISSHL who are refractory to intravenous steroid and vasoactive therapy. The study took place in an academic tertiary referral hospital involving 21 patients with pantonal ISSHL, 10 patients with sudden deafness or sudden profound SHL and 9 patients with a high-frequency ISSHL. Intratympanic dexamethasone/hyaluronic acid was administered in the affected ear. Hearing was evaluated by means of standard pure-tone audiometry. The differences between pure-tone hearing thresholds by air conduction before intravenous therapy and before the beginning of the intratympanic therapy, as well as before and after intratympanic therapy, were calculated. Statistical analysis was performed by means of the Wilcoxon’s test for paired samples. Intratympanic injection of dexamethasone/hyaluronic acid results in a significant global (pantonal) improvement in hearing in patients with pantonal ISSHL. It also effects improvement in hearing at selected frequencies (namely at 1.5 and 3 kHz) in patients with a predominant high-frequency ISSHL and at selected frequencies (namely at 0.5, 0.75 and 1 kHz) in patients with sudden deafness or sudden profound SHL. Neither systemic nor local side effects were observed. Intratympanic administration of dexamethasone/hyaluronic acid provides a safe and efficacious therapeutic option for the treatment of patients with pantonal and high-frequency ISSHL who don’t respond to intravenous steroid and vasoactive therapy.

Keywords

Sudden hearing loss Dexamethasone Hyaluronic acid Intratympanic Therapy 

Abbreviations

dB HL

decibel hearing level

(IS)SHL

(idiopathic sudden) sensorineural hearing loss

kHz

kiloHertz

References

  1. 1.
    Arriaga MA, Goldmann S (1998) Hearing results of intratympanic steroid treatment of endolymphatic hydrops. Laryngoscope 108:1682–1685CrossRefPubMedGoogle Scholar
  2. 2.
    Bagger-Sjoback D (1991) Sodium hyaluronate application to the open inner ear: an ultrastructural investigation. Am J Otol 12:35–39PubMedGoogle Scholar
  3. 3.
    Billett TE, Thorne PR, Gavin JB (1989) The nature and progression of injury in the organ of Corti during ischemia. Hear Res 41:189–197CrossRefPubMedGoogle Scholar
  4. 4.
    Chandrasekhar SS, Rubinstein RY, Kwartler JA, Gatz M, Connelly PE, Huang E, Baredes S(2000) Dexamethasone pharmacokinetics in the inner ear: Comparison of route of administration and use of facilitating agents. Otolaryngol Head Neck Surg 122:521–528PubMedGoogle Scholar
  5. 5.
    Chandrasekhar SS (2001) Intratympanic dexamethasone for sudden sensorineural hearing loss: clinical and laboratory evaluation. Otol Neurotol 22:18–23CrossRefPubMedGoogle Scholar
  6. 6.
    Coleman JKM, Quirk WS, Dengerink HA, Wright JW (1990) Pentoxiphylline increases cochlear blood flow while decreasing blood pressure in guinea pigs. Hear Res 47:169–174CrossRefPubMedGoogle Scholar
  7. 7.
    Kanzaki J, Taiji H, Ogawa K (1988) Evaluation of hearing recovery and efficacy of steroid treatment in sudden deafness. Acta Otolaryngol [Suppl] 456:31–36Google Scholar
  8. 8.
    Lamm K, Lamm H, Arnold W (1998) Effect of hyperbaric oxygen therapy in comparison to conventional or placebo therapy or no treatment in idiopathic sudden hearing loss, acoustic trauma, noise-induced hearing loss and tinnitus. A literature survey. Adv Otorhinorhinolaryngol 54:86–99Google Scholar
  9. 9.
    Lange G, Maurer J, Mann W (2004) Long-term results after interval therapy with intratympanic gentamicin for Meniere’s disease. Laryngoscope 114:102–105CrossRefPubMedGoogle Scholar
  10. 10.
    Laurent C, Anniko M, Hellstrom S (1991) Hyaluronan applied to lesioned round window membrane is free from cochlear ototoxicity. Acta Otolaryngol 111:506–514Google Scholar
  11. 11.
    Luetje CM, Berliner KI (1997) Plasmapheresis in autoimmune inner ear disease: long-term follow-up. Am J Otol 18:572–576Google Scholar
  12. 12.
    Parnes LS, Sun A-H, Freeman DJ (1999) Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. Laryngoscope [Suppl 91]:1–17Google Scholar
  13. 13.
    Selivanova O, Maurer J, Ecke U, Mann W (2003) The effects of streptolysin-O and sodium hyaluronate on the permeability of the round window membrane in guinea pigs—an electrophysiologic study (German). Laryngorhinootologie 82:1–5CrossRefGoogle Scholar
  14. 14.
    Sha S, Taylor R, Forge A, Schacht J (2001) Differential vulnerability of basal and apical hair cells is based on intrinsic susceptibility to free radicals. Hear Res 155:1–8CrossRefPubMedGoogle Scholar
  15. 15.
    Shirwany NA, Seidman MD, Tang W (1998) Effect of transtympanic injection of steroids on cochlear blood flow, auditory sensitivity and histology in the guinea pig. Am J Otol 19:230–235Google Scholar
  16. 16.
    Stennert E (1979) Bell’s palsy—a new concept of treatment. Arch Otorhinolaryngol 225:265–268Google Scholar
  17. 17.
    Tabuchi K, Oikawa K, Uemaetomari I, Tsuji S, Wada T, Hara A (2003) Glucocorticoids and dehydroepiandrosterone sulfate ameliorate ischemia-induced injury of the cochlea. Hear Res 180:51–56CrossRefGoogle Scholar
  18. 18.
    Ulfendahl M, Scarfone E, Flock A, Le Calvez S, Conradi P (2000) Perilymphatic fluid compartments and intercellular spaces in the inner ear and the organ of Corti. Neuroimage 12:307–313CrossRefGoogle Scholar
  19. 19.
    Whitaker S (1980) Idiopathic sudden hearing loss. Am J Otol 1:180–183PubMedGoogle Scholar
  20. 20.
    Wilson WR, Byl FM, Laird N (1980) The efficacy of steroids in the treatment of idiopathic sudden hearing loss: a double blind study. Arch Otolaryngol 106:772–776Google Scholar
  21. 21.
    Ziegler EA, Hohlweg-Majert B, Maurer J, Mann W (2003) Epidemiological data of patients with sudden hearing loss. A retrospective study over a period of 3 years (German). Laryngorhinootologie 82:4–8CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Haralampos Gouveris
    • 1
  • Oksana Selivanova
    • 1
  • Wolf Mann
    • 1
  1. 1.Department of Otorhinolaryngology and Head and Neck SurgeryUniversity of MainzMainzGermany

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