European Archives of Oto-Rhino-Laryngology

, Volume 267, Issue 5, pp 701–707 | Cite as

Modified intratympanic treatment for idiopathic sudden sensorineural hearing loss

  • Emrah Kara
  • Fikret Çetik
  • Özgür Tarkan
  • Özgür Sürmelioğlu
Otology

Abstract

Steroids are the only proven drugs in the treatment for idiopathic sudden sensorineural hearing loss. In the recent studies, it has been suggested that, steroids delivered through the intratympanic route obtained higher perilymph levels, resulting in better hearing outcomes. The purpose of this study is to compare the hearing outcomes of the two routes of steroid treatment: intratympanic route and systemic route. In this prospective study, 60 consecutive patients with idiopathic sensorineural hearing loss treated between January 2005 and September 2008 were enrolled: 29 were in the intratympanic steroid group (ITSG) and 31 were in the systemic steroid group (SSG). In the ITSG, 5 intratympanic injections of dexamethasone were performed with the dose of 4 mg/ml, consecutively. Oral methylprednisolone was given at the dose of 1 mg/kg, tapered every 2 days and stopped at 10 days, in the SSG. The pure tone averages (PTA), speech discrimination scores (SDS) and the percentage of the patients who made an improvement more than 10 dB were analyzed on the tenth day and 2 months after the treatment statistically. The improvement in PTA on tenth day and second month after treatment was 31.38 and 37.55 dB, in the ITSG and 19.35 and 20.68 dB in the SSG, respectively. The improvement in SDS in the same time period was 35.24 and 37.52% in the ITSG and 20.13 and 19.61% in the SSG, respectively. Also, 25 of the 29 patients (86.2%) in the ITSG and 16 of the 31 patients (51.6%) in the SSG made an improvement more than 10 dB on PTA in the second month control. Intratympanic steroids gave better hearing results than systemic steroids with no systemic side effects. Studies with more sample sizes will identify the best steroid for injection, application time, frequency and dose.

Keywords

Intratympanic Steroid Sudden sensorineural hearing loss Treatment 

References

  1. 1.
    Fetterman BL, Saunders JE, Luxford WM (1996) Prognosis and treatment of sudden sensorineural hearing loss. Am J Otol 17:529–536PubMedGoogle Scholar
  2. 2.
    Wilson W, Byl F, Laird N (1980) The efficacy of steroids in the treatment of idiopathic sudden hearing loss. Arch Otolarygol 106:772–776Google Scholar
  3. 3.
    Parnes LS, Sun AH, Freeman DJ (1999) Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed-up by clinical application. Laryngoscope 109:S1–S17CrossRefGoogle Scholar
  4. 4.
    Chandrasekhar SS (2001) Intratympanic dexamethasone for sudden sensorineural hearing loss: clinical and laboratory evaluation. Otol Neurotol 22:18–23CrossRefPubMedGoogle Scholar
  5. 5.
    Moskowitz D, Lee KJ, Smith HW (1984) Steroid use in idiopathic sudden sensorineural hearing loss. Laryngoscope 94:664–666CrossRefPubMedGoogle Scholar
  6. 6.
    Su J, Bachmann G, Tang A, Zumegen C, Michel O, Wittekindt C (2003) The different levels of prednisolone in perilymph after local and systemic treatment. Lin Chuang Er Bi Yan Hou Ke Za Zhi 17(10):615–617PubMedGoogle Scholar
  7. 7.
    Kopke RD, Hoffer ME, Wester D, O’Leary MJ, Jackson RL (2001) Targeted topical steroid therapy in sudden sensorineural hearing loss. Otol Neurotol 22:475–479CrossRefPubMedGoogle Scholar
  8. 8.
    Gianoli GJ, Li JC (2001) Transtympanic steroids for treatment of sudden hearing loss. Otolaryngol Head Neck Surg 125:142–146CrossRefPubMedGoogle Scholar
  9. 9.
    Lefebvre PP, Staecker H (2002) Steroid perfusion of the inner ear for sudden sensorineural hearing loss after failure of conventional therapy: a pilot study. Acta Otolaryngol 122:698–702CrossRefPubMedGoogle Scholar
  10. 10.
    Guan-Min H, Hung-Ching L, Min Tsan S (2004) Effectiveness of intratympanic dexamethasone injection in sudden deafness patients as salvage treatment. Laryngoscope 114:1184–1189CrossRefGoogle Scholar
  11. 11.
    Gouveris H, Selivanova O, Mann W (2005) Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy. Eur Arch Otorhinolaryngol 262:131–134CrossRefPubMedGoogle Scholar
  12. 12.
    Battista RA (2005) Intratympanic dexamethasone for profound idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 132:902–905CrossRefPubMedGoogle Scholar
  13. 13.
    Herr BD, Marzo SJ (2005) Intratympanic steroid perfusion for refractory sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 132:527–531CrossRefPubMedGoogle Scholar
  14. 14.
    Plontke S, Löwenheim H, Preyer S, Leins P, Dietz K, Koitschev A, Zimmermann R, Zenner HP (2005) Outcomes research analysis of continuous intratympanic glucocorticoid delivery in patients with acute severe to profound hearing loss: basis for planning randomized controlled trials. Acta Otolaryngol 125:830–839CrossRefPubMedGoogle Scholar
  15. 15.
    Slattery WH, Fisher LM, Iqbal Z, Liu N (2005) Oral steroid regimens for idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 132:5–10CrossRefPubMedGoogle Scholar
  16. 16.
    Choung YH, Park K, Shin YR, Cho MJ (2006) Intratympanic dexamethasone injection for refractory sudden sensorineural hearing loss. Laryngoscope 116:747–752CrossRefPubMedGoogle Scholar
  17. 17.
    Kakehata S, Sasaki A, Oji K, Futai K, Ota S, Makinae K, Shinkawa H (2006) Comparison of intratympanic and intravenous dexamethasone treatment on sudden sensorineural hearing loss with diabetes. Otol Neurotol 27:604–608CrossRefPubMedGoogle Scholar
  18. 18.
    Xenellis J, Papadimitriou N, Nikolopoulos T, Maragoudakis P, Segas J, Tzagaroulakis A, Ferekidis E (2006) Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: a control study. Otolaryngol Head Neck Surg 134:940–945CrossRefPubMedGoogle Scholar
  19. 19.
    Plaza G, Herráiz C (2007) Intratympanic steroids for treatment of sudden hearing loss after failure of intravenous therapy. Otolaryngol Head Neck Surg 137(1):74–78CrossRefPubMedGoogle Scholar
  20. 20.
    Kiliç R, Safak MA, Oğuz H, Kargin S, Demirci M, Samim E, Ozlüoğlu LN (2007) Intratympanic methylprednisolone for sudden sensorineural hearing loss. Otol Neurotol 28(3):312–316CrossRefPubMedGoogle Scholar
  21. 21.
    Battaglia A, Burchette R, Cueva R (2008) Combination therapy (intratympanic dexamethasone + high-dose prednisone taper) for the treatment of idiopathic sudden sensorineural hearing loss. Otol Neurotol 29:453–460CrossRefPubMedGoogle Scholar
  22. 22.
    Balyan FR, Taibah A, De Donato G, Aslan A, Falcioni M, Russo A, Sanna M (1998) Titration streptomycin therapy in Meniere’s disease: long-term results. Otolaryngol Head Neck Surg 118:261–266CrossRefPubMedGoogle Scholar
  23. 23.
    Himeno C, Komeda M, Izumikawa M, Takemura K, Yagi M, Weiping Y, Doi T, Kuriyama H, Miller JM, Yamashita T (2002) Intra-cochlear administration of dexamethasone attenuates aminoglycoside ototoxicity in the guinea pig. Hear Res 167:61–70CrossRefPubMedGoogle Scholar
  24. 24.
    Mynatt R, Hale SA, Gill RM (2006) Demonstration of a longitudinal concentration gradient along scala tympani by sequential sampling of perilymph from the cochlear apex. J Assoc Res Otolaryngol 7:182–193CrossRefPubMedGoogle Scholar
  25. 25.
    Hamid M, Trune D (2008) Issues, indications, and controversies regarding intratympanic steroid perfusion. Curr Opin Otolaryngol Head Neck Surg 16:434–440CrossRefPubMedGoogle Scholar
  26. 26.
    Rauch SD (2004) Intratympanic steroids for sensorineural hearing loss. Otolaryngol Clin N Am 37:1061–1074CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Emrah Kara
    • 1
  • Fikret Çetik
    • 1
  • Özgür Tarkan
    • 1
  • Özgür Sürmelioğlu
    • 1
  1. 1.ENT Department, Medicine SchoolÇukurova UniversityAdanaTurkey

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