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Intratympanale Dexamethasongabe

Nutzen in der Behandlung des hochgradigen Hörsturzes

Intratympanic steroid administration

Use in the treatment of profound idiopathic sudden sensorineural hearing loss

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Zusammenfassung

Hintergrund

Die Behandlung des Hörsturzes wird weiterhin kontrovers diskutiert. Systemische Steroide kommen in der Behandlung des Hörsturzes häufig zum Einsatz, da entzündliche oder autoimmune Prozesse postuliert werden. Die intratympanale Anwendung von Steroiden scheint eine gute Alternative oder Therapieerweiterung zu sein, ohne den Nachteil von systemischen Nebenwirkungen zu haben. Dies macht die Therapie auch Patienten mit Kontraindikationen für systemische Steroide zugänglich.

Material und Methoden

Diese retrospektive Analyse stellt die Therapieergebnisse von 25 Patienten, welche mit der Standardtherapie (Prednisolon, Hydroxyethylstärke, Pentoxyfyllin) behandelt wurden, 23 Patienten, die zusätzlich eine intratympanale Steroidtherapie erhielten (IT-Gruppe), gegenüber. Insgesamt erfolgten 4 Injektionen innerhalb von 10 Tagen. Die applizierte Lösung setzt sich aus 0,3 ml Dexamethason (8 mg/ml) und 0,2 ml Hyaluronsäure 0,2% zusammen. Das Reintonaudiogramm („pure-tone average“, PTA) wurde vor sowie 3 Monate nach Behandlung evaluiert.

Ergebnisse

Der PTA zeigte 3 Monate nach der Behandlung eine Verbesserung in der IT-Gruppe um 48 dB und in der Standardgruppe um 38 dB. Die IT-Gruppe erzielte mit 68% durchschnittlicher Verbesserung des PTA eine bessere Erholung als die Standardgruppe mit 59%. Beide Ergebnisse erreichten keine statistische Signifikanz.

Schlussfolgerungen

Die Kombinationstherapie mit intratympanalem Steroid zeigt eine Tendenz zu besseren Hörergebnissen ohne relevante Nebenwirkungen. Für die Zukunft stellt sich die Frage, ob Hörstürze nur noch intratympanal behandelt werden sollen. Die aktuelle Datenlage reicht noch nicht, um diese Frage zuverlässig klären zu können. Hierzu sind weitere groß angelegte Studien notwendig.

Abstract

Background

Therapy for idiopathic sudden sensorineural hearing loss is still controversial. Although there are no evidenced-based studies, therapy with systemic steroids is widely accepted as the gold standard. Intratympanic administration of steroids appears to be an alternative or additional method of management without the disadvantage of systemic side effects and, therefore, makes therapy accessible for patients with contraindication for systemic steroids.

Material and methods

This retrospective analysis compares the audiometric results of 25 patients who were treated with standard therapy (prednisolone, hydroxyethyl starch, pentoxyfylline) with 23 patients who additionally received intratympanic steroids (IT group). A total of 4 injections were administered within 10 days. The solution used consisted of 0.3 ml dexamethasone (8 mg/ml) and 0.2 ml hyaluronic acid 0.2%. The pure-tone average (PTA) was evaluated prior to and 3 months after treatment.

Results

The PTA 3 months after treatment showed an improvement of 48 dB in the IT group and 38 dB in the standard treatment group. The IT group achieved better recovery with an average PTA improvement of 68% compared to the standard treatment group with an average improvement of 59%. Neither result reached significance.

Conclusion

Combination therapy with intratympanic steroids showed a tendency for better hearing results without serious side effects. However, because current evidence is not adequate, randomized placebo-controlled multicenter studies are needed.

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  1. Klinik für Hals-Nasen-Ohren-Heilkunde, Kantonsspital Luzern, 6000, Luzern 16, Schweiz

    C. Burkart, T. Linder & M. Gärtner

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  1. C. Burkart
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  2. T. Linder
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Correspondence to C. Burkart.

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Burkart, C., Linder, T. & Gärtner, M. Intratympanale Dexamethasongabe . HNO 61, 152–158 (2013). https://doi.org/10.1007/s00106-012-2557-3

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