Intratympanic Gentamicin Injection in Ménière’s Disease: Our Ten Years’ Experience and Outcomes

Objective: The aim of our study is to evaluate the effectiveness of intratympanic gentamicin injection (ITG) on vertigo control with reduced doses and its hearing effects. Materials and Method: The study was conducted at Otolaryngology Department of AORN “S.G. Moscati” between January 2005 and January 2015 on 72 patients with disabling unilateral Meniere’s disease. We use 0.2-0.3 mL of gentamicin sulfate at a concentration of 40mg/ml, injected into the affected ear through the posterior-inferior quadrant of the tympanic membrane. The procedure was carried out for three following days. Main outcome measures: vertigo control and hearing threshold changes after ITG treatment. Results: In 98.6% of the patients(n=71) the ITG produced the full remission of the vertiginous symptoms. In 91.6% of cases(n=66) a single treatment (three consequent injections) was sufficient to control vertigo, in 5.5% of cases(n=4) two treatments were necessary to control vertigo and in 1.3% of patients(n=1) three treatments were necessary to control vertigo. In no case we have had hearing loss after ITG procedure. The pre-treatment pure tone average was 48db. The post-treatment pure tone average was 49.2db. This difference was no statistical difference. Conclusion: In this study we reported high vertigo control, long follow-up and no case of significant hearing worsening. We consider the three injections in the following three days with low doses of gentamicin a safe and valid treatment for Meniere’s disease.

Efficacy of intratympanic injection versus intravenous drip of prednisolone acetate in the treatment of sudden hearing loss / 中国基层医药

Objective:To investigate the efficacy of intratympanic injection versus intravenous drip of prednisolone acetate in the treatment of sudden hearing loss. Methods:A total of 120 patients with sudden hearing loss who received treatment in the Department of Otolaryngology, Mingzhou Hospital between January 2017 and January 2020 were included in this study. They were divided into intratympanic injection group (intratympanic injection of prednisolone acetate, n = 60) and intravenous injection group (intravenous injection of prednisolone acetate, n = 60) according to route of drug administration. After 8 days of treatment, clinical efficacy was compared between the two groups. The hearing thresholds at 500 Hz and 1 000 Hz in both groups were detected using pure tone audiometry. The levels of procalcitonin and high-sensitivity C-reactive protein and adverse drug reactions were compared between the two groups. Results:After treatment, total response rate in the intratympanic injection group was significantly higher than that in the intravenous injection group (93.33% vs. 80.00%, χ2 = 4.61, P < 0.05). The hearing threshold at 500 Hz in the intratympanic injection group was significantly lower than that in the intravenous injection group [(38.69 ± 3.56) vs. (42.36 ± 4.36), t = 5.05, P < 0.001). The hearing threshold at 1 000 Hz in the intratympanic injection group was significantly lower than that in the intravenous injection group [(32.36 ± 3.36) vs. (40.15 ± 4.12), t = 11.35, P < 0.001). After treatment, procalcitonin level in the intratympanic injection group was significantly lower than that in the intravenous injection group [(0.65 ± 0.12) μg/L vs. (0.98 ± 0.15) μg/L, t = 13.30, P < 0.001)]. High-sensitivity C-reactive protein level in the intratympanic injection group was significantly lower than that in the intravenous injection group [(3.28 ± 0.36) mg/L vs. (5.26 ± 0.56) mg/L, t = 23.03, P < 0.001]. There was no significant difference in incidence of adverse reactions between intratympanic injection and intravenous injection groups (8.33% vs. 10.00%, χ2 = 0.10, P > 0.05). Conclusion:Compared with intravenous drip of prednisolone acetate, intratympanic injection of prednisolone acetate can improve the clinical symptoms of patients with sudden hearing loss and enhance clinical efficacy.

Gadolinium-enhanced MRI reveals dynamic development of endolymphatic hydrops in Ménières disease / Ressonância magnética com gadolínio revela o desenvolvimento dinâmico da hidropsia endolinfática na doença de Ménière

Abstract Introduction: Meniere's disease is associated with impaired hearing, tinnitus, vertigo, and aural fullness. Many anatomical studies have suggested idiopathic endolymphatic hydrops as the pathological basis of Meniere's disease, which now can be visualized by using gadolinium -enhanced magnetic resonance imaging of the inner ear. Objective: To investigate the development of endolymphatic hydrops in Meniere's disease by monitoring the vestibules and cochleae of affected patients. Methods: Inner ears of 178 patients with definite unilateral Meniere's disease diagnosis were visualized by 3-dimensional fluid-attenuated inversion recovery and three-dimensional real inversion recovery magnetic resonance imaging following bilateral gadolinium intratympanic injection. The scans were used to evaluate the presence and degree of endolymphatic hydrops in the vestibules and cochlear structures, including the cochlear apical turn, the cochlear middle turn, and the cochlear basal turn. The correlation of endolymphatic hydrops occurrence between the various parts of the inner ear was determined. Results: Symptomatic endolymphatic hydrops was detected on the affected side in all patients, whereas asymptomatic endolymphatic hydrops was detected on the unaffected contra-lateral side in 32 patients (18.0%). On the affected side, the cochlear apical turn and the cochlear middle turn demonstrated significantly higher rates of endolymphatic hydrops than the cochlear basal turn and the vestibule. The severity of endolymphatic hydrops gradually decreased from the cochlear apical turn to the cochlear basal turn. On the contra lateral side, the incidence and degree of the detected asymptomatic endolymphatic hydrops were significantly greater in the cochleae than in the vestibules (p < 0.05), with no significant difference detected between the cochlear turns. Conclusion: Progression of endolymphatic hydrops appears to be directional, initiated in the cochlea. The order of endolymphatic hydrops severity gradually decreases from the cochlear apical turn to the cochlear basal turn and then to the vestibule. Endolymphatic hydrops in the vestibule is associated with symptomatic Meniere's disease.

Resumo Introdução: A doença de Ménière está associada a deficiência auditiva, zumbido, vertigem e plenitude auricular. Muitos estudos anatômicos sugerem hidropsia endolinfática idiopática como a base patológica da doença, que agora pode ser visualizada através de estudo por imagem da orelha interna por ressonância magnética com gadolínio. Objetivo: Investigar o desenvolvimento da hidropsia endolinfática na doença de Ménière com monitoramento dos vestíbulos e das cócleas dos pacientes afetados. Métodos: Orelhas internas de 178 pacientes com diagnóstico definitivo de doença de Ménière unilateral foram visualizados através de imagem de recuperação de inversão atenuada por fluidos em ressonância magnética tridimensional, 3-D FLAIR, e por inversão real após injeção intratimpânica bilateral de gadolínio. Os exames foram usados para avaliar a presença e o grau de hidropsia endolinfática nos vestíbulos e nas estruturas cocleares, inclusive o giro coclear apical, o giro coclear médio e o giro coclear basal. A correlação da ocorrência de hidropsia endolinfática entre as várias partes da orelha interna foi determinada. Resultados: Hidropsia endolinfática sintomática foi detectada no lado afetado em todos os pacientes, enquanto hidropsia endolinfática assintomática foi detectada no lado contralateral não afetado em 32 pacientes (18,0%). No lado afetado, o giro apical da cóclea e o giro coclear médio demonstraram taxas significativamente mais altas de hidropsia endolinfática do que o giro basal e o vestíbulo. A gravidade da hidropsia endolinfática diminuiu gradualmente do giro apical da cóclea para o giro basal. No lado contralateral, a incidência e o grau da hidropsia endolinfática assintomática detectada foram significantemente maiores nas cócleas do que nos vestíbulos (p < 0,05), sem diferença significante entre os giros cocleares. Conclusões: A progressão da hidropsia endolinfática parece ser direcional, iniciando-se na cóclea. A sua ordem da gravidade diminui gradualmente do giro apical da cóclea para o giro basal e, em seguida, para o vestíbulo. A hidropsia endolinfática no vestíbulo está associada à doença de Ménière sintomática.

The efficacy of intratympanic steroid injection for the treatment of idiopathic sudden sensorineural hearing loss

@#Objective: A systemic steroid is known to have a potential to recover hearing after idiopathic sudden sensorineural hearing loss (ISSHL). However, lately many centres have introduced the use of intratympanic (IT) steroid therapy as an option. We reviewed our experience in the treatment of patients with ISSHL looking at the overall success of using systemic steroid, IT steroid injections as salvage therapy and primary IT steroid injection. Methods: A retrospective study was conducted on 20 patients who had suffered from ISSHL from January 1, 2012, to December 31, 2017. ISSHL is defined as a rapid decline in hearing over three days or less affecting three or more frequencies by 30dB or greater. Comparison between the mode of steroid therapies and improvement in patients was done. At least 15dB improvement in pure tone audiogram (PTA) was considered as successful therapeutic intervention. Results: Twenty male and female patients who fit the inclusion and exclusion criteria were included. The mean age of the patients was 41.4 years with a range from 13 to 72 years. Ninety percent patients presented with unilateral ISSHL involvement. Eight ears of patients who received systemic steroid therapy alone had improved hearings (75%). Out of seven ears from six patients who received salvage therapy, four ears (57.1 %) had improvement in PTA. Seven ears showed improvement in PTA from a total of eight patients who primarily received IT injections. Conclusions: IT steroid therapy promises a favourable outcome in the improvement of the hearing, as compared to systemic steroid administration. Its usage is recommended not only for salvage therapy but should be used as primary treatment especially in those with co- morbiditie

Effect of tympanic dexamethasone injection in the treatment of different types of sudden deafness / 临床耳鼻咽喉头颈外科杂志

Objective@#The aim of this study is to explore the best administration, timing and efficacy of dexamethasone and Mison in the treatment of different types of sudden deafness. @*Method@#242 cases of sudden deafness first diagnosed in our department were selected. According to the guidelines（2015）, the patients were divided into low frequency descending type （49 cases）, high frequency descending type （66 cases）, flat descending type （71 cases） and total deafness （56 cases）. Different types of patients were randomly divided into tympanic injection group and systemic administration group on the basis of routine treatment. Tympanic injection group was further divided into initial injection group and delayed injection group. Tympanic injection was performed under ear endoscope, once every other day, three times for low frequency descending deafness, and five times for other types of deafness. @*Result@#In comparison of total effective rate, there were significant differences among the three treatments in 49 cases of low frequency descending type, 71 cases of flat descending type and 56 cases of total deafness type （P<0.05）. In 66 cases of high frequency descending type, there was no significant difference among the three treatments （P>0.05）. In the comparison of cure rate, the difference of cure rate among the three treatment methods was also significant in low frequency descending type （P<0.05）. In the other three types of deafness, there was no significant difference among the three treatment methods （P>0.05）. There was no significant difference in the effective rate between men and women （P>0.05） in all patients treated by tympanic injection. There was significant difference in the effective rate of tympanic injection within 7 days of onset and 7 days after onset （P<0.05）. @*Conclusion@#Intratympanic injection of dexamethasone is safe, effective, and easy to use as an initial treatment for low frequency descent, flat, and full deafness, and the sooner the better.

Effect of tympanic dexamethasone injection in the treatment of different types of sudden deafness / 临床耳鼻咽喉头颈外科杂志

The aim of this study is to explore the best administration, timing and efficacy of dexamethasone and Mison in the treatment of different types of sudden deafness. 242 cases of sudden deafness first diagnosed in our department were selected. According to the guidelines（2015）, the patients were divided into low frequency descending type （49 cases）, high frequency descending type （66 cases）, flat descending type （71 cases） and total deafness （56 cases）. Different types of patients were randomly divided into tympanic injection group and systemic administration group on the basis of routine treatment. Tympanic injection group was further divided into initial injection group and delayed injection group. Tympanic injection was performed under ear endoscope, once every other day, three times for low frequency descending deafness, and five times for other types of deafness. In comparison of total effective rate, there were significant differences among the three treatments in 49 cases of low frequency descending type, 71 cases of flat descending type and 56 cases of total deafness type （0.05）. In the comparison of cure rate, the difference of cure rate among the three treatment methods was also significant in low frequency descending type （0.05）. There was no significant difference in the effective rate between men and women （>0.05） in all patients treated by tympanic injection. There was significant difference in the effective rate of tympanic injection within 7 days of onset and 7 days after onset （<0.05）. Intratympanic injection of dexamethasone is safe, effective, and easy to use as an initial treatment for low frequency descent, flat, and full deafness, and the sooner the better.

Sudden Sensorineural Hearing Loss: Comparative Study of Different Treatment Modalities

Abstract Introduction Idiopathic sudden sensorineural hearing loss (ISSNHL) is hearing loss of at least 30 dB in at least 3 contiguous frequencies within at least 72 hours. There are many different theories to explain it, and many differentmodalities are used for its management, such as: systemic steroids (SSs), intratympanic steroid injection (ITSI), hyperbaric oxygen therapy (HOT), antiviral drugs, and vasodilators or vasoactive substances. Objectives This study aims to evaluate the efficacy of the combination of the most common treatmentmodalities of ISSNHL and to compare the results if HOTwas not one of the treatment modalities administered. Methods The study was conducted with 22 ISSNHL patients with ages ranging from 34 to 58 years. The patients were divided into 2 groups; group A included 11 patients managed by SSs, ITSI, antiviral therapy, and HOT simultaneously, and group B included 11 patients exposed to the aforementioned modalities, with the exception of HOT. Results After one month, all of the patients in group A showed total improvement in hearing in all frequencies, with pure tone average (PTA) of 18.1 ± 2.2, while in group B, 5/11 (45.5%) patients showed total improvement, and 6 /11 (54.5%) patients showed partial improvement, with a total mean PTA of 28.1 ± 8.7. Conclusion The early administration of HOT in combination with other clinically approved modalities (SSs, ITSI, antiviral therapy) provides better results than the administration of the same modalities, with the exception of HOT, in the treatment of ISSNHL.

The Effects of Experimental Intratympanic Steroid Administration on Organ of Corti Type 1 Spiral Ganglion

Abstract Introduction It is unclear how effective is the intratympanic (IT) steroid treatment on organ of Corti type 1 spiral ganglion, its optimal dosage and frequency of administration. The effect of dexamethasone on cochlear functions in individuals with a normal hearing ability is also unknown. Objective The aim of this study was to evaluate, at the electrophysiological and ultrastructural levels, the effect of IT dexamethasone administration in guinea pigs with normal hearing on organ of Corti type 1 spiral ganglion. Methods A total of 20 guinea pigs (n = 40 ears) whose hearing was detected to be normal by electrophysiological tests were included in the study and randomly divided into 6 groups. Four groups were considered study groups, while 2 groups were considered control groups. Dexamethasone was administered intratympanically in doses of 2 mg/mL and 4 mg/mL in the guinea pigs in the study groups. The animals in the control groups received physiological saline in equal doses as the study groups. All interventions were performed under general anesthesia, and the electrophysiological tests were repeated following the IT injections. Results No statistically significant differences were found among the groups when the IT injections were evaluated in terms of the electrophysiological measurements (p > 0.05). The ultrastructural evaluation showed a cellular mitochondrial increase in the spiral ganglions of the cochlea in the groups in which dexamethasone was administered in a dose of 4 mg/mL. Conclusion According to the findings of this study, it can be suggested that the IT injection of dexamethasone is safe, and when applied in a dose of 4mg/mL, it increases metabolic activity at the cellular level.

Intratympanic Gentamicin for Intractable Ménière's Disease - A Review and Analysis of Audiovestibular Impact

Abstract Introduction Intratympanic gentamicin regulates the symptoms in most patients with incapacitating Ménière's disease. The treatment protocols have changed over the years from medical labyrinthectomy to preservation of vestibular function. Objectives This study aims to review the audiovestibular response related to the effect of the drug in controlling vertigo. Data Synthesis Articles were identified by means of a search in the PubMed database using the key words Meniere and intratympanic or transtympanic gentamicin. Total 144 articles were reviewed after excluding those that were technical reports, those based on experimental animal studies, those that focused on outcomes other than vertigo (tinnitus or aural fullness), those with delivery methods other than tympanic membrane injection, and those with bilateral cases. If there was more than one article by the same author(s) or institution, only the most recent one matching the aforementioned criteria and those that were not overlapping were included. Conclusion Titration methods or multiple injections on a daily basis can be preferred if the patients have profound or non-serviceable hearing, since these methods have significant incidence of hearing loss. Treatment protocols with a frequency of injection not shorter than once a week, or those with injections on a monthly basis as "needed" provide the same level of vertigo control with better preservation of hearing. Caloric testing is not an ideal tool to analyze the correlation between vertigo control and the effect of gentamicin as compared with gain asymmetry of the vestibulo-ocular reflex. Vestibular-evoked myogenic potentials and the head thrust test are more reliable than other vestibular tests for the follow-up of patients undergoing gentamicin treatment.

Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss / Injeção intratimpânica de corticoides e oxigenoterapia hiperbárica para o tratamento da perda auditiva súbita refratária

Abstract Introduction Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. Objective We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. Methods Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20 dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4 mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120 min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. Results The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p = 0.364 and p = 0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. Conclusion ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss.

Resumo Introdução Há muita controvérsia sobre o uso de terapias de resgate para tratar a perda auditiva neurossensorial súbita (PANSS), sem consenso sobre as recomendações. Embora vários estudos tenham demonstrado a eficácia do uso de corticoides intratimpânicos (CIT) e o tratamento com oxigenoterapia hiperbárica (HBO), poucos têm comparado a eficácia da terapia ITS e HBO em pacientes com PANSS refratária. Objetivo Avaliamos a eficiência da terapia com CIT e HBO em pacientes com PANSS refratária. Método Pacientes que não se beneficiaram adequadamente do tratamento sistêmico foram avaliados retrospectivamente. Pacientes refratários foram definidos como aqueles que ganharam menos de 20 dB na audição após o tratamento inicial. Todos os pacientes refratários foram informados sobre as opções de terapia de resgate: terapia com CIT ou HBO, cujas vantagens e desvantagens foram explicadas brevemente. O CIT envolveu 4 mg/mL de dexametasona administrada através de uma agulha de calibre 25. Os pacientes foram submetidos à terapia HBO em uma câmara hiperbárica onde respiraram 100% de oxigênio por 120 min a 2,5 pressão atmosférica. Os níveis de audição de ambos os grupos foram avaliados antes da terapia de resgate e três meses após o tratamento. As melhorias na audição foram avaliadas de acordo com os critérios de Furahashi. Também comparamos as duas terapias em termos de Escores de Discriminação de Fala (EDF) e a recuperação de todas as frequências. Resultados As terapias de resgate demonstraram resultados semelhantes. As alterações nas médias de tons puros e nas EDF foram semelhantes para a terapia com CIT e HBO (p = 0,364 e p = 0,113). A comparação dos EDF e dos limiares de audição em todas as frequências mostrou níveis de melhoria semelhantes. Conclusão CIT e HBO produziram melhorias semelhantes nos pacientes com PANSS, mas o tamanho da amostra era muito pequeno para tirarmos conclusões definitivas. Estudos randomizados e controlados adicionais são necessários para identificar a melhor terapia para pacientes com perda auditiva repentina refratária.

La importancia del comienzo temprano del tratamiento con corticoide intratimpánico en hipoacusia súbita / The importance of early treatment with intratympanic corticoid for sudden hypoacusia / A importância do começo temporão do tratamento com corticoide intratimpánico em hipoacusia subita

INTRODUCCIÓN: La hipoacusia neurosensorial súbita idiopática se define como la pérdida de audición súbita, de más de 30 dB, en por lo menos 3 frecuencias contiguas de la audiometría tonal, que ocurre dentro de los 3 días de inicio del síntoma, en un paciente sin antecedentes otológicos previos. OBJETIVOS: Evaluar la relación entre el comienzo temprano del tratamiento con corticoide intratimpánico y el grado de recuperación auditiva. MATERIAL Y MÉTODO: Es un estudio observacional, descriptivo y retrospectivo. A través de una revisión de historias clínicas se recolectaron pacientes con diagnóstico de hipoacusia neurosensorial súbita, valorados entre 2016 y 2017. El protocolo terapéutico utilizado fue la inyección de corticoide intratimpánico bajo visión microscópica, del oído afectado. Este procedimiento se realizó una vez por semana, durante 4 semanas. Se solicitó un control audiométrico una vez finalizado el tratamiento para evaluar el grado de recuperación auditiva...

INTRODUCTION: Sudden sensorineural hearing loss surdez neurosensorial subita is defined as a sudden loss of hearing, of more than 30dB, in at least three adjacent frequencies of the tone audiometry, which occurs within the three days after the symptom onset, in patients without previous otologic background. OBJECTIVE: Analyze the relationship between the early beginning of treatment with intratympanic corticoid and the degree of hearing recovery. MATERIAL AND METHOD: This is an observational, descriptive and retrospective study. Medical records of patients with sudden sensorineural hearing loss diagnosis between 2016 and 2017 were gathered. The therapeutic protocol used was injection of intratympanic corticoid in the affected ear under microscopic vision. This procedure was carried out once a week, for 4 weeks. An audiometric control was done after finishing treatment in order to assess the hearing recovery degree…

INTRODUÇÃO: A surdez neurosensorial subita idiopatica define-se como a perda de audição subita, a mais de 30dB, em pelo menos 3 frequências contíguas da audiometria tonal, que ocorre dentro dos 3 dias de início do sintoma, num paciente sem antecedentes otológicos prévios. OBJETIVOS: Avaliar a relação entre o começo temporão do tratamento com corticoide intratimpánico e o grau de recuperação auditiva. MATERIAL E MÉTODO: É um estudo observacional, descritivo e retrospectivo. Através de uma revisão de histórias clínicas colectaram-se pacientes com diagnóstico de hipoacusia neurosensorial súbita, avaliados entre 2016 e 2017. O protocolo terapêutico utilizado foi a injeção de corticoide intratimpánico baixo visão microscópica, do ouvido afectado. Este procedimento realizou-se uma vez por semana, durante 4 semanas. Solicitou-se um controle audiométrico uma vez finalizado o tratamento para avaliar o grau de recuperação auditiva...

Comparison of the Effect of Intratympanic Steroid Injection Medications in Patients with Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study is aimed to investigate the efficacy of dexamethasone and methylprednisolone when used for Intratympanic steroid injection (ITSI) concurrent with systemic steroid as primary therapy. SUBJECTS AND METHOD: We undertook a retrospective study of 106 patients diagnosed with Idiopathic Sudden Sensorineural Hearing Loss at our institution. These patients were divided into the following groups based on their intratympanic steroid medications: Group 1 (which received dexamethasone for ITSI) and Group 2 (which received methylprednisolone for ITSI). The severity of pain after ITSI was also compared using Visual Analogue Scale. RESULTS: The therapeutic results of both groups showed no significant difference. The improvement of pure tone audiometry average threshold were 18.3±19.5 dB for Group 1 and 22.4±25.8 dB for Group 2, with no significant differences (p=0.402). The recovery rate according to Siegel's criteria were 34/70 (48.6%) and 18/36 (50.0%) respectively, with no significant differences (p=0.889). The degree of pain after ITSI were 1.51±1.06 and 3.92±1.63 for Group 1 and 2, respectively, showing significant differences (p<0.001). Again, there were no significant differences even when accompanying symptoms or severity of initial hearing loss were considered. CONCLUSION: There was no significant difference between efficacy of dexamethasone and methylprednisolone when used as primary therapy. Methylprednisolne caused more severe pain after ITSI, suggesting the choice of dexamethasone. Further studies are needed about the concentration of injected steroid.

Analysis of clinical effects of intratympanic injection of dexamethasone in treatment of sudden deafness in different time windows / 中国基层医药

Objective To investigate the clinical effect of intratympanic injection of dexamethasone in treatment of sudden deafness in different time windows.Methods 60 patients (60 ears) with sudden deafness were selected.Sixty patients were divided into control group and observation group according to the random number table method,30 cases (30 ears) in the control group and 30 cases (30 ears) in the observation group.The two groups were given systemic basic therapy, intravenous vinpocetine, alprostadil improve microcirculation, while hyperbaric oxygen therapy,12 days for a course of treatment, treatment for 2 courses.In the control group, dexamethasone was intravenously administered for 12 days.From the 7th day, dexamethasone was injected into the tympanic cavity and injected once every other day.The observation group was treated with dexamethasone at the same time.Injection of dexamethasone, treatment method and time were the same as the control group.At the end of the treatment, the clinical curative effect of the two groups was compared.The average hearing thresholds of the two groups were observed before and after treatment.The dizziness, tinnitus and hearing recovery time of the two groups were observed.Results The total effective rate was 96.67% in the observation group and 93.33% in the control group, the difference was not statistically significant (x2 =0.97,P> 0.05).After treatment, the average hearing threshold of the two groups was significantly improved (t=7.69,8.23,all P<0.05),the average hearing threshold of the observation group was higher than that of the control group, the average hearing threshold before and after treatment had statistically significant differences (t=2.34,2.67,all P<0.05).In the observation group, dizziness, tinnitus and hearing recovery time were shorter than those in the control group (t=3.32,3.14,3.67,all P<0.05).Conclusion The effect of dexamethasone combined with systemic treatment of sudden deafness in patients compared with intratympanic injection of dexamethasone after intravenous administration of dexamethasone is not significantly different, but the improvement of hearing threshold after treatment compared with the latter is obvious, and the average time to disappear symptoms is shorter than the latter, and therefore worthy of clinical promotion.

Refractory episodic vertigo: role of intratympanic gentamicin and vestibular evoked myogenic potentials / Vertigem refratária episódica: papel da gentamicina intratimpânica e potencial evocado miogênico vestibular

Abstract Introduction: Even today, the treatment of intractable vertigo remains a challenge. Vestibular ablation with intratympanic gentamicin stands as a good alternative in the management of refractory vertigo patients. Objective: To control intractable vertigo through complete saccular and horizontal canal vestibular ablation with intratympanic gentamicin treatment. Methods: Patients with refractory episodic vertigo were included. The inclusion criteria were: unilateral ear disease, moderate to profound sensorineural hearing loss, and failure to other treatments. Included patients underwent 0.5-0.8 mL of gentamicin intratympanic application at a 30 mg/mL concentration. Vestibular ablation was confirmed by the absence of response on cervical vestibular evoked myogenic potentials and no response on caloric tests. Audiometry, electronystagmography with iced water, and vestibular evoked myogenic potentials were performed in all patients. Results: Ten patients were included; nine patients with Meniere's disease and one patient with (late onset) delayed hydrops. Nine patients showed an absent response on vestibular evoked myogenic potentials and no response on caloric tests. The only patient with low amplitude on cervical vestibular evoked myogenic potentials had vertigo recurrence. Vertigo control was achieved in 90% of the patients. One patient developed hearing loss >30 dB. Conclusions: Cervical vestibular evoked myogenic potentials confirmed vestibular ablation in patients treated with intratympanic gentamicin. High-grade vertigo control was due to complete saccular and horizontal canal ablation (no response to iced water in electronystagmography and no response on cervical vestibular evoked myogenic potentials).

Resumo Introdução: Ainda hoje, o controle da vertigem intratável permanece um desafio. A ablação vestibular com gentamicina intratimpânica permanece como uma boa alternativa no tratamento de pacientes com vertigem refratária. Objetivo: Controlar a vertigem intratável por meio de ablação vestibular completa dos canais sacular e horizontal com gentamicina intratimpânica como tratamento. Método: Pacientes com vertigem refratária episódica foram incluídos. Os critérios de inclusão foram doença unilateral da orelha, perda auditiva neurossensorial de moderada a profunda e fracasso com outros tratamentos. Os pacientes incluídos receberam uma aplicação de 0,5-0,8 mL de gentamicina intratimpânica com concentração de 30 mg/mL. A ablação vestibular foi confirmada pela ausência de resposta no teste de potencial evocado miogênico vestibular cervical (PEMVc) e nenhuma resposta nas provas calóricas. Audiometria, eletronistagmografia com água gelada e potencial evocado miogênico vestibular foram realizados em todos os pacientes. Resultados: Ao todo, dez pacientes foram incluídos: nove com doença de Ménière e um com hidropisia tardia. Nove pacientes apresentaram ausência de resposta no teste de potencial evocado miogênico vestibular e nenhuma resposta na prova calórica. O único paciente com baixa amplitude no PEMVc apresentou recorrência da vertigem. O controle da vertigem foi obtido em 90% dos pacientes. Um paciente desenvolveu perda auditiva > 30 dB. Conclusões: O PEMVc confirmou ablação vestibular nos pacientes tratados com gentamicina intratimpânica. O alto grau de controle da vertigem foi devido à ablação completa do sáculo e canal horizontal (sem resposta à água gelada na eletronistagmografia e ausência de resposta no PEMVc).

Intratympanic Steroid Injection in Tinnitus Management / 한양의대학술지

Intratympanic (IT) steroid injection has been used increasingly in various inner ear diseases instead of systemic steroid, because of the higher concentration of the drug into the target organ and the lower risk of the systemic side effect. Although there were several trials applying IT steroid injection on tinnitus, most of them failed to demonstrate its therapeutic effect more than controls. However, a study has shown a meaningful outcome when the therapeutic target is limited to acute tinnitus developed within 3 months. Although IT steroid injection treatment in tinnitus requires more evidence, when the therapeutic target is limited to the acute phase, IT steroid injection could be a treatment option for tinnitus. Early intervention, asymmetric hearing loss and unilateral tinnitus seem to be favorable factors for outcome of IT steroid injection.

Efifcacy of early combination treatment with intratympanic glucocorticoid injection for sudden hearing loss / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo investigate the therapeutic effect of early combination treatment with intratympanic glucocorticoid injection for sudden sensorineural hearing loss(SSNHL).METHODSTotal of 178 patients with diagnosis of SSNHL, including 44 with hearing loss at middle-low frequencies,50 at high frequencies,44 at all frequencies and 40 at total deafness, were randomly divided into combination treatment group (CT group) and systemic oral prednisone group (OP group).CT group (82 patients) received intratympanic administration of methylprednisolone and oral prednisone in tapering doses. Pure-tone threshold audiometry (PTA) was performed at week 8 after beginning of therapy. RESULTSIn middle-low frequencies, the final PTA and PTA improvement were 26.14±24.82 dB and 42.23±1.61 dB in CT group respectively, and were 37.91±13.98 dB and 30.00±13.30 dB in OP group respectively (both P<0.05). In high frequencies, all frequencies and total deafness SSNHL group, the differences of the final PTA and PTA improvement were not statistically significant in both groups. The PTA improvement in CT group for total deafness (26.52±14.03) dB was more than that of OP group (22.06±11.17)dB (t=2.361,P<0.05). In middle-low frequencies, the recovery rate was 72.73%(16 cases) in CT group, and 40.91% (9 cases) in OP group, the difference was significant (χ2=4.539,P<0.05), but not in apparent effective rate, effective rate and total effective rate. In high frequencies, all frequencies and total deafness, there were no significant differences in therapeutic effect. The recovery rate of total CT group (40.24%) was significantly increased compared with that of OP group (26.04%)(χ2=4.061,P<0.05), the differences of apparent effective rate, effective rate and total effective rate were not statistically significant in both groups.CONCLUSIONFor low-middle frequencies SSNHL, the early combination treatment with intratympanic glucocorticoid injection leads to higher hearing recovery and therapeutic effect compared with traditional oral prednisone. Systemic application should be applied for high frequencies, all frequencies and total deafness of SSNHL.

The Effectiveness of Intratympanic Steroid Therapy and Systemic Steroid Therapy on the treatment of Idiopathic Sudden Sensorineural Hearing Loss Patients with Damaged Glucose Tolerance / 听力学及言语疾病杂志

Objective To evaluate the efficacy of intratympanic steroid therapy compared with systemic ster‐oid therapy on the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) patients with damaged glu‐cose tolerance .Methods Fifty first -diagnosed unilateral ISSNHL patients with damaged glucose tolerance were randomized devided equally to the intervention group (intratympanic steroid therapy) or the control group (systemic steroid therapy) ,all patients received conventional drug therapy simultaneously .Pure-tone hearing threshold tests were performed in all patients every 3 days after the first time ,and repeated measures anova was used to assess effects of hearing recovery accompanied with time .Results The mean hearing threshold in the control group de‐creased from 85 .4 ± 5 .6 dB to 48 .2 ± 4 .9 dB ,while in the intervention group it decreased from 84 .8 ± 5 .6 dB to 31 .7 ± 4 .6 dB .Total effective rate in the intervention group (84 .00% ,21/95) was higher than that in the control group (68 .00% ,17/25)(P<0 .05) .Conclusion The intratympanic steroid therapy is more effective than systemic steroid therapy in the treatment of ISSNHL patients with damaged glucose tolerance .

Efficacy of Intratympanic Methylprednisolone Perfusion for the Treatment of Sudden Sensorineural Hearing Loss / 听力学及言语疾病杂志

Objective To investigate the efficacy of intratympanic methylprednisolone perfusion (IMP) for the treatment of sudden sensorineural hearing loss (SSNHL ) which failed to be fully responsive to conventional treatment .Methods The hearing outcomes of 87 patients with unilateral SSNHL were retrospectively analyzed .All of the patients received IMP after not fully responsive to conventional treatment of varying periods of time .They were hospitalized in our department between January 2008 and December 2012 and were followed up for at least one year to exclude recurrent hearing loss .Results The effective rate was 66 .67% and the mean PTA improvement was (18 .53 ± 13 .54)dB of the patients with the time interval between onset of symptoms and IMP within 15 days , 21 .21% and (5 .92 ± 15 .18)dB of the patients with the interval between 16 and 30 days ,4 .76% and (3 .69 ± 7 .00) dB of the patients with the interval more than 30 days respectively .The significant difference in the effective rates were compared among the three groups(χ2 =25 .91 ,P<0 .01) .Regarding to the PTA improvement ,the group with interval within 15 days was better than the other two groups(F=11 .182 ,P<0 .01) .A total of 30 cases acquired more than 15 dB hearing gain after IMP .One of them was hearing loss in low frequencies and the other 29 cases were hearing loss at all frequencies .The mean hearing gains of the 29 cases in 0 .25 kHz ,0 .5 kHz ,1 kHz ,2 kHz , 4 kHz and 8 kHz were 35 .17 ± 18 .15 dB ,35 .38 ± 15 .90 dB ,31 .28 ± 19 .74 dB ,21 .31 ± 17 .34 dB ,14 .97 ± 16 .00 dB and 13 .80 ± 16 .35 dB ,respectively .The mean hearing gains at lower three frequencies (0 .25~1 kHz)were better than those at higher three frequencies (2 k~8 kHz)(F=9 .494 ,P<0 .01) .Conclusion Receiving IMP earlier might help to acquire better hearing gain for the patients with SSNHL after not fully responsive to conventional treat‐ments .The hearing gains at the lower frequencies were better than those at the higher frequencies after IMP .

The AppIication of EndoIymphatic Space Imaging in the Diagnosis of DeIayed EndoIymphatic Hydrops / 听力学及言语疾病杂志

Objective To investigate the pathological mechanism of delayed endolymphatic hydrops(DEH) , and clarify the clinical value of endolymphatic space imaging after intratympanic injection of gadolinium in the diag_nosis of delayed endolymphatic hydrops .Methods Twenty -four hours after bilateral intratympanic injection of gadolinium ,the locations and severity of endolymphatic hydrops of all patients were evaluated by using three dimen_sional fluid-attenuated inversion recovery (3D -FLAIR) and three dimensional real inversionrecovery (3D -real IR) .ResuIts All patients had unilateral or bilateral endolymphatic hydrops .Among 9 ipsilateral DEH patients , only 1 (11 .1% ) patient was identified as mild endolymphatic hydrops and the rest (88 .9% ) examined had signifi_cant endolymphatic hydrops in vestibule of their affected ears ;Endolymphatic hydrops appeared in cochlea of the af_fected ear in 8 (88 .9% ) patients ,except for 1 patient .Endolymphatic hydrops were not observed in the contralater_al ears of 9 ipsilateral DEH patients .Mild endolymphatic hydrops in bilateral vestibule ,severe in right cochlear and none in left cochlea of contralateral DEH patient were identified .ConcIusion Endolymphatic hydrops is the primary pathological factors of DEH .Endolymphatic space imaging after intratympanic injection of gadolinium can intuitively reflect the locations and severity of endolymphatic hydrops in DEH patients .

Is Intratympanic Dexamathasone Injection Effective for the Treatment of Idiopathic Sudden Sensorineural Hearing Loss?

BACKGROUND AND OBJECTIVES: The purpose of this study is to identify the effectiveness of intratympanic (IT) steroids when used as an initial therapy in sudden sensorineural hearing loss (SSNHL), and when it is used as a salvage therapy in a refractory SSNHL. SUBJECTS AND METHODS: This retrospective study included 122 patients with SSNHL. First, patients were divided into three groups according to the initial treatment; IT steroid, systemic steroid and combined (systemic and IT steroid) groups. Second, patients were divided into two groups according to the salvage treatment in a refractory SSNHL; IT steroid and the control (non IT group). Fifty eight patients who did not respond to initial therapy were included in the second analysis. Hearing was assessed immediately before the treatment and 2 weeks, 4 weeks and 3 months after the treatments. Hearing recovery was defined as an improvement of >15 dB and the final hearing of 25-45 dB in the audiogram. RESULTS: When we analyzed the hearing recovery in initial treatment, the comparison of audiogram among three groups did not result in significantly different outcomes. There were no differences in the recovery rate in 2 and 4 weeks throughout all the frequencies. Also, the analysis of the salvage treatment demonstrated that neither IT steroid group nor control group was significantly effective in treating the refractory SSNHL. CONCLUSIONS: The results suggest that initial treatment of SSNHL with IT steroid alone is as effective as systemic steroid alone or a combination therapy. Also, salvage IT steroids for refractory SSNHL did not have any additional beneficial effects.