Effects of an intratympanic injection of dexamethasone combined with gentamicin on the expression level of serum p0 protein antibodies in patients with meniere's disease

OBJECTIVES: To investigate the effects of an intratympanic injection of dexamethasone combined with gentamicin on the expression level of serum P0 protein antibodies in patients with Meniere's disease (MD). METHODS: A total of 136 patients with MD treated in our hospital were enrolled in this study. Among them, 68 patients were treated with an intratympanic injection of dexamethasone combined with gentamicin (observation group). Another 68 patients were treated with gentamicin alone (control group). RESULTS: After treatment, the expression levels of IgG and IgM in the two groups significantly decreased (p<0.05); the levels in the observation group were significantly lower than those in the control group (p<0.05). The incidences of vertigo, tinnitus, and gait instability in the observation group were significantly lower than those in the control group (p<0.05). Vestibular symptom index (VSI) scores in the observation group were significantly lower than those in the control group (p<0.05). We observed no significant difference between the two groups in the number of vertigo attacks 6 months after treatment (p>0.05). CONCLUSION: For patients with MD, dexamethasone combined with gentamicin can reduce the incidence of vertigo, tinnitus, and gait instability, but it has no effect on the efficacy or number of vertigo attacks 6 months after treatment. Therefore, the levels of myelin P0 protein antibodies after treatment can be used as predictors of vertigo at 6 months after treatment.

Comparison of Intratympanic, Systemic, and Combined Steroid Therapies for Sudden Sensorineural Hearing Loss in Patients with Diabetes Mellitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We investigated whether the intratympanic steroid injections might be an effective initial treatment for sudden sensorineural hearing loss (SSNHL) in patients with diabetes mellitus (DM). SUBJECTS AND METHOD: We assessed a total of 167 patients with DM and SSNHL who visited a tertiary referral otolaryngology department between January 2010 and April 2018. Forty-two patients with DM and SSNHL received intratympanic steroid injections; 48 patients with DM and SSNHL received systemic steroid treatment; and 77 patients with DM and SSNHL received a combination of systemic and intratympanic treatment. Initial and post treatment hearing levels and fasting blood sugar (FBS) were assessed, and correlations between hearing gain and the duration of DM, HbA1c, FBS were investigated. RESULTS: After steroid treatment, hearing levels were 38.87±25.35 dB in the intratympanic injection group, 41.09±28.49 dB in the systemic steroid treatment group, and 47.81±27.12 dB in the combined treatment group. Final hearing levels and hearing gain in the three groups did not differ significantly. FBS after treatment in the systemic steroid treatment and combined steroid treatment group worsened relative to the intratympanic injection group (202.00±9.40 mg/dL to 326.63±7.85 mg/dL). FBS, duration of DM, and HbA1c levels did not affect the hearing gain in patients with DM and SSNHL. CONCLUSION: Intratympanic steroid injections are comparable to the systemic steroid treatment modality for SSNHL in patients with DM. Thus, intratympanic steroid injections may serve as an effective initial treatment modality for SSNHL in patients with DM.

Tratamento clínico de zumbido primário em adultos e idosos: revisão sistemática / Clinical treatment of primary tinnitus in adults and in the elderly: systematic review

O zumbido no ouvido é definido como uma ilusão auditiva ou sensação sonora endógena, não relacionada a nenhuma fonte externa de estimulação. É um sintoma frequente na população idosa. Até hoje, vários autores argumentam que o desconhecimento da etiologia do zumbido, aliado à subjetividade desta manifestação, mais a sobreposição das enfermidades e dos sintomas que, geralmente, acometem os pacientes idosos, dificultam a obtenção de um bom resultado terapêutico. O objetivo desta revisão foi levantar quais os tratamentos clínicos mais utilizados na prática clínica no tratamento do zumbido primário em adultos e idosos. Procedeu-se à verificação do status dos últimos 5 anos de estudos em textos de acesso livre, no banco de dados eletrônicos da PubMed. Apresentaram tratamentos clínicos para o zumbido primário 25 artigos; aqueles com resultados satisfatórios foram quatro artigos sobre acupuntura, dois sobre neuromodulação de resenha coordenada acústica, um sobre uso combinado de amplificação e gerador de som, e um sobre psicoterapia corporal, que incluíam tanto adultos e idosos, tendo a idade média entre 51 a 54 anos. Não se pode afirmar que os tratamentos propostos são eficazes na cura dos sintomas de zumbido em adultos e idosos, mas sim que existem algumas terapêuticas de baixo custo que apresentam respostas relativamente satisfatórias. (AU)

Tinnitus is defined as a hearing illusion or endogenous auditory sensation that is not related to any external stimulation source. It is a frequent symptom among elderly people. To date, many authors have argued that the lack of knowledge about the tinnitus etiology, added to the subjectivity of this manifestation, and the overlap of other diseases and symptoms that often occur with aged patients make the obtainment of a good therapeutic result difficult. The objective of this review was to find the most used clinical treatment in clinical practice for primary tinnitus on adults and elderly. The status of the last five years of studies in free full texts on PubMed database was checked. Twenty-five articles showed clinical treatment for primary tinnitus, with four articles about acupuncture, two about acoustic coordinate reset neuromodulation, one about sound generator associated with conventional amplification, and one about body-psychotherapy which included adults and elderly with an average age between 51 to 54 years old showing satisfactory results. It is difficult to state that the proposed treatment is efficient on healing the tinnitus symptoms on adults and elderly but there are some low-cost therapies showing relatively satisfactory responses. (AU)

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.

Série de casos: avaliação clínica, audiométrica e eletrococleográfica no tratamento da Doença de Ménière com injeção de corticóide intratimpânico associado à betaistina / Case series: clinical, audiometric and electrocochleographic evaluation in the treatment of Ménière's Disease with intratympanic corticosteroid injection associated with betahistine

RESUMO Introdução: A doença de Ménière é uma vestibulopatia frequente e manifestase geralmente após a 4ª década de vida. O diagnóstico é clínico e caracterizase por vertigem, perda auditiva neurossensorial, zumbido e plenitude aural. O tratamento consiste em dieta hipossódica e aumento da ingesta hídrica, além da terapia medicamentosa que pode incluir Betaistina, diuréticos, vasodilatadores e Ginko Biloba. Nos casos refratários ao tratamento tem-se a opção da abordagem cirúrgica, das injeções intratimpânicas de corticoide e de gentamicina, da ablação do nervo vestibular ou da descompressão do saco endolinfático. Objetivos: Avaliar os aspectos clínicos, audiométricos e eletrococleográficos antes e após o tratamento dos pacientes com Doença de Ménière tratados com corticoide intratimpânico e Betaistina. Métodos: Estudo observacional descritivo de relatos de casos, cujos dados foram obtidos a partir dos prontuários dos pacientes com Doença de Ménière no período de dezembro de 2017 a maio de 2018. Todos os pacientes tinham diagnóstico definido da Doença de Ménière segundo critérios da Bárány Society. Resultados: Dos 6 pacientes avaliados, 3 relataram melhora da vertigem, 2 referiram não haver mudanças e 1 referiu piora da vertigem após a aplicação do corticoide intratimpânico associado à Betaistina. Em relação ao zumbido, 3 pacientes referiram melhora, e 3 pacientes referiram não haver mudanças do zumbido após o tratamento. Já em relação à plenitude aural, 4 pacientes relataram melhora, 1 referiu que não houve alteração, e 1 relatou piora da plenitude aural. Em relação à audição, 2 apresentaram melhora de 10 dB, 3 pacientes não apresentaram mudanças na audiometria e 1 paciente apresentou piora de 15-30 dB de 250 a 2000 hz e melhora de 10 dB em 4000 hz após a injeção de corticoide intratimpânico associado a Betaistina. Em relação à eletrococleografia, 3 apresentaram melhora nos parâmetros eletrococleográficos, ou seja, diminuição dos valores da relação SP/AP após a aplicação de corticoide intratimpânico associado à Betaistina, 1 paciente apresentou aumento da relação SP/AP no ouvido submetido à aplicação de corticoide intratimpânico, e 2 apresentaram aumento do parâmetro no ouvido contralateral à aplicação. Conclusão: Verificou-se melhora, em parte dos pacientes, em relação aos parâmetros clínicos, audiométricos e eletrococleográficos nos pacientes com Doença de Ménière tratados com corticoide intratimpânico associado à Betaistina. Palavras-chave: Doença de Menière, Injeção intratimpânica, Audiometria.

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.

The Efficacy of Adjuvant Intratympanic Steroid Treatment for Otitis Media with Effusion in Children

Abstract Introduction Otitis media with effusion (OME) is a leading cause of hearing impairment in children. Therefore, early and proper management is essential. Objectives The objective of this research is to assess the efficacy of intratympanic (IT) steroids injection for management of otitis media with effusion (OME). Methods This study involved 42 children (84 ears) with bilateral OME. We used tympanometry to confirm the childreń s middle ear effusion and pure tone audiometry to determine hearing threshold. We performed myringotomy and inserted ventilation tubes (VTs) bilaterally, followed by a steroid injection of 0.4-0.6mLmethylprednisolone (40 mg/mL) into one randomly selected middle ear. This procedure was followed by once-weekly administration of steroids (0.5 mL methylprednisolone at a concentration of 40 mg/mL) into the middle ear for three consecutive weeks. Results We found recurrent OME after VT alone in nine (21.4%) ears; whereas, after VT combined with steroid administration, we found two (4.76%), with statistically significant difference. We noted tympanosclerosis postoperatively in six (12.9%) ears and in one of the injected ears (2.3%) (p = 0.0484). Otorrhea occurred in eight (19%) ears with VT alone and in three (7.1%) injected ears, with non-significant difference. The duration between VT insertion and its extrusion was 6.6 = 1.1months for ears with VT alone and 6.95 =1.12 months in injected ears (p = 0.1541 NS). Conclusion IT Steroids injection for treatment of OME is a safe and simple intervention with lower incidence of symptoms recurrence and postoperative complications. Thus, its use in management of OME is recommended.

Intratympanic corticosteroid for sudden hearing loss: does it really work? / Corticosteroide intratimpânico para perda súbita da audição: isso realmente funciona?

ABSTRACT INTRODUCTION: Sudden deafness is characterized by an abrupt hearing loss of at least 30 dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids. OBJECTIVE: To determine the effectiveness of therapy with intratympanic steroids in sudden deafness. METHODS: A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids. RESULTS: Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies. CONCLUSION: Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient.

Resumo Introdução: A surdez súbita é caracterizada por uma perda abrupta da audição de pelo menos 30 dB em três frequências sequenciadas no audiograma tonal de rotina ao longo de três dias, oumenos. O tratamento é fundamentado em sua etiologia e corticosteroides orais são amplamenteutilizados. A terapia com corticosteroide intratimpânico foi incluída como tratamento primárioou secundário nos casos em que não houve melhora com o uso de corticosteroides orais. Objetivo: Determinar a eficácia da terapia intratimpânica com esteroides em casos de surdez súbita. Método: Foi realizada uma revisão sistemática das publicações sobre o tópico no banco dedados Pubmed/Medline, com as palavras-chave: surdez súbita, perda súbita da audição e corticosteroides. Resultados: Foram analisados 30 estudos científicos. Com relação aos objetivos dos estudos analisados, 76,7% procuravam avaliar o uso da terapia intratimpânica em seguida ao insucesso com o tratamento convencional; a terapia intratimpânica foi empregada como tratamento primário em 23,3% dos estudos. Conclusão: A terapia com corticosteroide intratimpânico é prescrita primariamente nos casos de insucesso com a terapia convencional e quando há limitação para o uso de corticosteroides sistêmicos, como ocorre com o paciente diabético.

Unilateral Meniere's disease; intra tympanic injection of low dose gentamicin in the treatment

ABSTRACT: Meniere's disease is chronic progressive disease with unclear idiopathic etiology and symptomatic improvements with treatment

Objectives: To analyze the efficacy of low dose intratympanic injection of gentamicin for vertigo control in unilateral Meniere's disease. Study Design: Quasi experimental study. Settings: Department of ENT, PIMS, NESCOM and IMDC Islamabad

Materials and Methods: Gentamicin was used intra tympanically in this multicentre study of 75 patients over a period of 8.5 years between 1[st] January 2005 to 30[th] June 2013 in definite Meniere's disease according to the 1995 Document of American academy of otolaryngology- Head and Neck Surgery [AAO-HNS].All these centers followed same criteria and procedures. Single dose of 1 ml Gentamicin solution 40 mg/ml was instilled in the middle ear through the grommet under microscope and followed up for 3 months and two years. The staging of disease [hearing thresholds] the degree of disability [frequency of attacks per month] and the functional level were assessed before and after treatment

Results: Among 75 patients, 41 were female and 34 were males between age ranges of 25 to 70 years. Most of the patients in the study had stage 2 [23/75] and stage 3 [41/75] Meniere's disease. About 68[91%] patients were having good control of vertigo at the end of two year of intratympanic gentamicin without any loss of hearing

Conclusion: A single Low dose intratympanic gentamicin is effective in controlling vertigo in patients with Meniere's disease with no further deterioration in hearing for at least two years follow up

Modified titration intratympanic gentamicin injection for unilateral intractable Ménière's disease / 华中科技大学学报（医学）（英德文版）

This study looked into the efficacy of a modified titration protocol of intratympanic gentamicin injection (ITG) in the patients with unilateral intractable Ménière's disease (MD). Modified titration protocol of ITG at a low dose (20 mg/mL) was administered to 10 patients with definite unilateral intractable MD. After initial first two fixed ITGs on weekly basis, the patients might or might not be given any more injections, depending on the appearance of unilateral vestibular loss (UVL). ITG was terminated if the patients satisfied the criteria of UVL. All patients were followed-up for at least two years. The effects of ITG on the vertigo attack, functional level scores and postural balance were evaluated. Of the 10 cases, 8 showed the sign of UVL after receiving initial two ITGs and were not given any more intratympanic injections, and the other 2 patients were administered three ITGs. A two-year follow-up revealed that complete and substantial vertigo control was achieved in 9 cases, and limited vertigo control in 1 patient. Hearing level was lowered in 2 patients. The posture stability and functional level scores were improved. Our study showed that the modified titration protocol of ITG at a low dose could effectively control vertigo in patients with unilateral intractable MD.

Intratympanic methylprednisolone hemisuccinate injection in treating the refractory noise induced deafness / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To analyze the efficacy of Methylprednisolone hemisuccinate intratympanic injection for refractory noise induced deafness.</p><p><b>METHODS</b>One hundred and twenty cases (215 ears) of noise induced deafness were treated with either hormone group (107 ears) or with non hormone group (108 ears). Following prior interventions, 145 ears went on to receive intratympanic Methylprednisolone hemisuccinate injection twice a week.</p><p><b>RESULTS</b>After Intratympanic therapy, the total effective rate was 46.2%. 32 of 71 ears (45.1%) demonstrated hearing improvement in hormone group and 35 of 74 ears (47.3%) in non hormone group. The difference was statistically insignificant (P = 0.788).</p><p><b>CONCLUSION</b>Intratympanic therapy appears to provide additional treatment benefits for patients with refractory noise induced deafness who have been treated with prior interventions. The outcome is not affected by pretreatment with hormone.</p>

The efficacy of intratympanic dexamethasone injection for the moderate and severe sudden deafness with BPPV / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the efficacy of intratympanic dexamethasone injection for the moderate and severe sudden deafness with BPPV.@*METHOD@#A total of 63 patients diagnosed with sudden sensorineural hearing loss with BPPV were treated through OPD. Patients were divided into three groups: 20 cases in intratympanic dexamethasone injection as initial treatment (group A); 18 cases in systemic hormone therapy group (group B); 25 cases in intratympanic dexamethasone injection as salvage treatment (group C). In addition, routine drugs were used to all patients.@*RESULT@#The overall effective rate of group A, B and C in hearing recovery was 60.0%, 38.9% and 48.0%, respectively: (1) No significant difference of hearing recovery was observed among three groups (P > 0.05); (2) A significant difference of hearing recovery was evidenced between group A and C (P 0.05).@*CONCLUSION@#Our data showed that intratympanic dexamethasone should be used as initial therapy for treating the moderate and severe sudden deafness with BPPV.

The function of tubomanometry in forcasting the progonosis of acute otitis media with effusion / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the function of tubomanometry (TMM) in forcasting the progonosis of acute otitis media with effusion (OME).@*METHOD@#We used the technique of TMM to quantify the degree of eustachian tube (ET) dysfunction in 65 patients with OME. The opening of the ET and the transportation of gas into the middle ear were registered by a pressure sensor in the occluded outer ear after applying the stimulus of a controlled gas bolus into the nasopharynx during swallowing. Three excess pressure values were tested subsequently (30, 40, and 50 mbar). If tube opening was registered, the time of opening in relation to pressure applied was measured. The TMM calculated the opening latency index or index R. An R value of 1 indicated late opening of the tube occurring after the initial stimulus and was interpreted as suboptimal. Inability to calculate the index R value indicated that the tube was unable to actively open at all. The TMM results, were weighted as follows: no R with 0 points, R > 1 with 1 point and R < 1 with 2 points for the measurements at 30, 40, and 50 mbar, respectively. The points of these three tests were added so the ET score (ETS) ranges from 0 (worst value) to 6 (best value). According to the medical history, the patients were divided into two groups, chronic OME group (defined as positive control group), 30 cases with 38 ears; and acute OME group, 35 cases with 46 ears. The healthy ears of all patients were defined as normal control group, 46 cases with 46 ears. The same regular treatments, including classic medical treatments and intratympanic dexamethasone injections, were used to acute OME group in the following 1-2 months. On the basis of therapeutic effect, acute OME group was subdivided into valid group (26 cases with 33 ears) and invalid group (9 cases with 13 ears).@*RESULT@#The ETS of normal control group was 5.11 ± 1.32 while it was 1.08 ± 1.32 in positive control group. It was found marked differences between the two groups (P < 0.01). The ETS of both valid and invalid subgroup of actue OME group were significantly lower than normal control group (P < 0.01), but in valid subgroup it was significantly higher than positive control group (P < 0.01), and no marked difference was found between the invalid subgroup and positive control group. After treatments, a significant improvement of the ETS was found in both valid and invalid subgroup (P < 0.05) there was no marked difference between valid subgroup and normal control group. But in invalid subgroup it was still significantly lower than normal cohtrol group (P < 0. 01).@*CONCLUSION@#TMM could forecast the prognosis of acute OME. Patients with acute OME suffered from ET dysfunction of varied degrees. Those with high ETS could be cured by classic medical treatments and intratympanic dexamethasone injections. But those with poor ETS could not be cured in short period, tube insertion should be considered. If ETS could not be improved by ventilation tube placement, more active treatment, for example, balloon Eustachian tuboplasty (BET), should be used to prevent transforming into chronic OME.

Efficacy of intratympanic steroid injection as supplementary or initial treatment for sudden sensorineural hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the efficacy of intratympanic steroid injection as supplementary or initial treatment for sudden sensorineural hearing loss (SSNHL).@*METHOD@#A total of 68 patients diagnosed with SSNHL were randomized into group A (45 cases including systemic steroid for 33 cases and systemic steroid + intratympanic steroid as supplementary treatment for 12 cases) and group B (23 cases, initial intratympanic steroid). Then observe the therapeutic effect in two groups.@*RESULT@#The total effective rate was 55.6% in group A and 56.5% in group B. No statistical difference was detected between these two groups (P > 0.05). There was statistical difference after therapy of intratympanic steroid as supplementary treatment for 12 patients due to poor hearing improvement after systemic steroid in group A (P < 0.05).@*CONCLUSION@#Both systemic and intratympanic steroid injection for SSNHL are effective. The efficiency of intratympanic steroid injection as supplementary or initial treatment for SSNHL is similar to that of systemic steroid. The intratympanic steroid injection for SSNHL as initial protocol or as supplementary treatment when poor hearing improvement after systemic steroid is recommended.

Intratympanic versus systemic steroid initial treatment for idiopathic sudden hearing loss: a Meta-analysis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To assess the efficacy and safety of glucocorticoid in initial treatment of sudden hearing loss with intratympanic (IT) and systemic ways.@*METHOD@#We searched the database of PubMed, Cochrane, Embase,CBM, CNKI, VIP, Wanfang systematically. Literatures were screened according to the preestablished inclusion and exclusion standards,and all the RCT literatures associated with intratympanic and systemic glucocorticoid in the initial treatment of sudden hearing loss before may 2015 were collected. All the data, which meet the inclusion standards, were analyzed by using Meta-analysis software.@*RESULT@#Among all the qualified literatures, 11 randomized controlled trials were included. A total of 1298 cases were involved, including 521 cases with intratympanic administration, 410 with IV-therapy, and 201 with oral therapy. Meta analysis results showed that there was significant difference of the total effective rate and improvement rate between the intratympanic and systemic administration. Intratympanic injection (P > 0.05) was more effective than systemic administration. There was no significant difference between intratympanic group and oral group (RR = 1.15, 95% CI: 0.92-1.42, P > 0.05). A significant difference of the effective rate occurred between intratympanic group and IV therapy group (RR = 1.17, 95% CI: 1.02-1.34, P < 0.05). The major complications of intratympanic were pain, dizziness/vertigo, which occurred more frequently than systemic therapy group; The major complications of systemic therapy group were hyperglycaemia, loss of appetite and insomnia.@*CONCLUSION@#This study shows that the intratympanic (IT) glucocorticoid for sudden deafness is more effective than the systemic administration. But it was not the first choice in clinical treatment. Further studies are warranted.

Time of salvage treatment on sudden sensorineural hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the best time of intratympanic dexamethasone injection to treat sudden sensorineural hearing loss (SSNHL) as salvage therapy so that to improve the curative efficacy on sudden deafness at the utmost.@*METHOD@#A total of 192 patients with SSNHL were included in this study, among whom 63 cases received the systemic steroid therapy throughout the study, while the other ones were treated with systemic steroid as initial treatment and were given intratympanic steroid administration as salvage treatment starting at different time point. The salvage treatment started on the 3rd day after the beginning of the initial treatment for 29 cases, on the 7th day for 38 cases, on the 14th day for 43 cases, and 1 month later for 19 cases. All the patients were followed up for 2 months.@*RESULT@#The recovery rates and total effective rates showed no statistically significant difference between the patients received only systemic steroid therapy and the ones received intratympanic steroid administration on the 3rd, 7th day and 1 month later after the initial treatment. The recovery rate and total effective rate exhibited statistically significant difference between the patients received intratympanic steroid administration since the 14th day after the initial treatment and the ones received only systemic steroid therapy, with the numerical value of P 0. 037 and 0. 034, respectively.@*CONCLUSION@#(1) As an initial management plan, the curative effects. between the intratympanic steroid administration and the systemic steroid therapy were not significantly different. (2) As a salvage treatment, intratympanic steroid was a better choice for patients who have not completely recover from ISSNHL after failure of initial management with systemic steroid only. (3) The best time point of salvage treatment with intratympanic steroid was about 2 weeks after initial management with systemic steroid.

Injeções intratimpânicas de gentamicina no tratamento da doença de ménière / Intratympanic gentamicin for treatment of ménière's disease

A vertigem é, na maioria dos casos, o sintoma mais incapacitante dos pacientes com doença de Ménière. Várias medidas terapêuticas têm sido propostas: tratamentos clínicos nas fases iniciais e procedimentos cirúrgicos para pacientes de difícil controle clínico. A administração de gentamicina intratimpânica permite realizar uma "labirintectotnia química seletiva". Trata-se de uma opção de tratamento cuja relação custo/benefício é superior aos procedimentos cirúrgicos. Na paciente aqui descrita, pequenas doses (40 mg) de gentamicina são injetadas na orelha média em intervalos semanais, no total de quatro sessões. A função vestibular é monitorada através de provas calóricas, observando-se um decréscimo das respostas vestibulares. A audição é acompanhada por audiometrias seriadas; qualquer queda audiométrica leva a interrupção imediata do tratamento. Sendo a gentamicina mais vestibulotóxica do que cocleotóxica, é comum observar-se uma manutenção dos níveis auditivos, na maioria cios casos, ou até alguma pequena recuperação, como foi vista no caso descrito. A melhora da sintomatologia labiríntica, acompanhada a médio/longo prazo foi muito evidente na paciente apresentada. A injeção intratimpânica de gentamicina tem se mostrado segura, de simples realização (procedimento ambulatorial) e bastante eficaz no tratamento de quadros vertiginosos de pacientes com Ménière.

Vertigo is the most disabling symptom for most patients with Meniere's disease. Many treatments have been proposed: conservative medical means in the initial phases of the disease and surgical procedures for intractable cases. The intratympanic injection of gentamicin can achieve "selective chemical labirinthectomy". This treatment can offers better risk/benefit outcome than others surgical procedures. Herein we report a patient which was treated with low doses (40 mg) of gentamicin injected in the middle ear, once a week during 4 weeks. Vestibular function was assessed with caloric tests; a reduction in caloric function was noted. Hearing was staged by periodic audiometric tests; treatment is immediately cut if any change occurs in hearing levels. As gentamicin is relatively more vestibulotoxic than cocleotoxic the hearing thresholds do not change in most cases or may be even better as observed in the reported patient. Our patient stated a relief in episodes of vertigo in longer follow-up. Intratympanic gentamicin is safe and simple (office procedure) that is very effective in controlling vertiginous episodes in patients with Ménière.