Effects of Insulin-Like Growth Factor (IGF-1) in Patients with Sensorineural Hearing Loss.

OBJECTIVES: (1) To test the effect of local administration of insulin-like growth factor-1 (IGF-1) in patients with sensorineural hearing loss (SNHL). (2) To test the effect of local administration of IGF-1 in patients with ototoxicity. METHODS: Forty patients with SNHL were included in the study. Their hearing thresholds at different frequencies (0.5, 1, 2, and 4 kHz) along with the average hearing threshold were noted. The patients were then randomly allocated to 2 groups and were treated with IGF-1 via one of the following routes: (1) intratympanic injection and (2) Gelfoam. Patients were followed-up at weekly intervals for 6 weeks but follow-up PTA was done at 3 weeks, 6 weeks, and 6 months only. RESULTS: Forty patients (25 male, 15 female) participated in the study. Their age ranged from 13 to 63 years, with a mean of 31.3 years. Nineteen (47.5%) patients exhibited some degree of recovery after 6 months of follow-up, while 21 (52.5%) did not exhibit any recovery. Fourteen (35%) patients showed slight recovery (SR), 1 (4%) patient showed marked recovery, and complete recovery was observed in 4 (10%) patients. Twelve of the 20 patients who underwent treatment using Gelfoam showed improvement in hearing (measured as a reduction in hearing threshold), while only 7 of the 20 patients who underwent intratympanic injection showed such improvement. Among adverse reactions, the most common was pain (88%) which typically did not last beyond 3 days. Other adverse reactions observed were dizziness (24%) and headache (20%). One patient suffered from acute suppurative otitis media (ASOM) and had a perforation in the tympanic membrane. However, this was treated successfully with medications. CONCLUSION: Intratympanic IGF-1 is a novel drug that has shown early promise in controlling and reversing SNHL.

Aberrant innominate artery may complicate a potentially safe surgery.

Surgeries of the anterior neck include thyroid surgery, open or percutaneous dilatational tracheotomy, bronchoscopy, mediastinoscopy and oesophagoscopy. These are potentially safe surgeries with mortality rates less than 1%. Today, the most common cause of death following a tracheotomy is haemorrhage and, following thyroid surgery, the causes are haemorrhage, giant goitres and upper airway complications. Bronchoscopies and mediastinoscopies are almost never fatal. While operating around the trachea, no major vessel is encountered in the surgical field. We report a case in which an aberrant innominate artery was encountered crossing anterior to the trachea just below the thyroid isthmus. As it is an uncommon finding, even minor complacency can lead to torrential bleeding culminating in death. Thus, we recommend surgeons to be vigilant for any aberrant artery in the surgical field rather than finding it accidentally; thereby preventing any complications in a potentially safe surgery.