The effect of intratympanic steroid injection frequency in idiopathic sudden sensorineural hearing loss.

PURPOSE: To evaluate the effect of intratympanic steroid injection frequency on hearing outcomes for patients with idiopathic sudden sensorineural hearing loss. MATERIALS AND METHODS: A retrospective chart review was performed from 2007 to 2015 at a neurotology tertiary referral center. Adults who met academy criteria for idiopathic sudden sensorineural hearing loss within two months of onset and negative imaging were grouped based on injection frequency. Injection schedules were every 1-4 (group 1), 5-10 (group 2), or 11-30 (group 3) days. All patients had at least two injections with Dexamethasone 10 mg/ml. All patients had pre- and post-injection audiograms. RESULTS: Seventy patients met inclusion criteria (group 1, n = 21; group 2, n = 29; group 3, n = 20). There was no significant difference between group demographics or baseline audiometric data. Mean gains were significant and similar between groups for pure tone average (group 1 = -23.6 ±â€¯22.0 dB; group 2 = -19.7 ±â€¯18.4 dB; group 3 = -24.9 ±â€¯24.7 dB; p = 0.67) and word recognition score (group 1 = +26.3 ±â€¯34.8%; group 2 = +23.3 ±â€¯29.9%; group 3 = +33.4 ±â€¯28.9%; p = 0.53). CONCLUSIONS: Frequency of intratympanic steroid injections does not significantly affect hearing outcomes. Following injection therapy, hearing outcomes improved regardless of prior or concomitant oral steroid regimen. Earlier time to initiating injections yielded a higher rate of hearing improvement. Long term hearing outcomes >6 months did not show significant additional improvement.

Acquired External Auditory Canal Atresia: A Comparison of Acellular Dermal Matrix and Split-thickness Skin Grafting Techniques.

OBJECTIVE: To describe the use of acellular dermal matrix (ADM) in the repair of acquired external auditory canal atresia (AEACA), and compare surgical results to AEACA repair by split-thickness skin grafting (STSG). STUDY DESIGN: Retrospective chart review. SETTING: Neurotology clinical practice. PATIENTS AND INTERVENTION: From 2007 to 2015, 25 AEACA surgeries (8 ADM and 17 STSG) were identified meeting inclusion and exclusion criteria. Pre- and postoperative audiometric data with clinical follow-up were examined. OUTCOME MEASURES: Rate of external auditory canal restenosis, improvement of conductive hearing loss, and resolution of otorrhea. RESULTS: Both surgical groups had similar preoperative air bone gaps (ABG). Mean follow-up was 24 months. There was no significant difference in restenosis rates between the ADM (13%, n = 1/8) and STSG (12%, n = 2/17) groups. ABG improved from 28 dB to 11 dB in the ADM group and from 24 dB to 9 dB in the STSG group. ABG closure with surgery was statistically significant (p < 0.05), but there was no difference between the two groups. There was no significant reduction of otorrhea. CONCLUSION: Acellular dermal matrix grafting has not been previously reported for use in AEACA repair, and is a reasonable alternative to STSG with similar hearing, restenosis, and otorrhea outcomes.