[Intratympanic dexamethasone as therapeutic option in sudden sensorineural hearing loss]. / Dexametasona intratimpánica como opción terapéutica en hipoacusia neurosensorial súbita.

INTRODUCTION AND OBJECTIVES: The administration of systemic corticosteroids has demonstrated effectiveness on the treatment of idiopathic sudden sensorineural hearing loss. However, its systemic toxicity and subsequent difficulty for its justification in some patients have led to it being applied intratympanically. The main aim of this study is to determine the effectiveness of intratympanic dexamethasone in these patients. In addition we evaluate the relationship between the prognosis of this condition and the magnitude of initial hearing loss, the presence of vertigo or delay in the beginning of therapy. METHODS: We performed a retrospective case study of 18 patients. All of them were treated with intratympanic dexamethasone (4 mg/ml), administered weekly for 3 weeks. The follow-up was 1 month at least. The therapeutic success was arbitrarily defined to be a mean improvement of 25 dB or greater. RESULTS: 72.2% of the population recovered hearing successfully. The mean auditory threshold prior to treatment was 91+/-25 dB versus 51+/-35 dB after the end of it (p<0.0005). In addition, we observed that the initial severity of the hearing loss, the presence of vertigo and the delay in starting therapy cannot be considered as indicators of poor auditory prognosis. CONCLUSIONS: Intratympanic dexamethasone appears to be an effective therapeutic option for patients with sudden onset sensorineural hearing loss who, for whatever reason, cannot be treated with systemic steroids. Nonetheless, randomized controlled trials should be instituted to improve levels of scientific evidence.

Dexametasona intratimpánica como opción terapéutica en hipoacusia neurosensorial súbita / Intratympanic dexamethasone as therapeutic option in sudden sensorineural hearing loss

Introducción y objetivos: La administración de corticosteroides sistémicos tiene efectividad comprobada en el manejo de pacientes con hipoacusia neurosensorial súbita idiopática. Sin embargo, su toxicidad sistémica y, en consecuencia, la dificultad para utilizarlos en algunos pacientes, ha llevado a su aplicación por vía intratimpánica. El objetivo principal de este estudio es determinar la efectividad de la dexametasona intratimpánica en estos pacientes. Como objetivo secundario, intentamos establecer la relación entre la magnitud inicial de la hipoacusia, la presencia de vértigo y la demora en el inicio del tratamiento con el pronóstico de esta afección. Métodos: Se estudió, de forma retrospectiva, a 18 pacientes tratados con dexametasona intratimpanica (4 mg/ml), en dosis de 1 ml semanal, durante 3 semanas consecutivas. Se realizó un seguimiento de, al menos, 1 mes. El suceso terapéutico fue definido en forma arbitraria, ante una recuperación auditiva promedio de, al menos, 25 dB. Resultados: El 72,2 % de los pacientes recuperó la audición exitosamente. El umbral auditivo promedio previo al inicio del tratamiento fue de 91 ± 25 dB, mientras que el posterior fue de 51 ± 35 dB (p < 0,0005). Además, observamos que la magnitud inicial de la hipoacusia, la presencia de vértigo y la demora en el inicio del tratamiento no pueden considerarse como indicadores de mal pronóstico auditivo. Conclusiones: La dexametasona intratimpánica puede ser una un opción efectiva en pacientes con hipoacusia neurosensorial súbita que no pueden ser tratados con esteroides sistémicos, aunque se necesitarán ensayos clínicos controlados y aleatorizados para obtener mayor evidencia al respecto(AU)

Introduction and objectives: The administration of systemic corticosteroids has demonstrated effectiveness on the treatment of idiopathic sudden sensorineural hearing loss. However, its systemic toxicity and subsequent difficulty for its justification in some patients have led to it being applied intratympanically. The main aim of this study is to determine the effectiveness of intratympanic dexamethasone in these patients. In addition we evaluate the relationship between the prognosis of this condition and the magnitude of initial hearing loss, the presence of vertigo or delay in the beginning of therapy. Methods: We performed a retrospective case study of 18 patients. All of them were treated with intratympanic dexamethasone (4 mg/ml), administered weekly for 3 weeks. The follow-up was 1 month at least. The therapeutic success was arbitrarily defined to be a mean improvement of 25 dB or greater. Results: 72.2 % of the population recovered hearing successfully. The mean auditory threshold prior to treatment was 91 ± 25 dB versus 51 ± 35 dB after the end of it (p < 0.0005). In addition, we observed that the initial severity of the hearing loss, the presence of vertigo and the delay in starting therapy cannot be considered as indicators of poor auditory prognosis. Conclusions: Intratympanic dexamethasone appears to be an effective therapeutic option for patients with sudden onset sensorineural hearing loss who, for whatever reason, cannot be treated with systemic steroids. Nonetheless, randomized controlled trials should be instituted to improve levels of scientific evidence (AU)