Intratympanic Methylprednisolone versus Dexamethasone for the Primary Treatment of Idiopathic Sudden Sensorineural Hearing Loss.

OBJECTIVES: The aim of the present study was to compare the therapeutic effectiveness of intratympanic (IT) methylprednisolone and dexamethasone in the initial treatment of patients with idiopathic sudden sensorineural hearing loss (ISSHL). MATERIALS AND METHODS: A total of 46 patients with ISSHL who had been treated with IT methylprednisolone or dexamethasone were included in the present study. Dexamethasone (4 mg/mL) and methylprednisolone (20 mg/mL) were given transtympanically to 22 and 24 patients, respectively, one dosage per day for 5 consecutive days. Audiologic evaluations were performed pretreatment, daily in inpatient clinics, and in the first week and second month after discharge, using four-frequency pure-tone average (PTA) and speech discrimination score (SDS). Audiologic improvement was classified according to the Furuhashi criteria. RESULTS: According to the Furuhashi criteria, the therapeutic success rate was 62.5% (complete improvement 16.7% and marked improvement 45.8%) in the methylprednisolone group, whereas it was 54.6% (complete improvement 27.3% and marked improvement 27.3%) in the dexamethasone group. Therapeutic success was higher in the methylprednisolone group; however, it was not statistically significant. When the audiologic improvement was accepted as >10 dB in PTA, the therapeutic success rates were 83.3% in the methylprednisolone group and 72.8% in the dexamethasone group. The mean (±SD) improvement of PTA before and after treatment was 30.8±21.4 in the methylprednisolone group and 24.7±2.5 in the dexamethasone group. The mean improvement in SDS was 32.6±25 in the methylprednisolone group and 23.7±26.9 in the dexamethasone group. CONCLUSION: IT steroids are safe, effective, and well-tolerated agents in the initial treatment of patients with ISSHL. Despite having different pharmacokinetic characteristics, IT methylprednisolone and dexamethasone have no superiorities over each other in the primary treatment in patients with ISSHL.

A case of extramedullary plasmacytoma in the sphenoid sinus with unilateral loss of vision.

Extramedullary plasmacytomas are localized tumours formed of monoclonal plasma cells in an extra-skeletal area. They constitute approximately 3% of all neoplasms originating from plasma cells. They generally display a destructive course. When the literature in English was reviewed, only 19 cases with the primary disease localized in the sphenoid sinus were found. We present the case of a 50-year-old male patient who presented with gradually increasing visual loss over 6 weeks, whose radiological tests revealed a formation of mass in the sphenoid sinus pressing against the optic nerve and internal carotid artery. A biopsy obtained by endoscopic sinus surgery was reported to be a plasmacytoma. A diagnosis of extramedullary plasmacytoma was made after investigations for other neoplastic plasma cell conditions proved negative. Extramedullary plasmacytomas were assessed by reviewing the literature.