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.

The use of honey in cochlear implant associated wounds in pediatric patients.

INTRODUCTION: The use of honey in wound care is becoming more common due to the proven benefit in all three phases of wound healing, as well as the antibacterial and antibiofilm properties. We present our experience using TheraHoney gel, a medical grade honey, for the successful treatment of cochlear implant associated skin breakdown. OBJECTIVE: To describe the role of TheraHoney gel in the management of cutaneous infection and ulceration associated with cochlear implants. METHODS: Three cases of wounds treated traditionally with antibiotics, plus the addition of TheraHoney, were retrospectively reviewed. The first patient had a superficial 1 × 1 cm ulcer, the second patient had bilateral ulcers: one superficial 1.5 × 1.5 cm ulcer and the other a 1.5 × 2 cm stage III pressure ulcer with an exposed receiver stimulator, and the third patient with a 3 × 3.5 cm stage III ulcer with an exposed receiver stimulator. RESULTS: With the addition of TheraHoney gel, complete wound closure was achieved at all three patients without the need for surgical reconstruction. CONCLUSION: Cutaneous infection with or without skin breakdown is a common delayed complication after cochlear implantation. We demonstrate the efficacy of adding medical grade honey in promoting healing in infected scalp pressure ulcers overlying the cochlear implant site.

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.

IL-4 inhibition of IL-1 induced Matrix metalloproteinase-3 (MMP-3) expression in human fibroblasts involves decreased AP-1 activation via negative crosstalk involving of Jun N-terminal kinase (JNK).

Matrix metalloproteinase-3 (MMP-3) over-expression is associated with tissue destruction in the context of chronic inflammation. Previous studies showed that IL-4 inhibits induction of MMP-3 by IL-1ß, and suggested that AP-1 might be involved. Here we show that IL-1 induced binding of transcription factor AP-1 to the MMP-3 promoter consists primarily of c-Jun, JunB, and c-Fos and that binding of c-Jun and c-Fos is inhibited by the combination of cytokines while binding of Jun B is not. Mutation of the AP-1 site in the MMP-3 promoter decreased the ability of IL-4 to inhibit its transcription in transfected MG-63 cells. Western blotting showed that both cytokines activate Jun N-terminal kinase (JNK), but with somewhat different kinetics, and that activation of JNK by both cytokines individually is inhibited by the combination. These results indicate that IL-4 inhibition of MMP-3 expression is associated with reduction of IL-1 induced binding of active forms of the AP-1 dimer, while less active JunB-containing dimers remain, and suggest that these changes are associated with decreased activation of JNK.