Application of a Corticosteroid (Triamcinolon) Protects Inner Ear Function after Surgical Intervention

Abstract

From these results, we conclude that extracochlear topical application of Triamcinolon has no ototoxic effect in the concentrations that were used and that intracochlear application supports an increased recovery of cochlear functions after surgical trauma. Furthermore, the results indicate a protective effect of corticosteroids, partially preventing progressive loss of hearing after cochleostomy over a period of 4 weeks. Intracochlear application of Triamcinolon may be useful to prevent hearing loss after surgical intervention on the inner ear; however, clinical safety and efficacy remain to be proven in clinical studies.

Cochlear implants: Current designs and future possibilities

“…Various surgical techniques and drug therapies have been developed to preserve low-frequency hearing in an implanted cochlea, including (1) deliberately shallow insertions of the electrode array (6, 10, 16, or 20 mm) so as not to damage the apical part of the cochlea and remaining hair cells there, (2) insertion of the electrode array through the round window membrane rather than through a cochleostomy to eliminate deleterious effects of drilling (loud and possibly damaging levels of noise, introduction of blood and bone dust into the perilymph, possible damage to delicate cochlear structures such as the BM), (3) use of "soft surgery" techniques to minimize trauma, (4) use of thin and highly flexible electrodes, (5) use of a lubricant such as hyaluronic acid to facilitate insertion of the array, and (6) use of corticosteroids and other drugs to help preserve cochlear structures in the face of surgical manipulations and the introduction of a foreign body into the inner ear. Moderate-to-excellent preservation of residual hearing has been reported for a majority of patients using the shallow insertions and some or all of the additional procedures and techniques just mentioned [93][94][95][96][97][98][99][100][101][102][103][104][105][106][107], although residual hearing is still completely lost for some patients with the same insertions and approaches. Among the tested methods, insertion through the round window for placement of 20 mm arrays or use of shorter arrays appear to be especially effective [103,106,[108][109].…”

Targeted Therapy of the Inner Ear

“…There is an emerging experimental literature that suggests the risk of immediate hearing loss after surgery may be minimized by the application of pharmacological agents to the cochlea in the peri-operative period [23,24,25]. Here, we introduce some new data on the long-term stability of hearing protection in our experimental model of cochlear implantation, and appraise some of the literature relevant to the clinical implementation of such strategies.…”

Principles of Local Drug Delivery to the Inner Ear

“…There is accumulating evidence from animal experiments that locally applied glucocorticoids can help preserve acoustic hearing thresholds following cochlear implantation [69,70,71]. As there is increasing interest in the possibility of implanting patients with high-frequency hearing loss but good low-frequency hearing, it has become an important goal to perform the implantation with minimal damage to residual hearing [72,73,74].…”