Comparison of 2 Different Intratympanic Methylprednisolone Injection Schedules in Combination With Intravenous Dexamethasone for Unilateral Sudden Sensorineural Hearing Loss

Abstract

Sudden sensorineural hearing loss is a common otologic disease in clinic. Systemic and intratympanic steroid treatment have been proved to be effective, but the regimens vary from center to center. The purpose of the study is to analyze the effects of the combined application of intravenous dexamethasone and intratympanic methylprednisolone injection in different time strategies for the treatment of unilateral sudden sensorineural hearing loss. A retrospective chart review was performed for the period from March 2016 to June 2018 at our Department of Otorhinolaryngology—Head and Neck Surgery. A total number of 61 patients who met the academy criteria for unilateral sudden hearing loss were included and grouped based on the time to introduce intratympanic methylprednisolone. All the patients received intravenous dexamethasone 10 mg once daily for 5 days, followed 5 mg once daily for the next 7 days. Intratympanic methylprednisolone (40 mg) was injected every other day 4 times into all patients. This regimen was commenced on day 1 in group 1 and on day 6 in group 2. The pre and posttreatment pure-tone audiograms were analyzed. Sixty-one patients met our inclusion criteria. No significant differences were observed between patients’ demographics or pretreatment hearing thresholds. In the 3 months posttreatment pure-tone audiogram assessment, the mean hearing threshold improvement were similar between groups with no frequency specificity. The curative rate in both groups were similar and satisfying. Two patients with diabetes mellitus had persistent small perforations. Some patients had other transient discomfort that disappeared before discharge. The different timing of initiation of intratympanic methylprednisolone injection does not significantly affect the outcome of the treatment for sudden sensorineural hearing loss. Thus, we suggest that intratympanic steroid injection should not be applied as a first-line method except for patients who do not respond early to systemic steroid therapy.

Residual Perforation Risk Assessment of Intratympanic Steroids via Tympanostomy Tube Versus Transtympanic Injections

“…This concept was supported by other publications, 27,28 making steroidal administration possible only via injection trans-TyT, transtympanic, or through myringotomy, as was performed by Kakehata et al 29 Injection via a myringotomy was suggested due to the concern about penetration after blind administration of steroids to an intubated ear's external auditory canal. This method ensures steroidal administration to the ME cleft and allows air to escape from the mesotympanum through the wide diameter of the perforation.…”

“…Ungar et al tested the penetration of various liquids, including dexamethasone 4 mg/dL solution (Medochemie Ltd., Limassol, Cyprus), via five types of TyTs with internal diameters ranging between 0.89 and 1.14 mm 26 and reported that the hydrostatic pressure is not sufficient to ensure effective liquid penetration after blind administration through TyT. This concept was supported by other publications, 27,28 making steroidal administration possible only via injection trans‐TyT, transtympanic, or through myringotomy, as was performed by Kakehata et al 29 …”

Sudden single-sided hearing loss. Disease analysis

“…Этиологические факторы, которые способствуют развитию ВСНТ, в большинстве случаев неизвестны, и заболевание носит идиопатический характер (в 71% случаев) [6][7][8][9]. Однако, считается, что внезапное снижение слуха может быть сосудистой, аутоиммунной или вирусной природы [7,[10][11][12][13][14]. Основными вирусными агентами, которые могут приводить к развитию внезапной СНТ, являются вирус иммунодефицита человека, вирус простого герпеса, краснухи, цитомегаловирус, вирус Западного Нила и пр., а по последним данным, вирус SARS-CoV-2 [15][16][17][18][19].…”

“…В 32-65% случаев возможно спонтанное выздоровление пациентов с ВСНТ в течение первых двух недель от начала заболевания, однако большинству пациентов требуются пристальное внимание и оказание своевременной и надлежащей помощи. Основным золотым стандартом лечения ВСНТ является применение системных глюкокортикостероидов (возможно интратимпанальное или постаурикулярное введение), положительный эффект которых впервые был продемонстрирован в 1980 г. Эффективность терапии зависит от многих сопутствующих факторов, и, к сожалению, не всегда удается добиться улучшения или восстановления порогов слуха, в связи с чем пациенты вынуждены адаптироваться к «новому» слуховому восприятию [1,6,7,11].…”

Therapeutic efficacy of methylprednisolone sodium succinate via diverse administration routes for mid- to high-frequency sudden sensorineural hearing loss

“…Methylprednisolone sodium succinate (MPSS), a newly developed glucocorticoid medication, has demonstrated significant efficacy due to its anti-inflammatory, antiallergic, and immunosuppressive effects. MPSS has a shorter half-life than conventional glucocorticoids, making it an attractive option[ 5 , 6 ]. Methylprednisolone has a plasma half-life of approximately 2.5 h, which varies depending on the route of administration and patient-specific factors[ 5 , 6 ].…”