Contribution of intratympanic steroids in the primary treatment of sudden hearing loss*

Demirhan, Hasan; Gökduman, Ali Rıza; Hamit, Bahtiyar; Altındağ, Müge Fethiye Yürekli; Yiğit, Özgür

doi:10.1080/00016489.2018.1438660

Cited by 15 publications

(8 citation statements)

References 20 publications

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“…50 pro Jahr) und in Reviews zusammengefasst [14]. Lediglich zwei Arbeiten [6,7] machen Angaben zu Schmerzen durch die Injektion, eine von Demirhan et al [6] zu einem VAS-Score bezüglich Schmerzen 5 und 60 min nach Injektion. Diese Angaben beziehen sich auf den Vergleich vom besser verträglichen DM zum in dieser Publikation besser wirksamen MP, das jedoch einen für das Mittelohr ungünstigeren pH-Wert aufweist und daher ein stärkeres Brennen nach Injektion hervorruft.…”

Section: Diskussionunclassified

“…Für viele Patient*innen ist die Injektion "in das Ohr" mit Angst und Zurückhaltung verbunden, die sich oft durch ein ausführliches Aufklärungsgespräch über Abläufe, Risiken, Chancen und Alternativen überwinden lässt. In der Literatur finden sich zahlreiche Artikel zu Methoden, Behandlungserfolgen und Komplikationen, eine Erhebung über Akzeptanz, Toleranz und Dyskomfort existiert nach unserer Recherche nur ansatzweise [5][6][7].…”

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Toleranz und Akzeptanz der intratympanalen Injektion

Mühlmeier

Tisch

2022

HNO

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Zusammenfassung Hintergrund Die intratympanale Gabe von Steroiden ist Bestandteil der Therapie von akuten Hörverlusten. Bislang existieren nur wenig Daten zur Akzeptanz und Toleranz aus Sicht der Patient*innen. Material und Methoden Zu den gesundheitlichen Voraussetzungen und den Umstäden ihrer intratympanalen Therapie wurden 84 Patient*innen befragt. Ergebnisse Es stellten sich 38 Frauen und 46 Männer im Alter von durchschnittlich 57,2 Jahren meist auf Empfehlung ihres HNO-Arztes zur Zweitlinientherapie vor und empfanden die Injektionen zu 3,6 % als schmerzhaft, 22,6 % unangenehm, 67,9 % erträglich und zu 41,7 % als schmerzfrei (Mehrfachnennungen möglich). Eine Weiterempfehlung gaben 77,4 %, eine fehlende Empfehlung resultierte aus mangelnder Wirkung und unangenehmer Empfindung. Schlussfolgerung Der weit überwiegende Anteil der Behandelten beurteilt die intratympanale Therapie als erträglich und gibt eine Weiterempfehlung. Die enge Patientenführung ist ein entscheidender Therapiebaustein.

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Section: Diskussionunclassified

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Toleranz und Akzeptanz der intratympanalen Injektion

Mühlmeier

Tisch

2022

HNO

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“…Intratympanic corticosteroids are increasingly used in patients with SSNHL as a topical corticosteroid therapeutic option, especially in patients in whom systemic corticosteroids are contraindicated or declined 32,36 This therapy is also recommended as initial therapy for severe and profound SSNHL by some otologists. 37,38 Treatment of topical intratympanic corticosteroid injection provides a high dose of corticosteroids in the perilymph through the intact round membrance. 37,38 The cochlear pharmacokinetics of intratympanic corticosteroids have been confirmed in animal models.…”

Section: Corticosteroid Therapymentioning

confidence: 99%

“…37,38 Treatment of topical intratympanic corticosteroid injection provides a high dose of corticosteroids in the perilymph through the intact round membrance. 37,38 The cochlear pharmacokinetics of intratympanic corticosteroids have been confirmed in animal models. 39 This therapeutic method is relatively easy to carry out under local anesthesia in an outpatient clinic or ward, and it is well tolerated by the patients.…”

Section: Corticosteroid Therapymentioning

confidence: 99%

Clinical management and progress in sudden sensorineural hearing loss during pregnancy

Xie

2019

J Int Med Res

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Sudden sensorineural hearing loss (SSNHL) is a relatively rare, but distressing, disease in pregnant women. Little is known about the causes, clinical manifestations, treatments, and prognosis of SSNHL. Some hypotheses have been proposed to explain the pathophysiological mechanism of SSNHL, but most of them have not been identified. This article reviews the existing literature to present a summary of this clinical problem. Most patients suffer from SSNHL in the second or third trimester, and show moderate to profound hearing loss. The interval between the initial treatment and onset of hearing loss is less than 10 days in most patients. Some patients with SSNHL show tinnitus, vertigo, or dizziness, and fullness of the ear. Although some patients have a tendency for self-cure, treatment with intravenous dextran 40 combined with intratympanic corticosteroids is probably a safe and effective therapeutic strategy for pregnant patients with SSNHL. Further clinical research is necessary to identify the best therapeutic strategy for these patients.

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“…Recent clinical approaches for steroid delivery to the ear have employed intratympanic injections, either as a supplement to systemic delivery [3][4][5][6] or as the primary treatment. [5][6][7] The rationale is that a higher concentration of drugs reaches the cochlea through the round window.…”

Section: Introductionmentioning

confidence: 99%

Intratympanically Delivered Steroids Impact Thousands More Inner Ear Genes Than Systemic Delivery

Trune

Shives

Hausman

et al. 2019

Ann Otol Rhinol Laryngol

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Objectives: Glucocorticoids are given for sensorineural hearing loss, but little is known of their molecular impact on the inner ear. Furthermore, in spite of claims of improved hearing recovery with intratympanic delivery of steroids, no studies have actually documented the inner ear molecular functions that are enhanced with this delivery method. Methods: To assess steroid-driven processes in the inner ear, gene chip analyses were conducted on mice treated systemically with the glucocorticoids prednisolone or dexamethasone or the mineralocorticoid aldosterone. Other mice were given the same steroids intratympanically. Inner ears were harvested at 6 hours and processed on the Affymetrix 430 2.0 Gene Chip for expression of its 34 000 genes. Results were statistically analyzed for up or down expression of each gene against control (untreated) mice. Results: Analyses showed approximately 17 500 genes are normally expressed in the inner ear and steroids alter expression of 55% to 82% of these. Dexamethasone changed expression of 9424 (53.9%) inner ear genes following systemic injection but 14 899 ear genes (85%) if given intratympanically. A similar pattern was seen with prednisolone, as 7560 genes were impacted by oral delivery and 11 164 genes (63.8%) when given intratympanically. The mineralocorticoid aldosterone changed expression of only 268 inner ear genes if given orally, but this increased to 10 124 genes (57.9%) if injected intratympanically. Furthermore, the glucocorticoids given actually impacted more inner ear genes via the mineralocorticoid receptor than the glucocorticoid receptor. Conclusions: Thousands of inner ear genes were affected by steroids, and this number increased significantly if steroids were delivered intratympanically. Also, the impact of glucocorticoids on inner ear mineralocorticoid functions is more substantial than previously known. Thus, the application of therapeutic steroids for hearing loss needs to be reassessed in light of their more comprehensive impact on inner ear genes. Furthermore, simply ascribing the efficacy of steroids to immunosuppression no longer appears to be warranted.

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Contribution of intratympanic steroids in the primary treatment of sudden hearing loss*

Abstract: In the primary treatment of sudden hearing loss, in which the level of hearing loss is 70-89 dB HL, the addition of ITS to the treatment significantly increased the success rate. The pain occurring in the middle ear was high but tolerable in the first few minutes by MP.

Cited by 15 publications

References 20 publications

Toleranz und Akzeptanz der intratympanalen Injektion

Toleranz und Akzeptanz der intratympanalen Injektion

Clinical management and progress in sudden sensorineural hearing loss during pregnancy

Intratympanically Delivered Steroids Impact Thousands More Inner Ear Genes Than Systemic Delivery

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