Dose Effect of Intratympanic Dexamethasone for Idiopathic Sudden Sensorineural Hearing Loss

Alexander, Thomas; Harris, Jeffrey P.; Nguyen, Quyen T.; Vorasubin, Nopawan

doi:10.1097/mao.0000000000000834

Cited by 44 publications

(36 citation statements)

References 32 publications

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“…larger change in PTA with earlier onset of treatment (figure 5a). This is in correspondence with arguments often used in communication of doctors with patients when they suggest to start a therapy as soon as possible to get the greatest benefit from the treatment (39–42). However, such an argument appears not to be supported by the present data.…”

Section: Discussionsupporting

confidence: 68%

Hearing Changes After Intratympanically Applied Steroids for Primary Therapy of Sudden Hearing Loss: A Meta-analysis Using Mathematical Simulations of Drug Delivery Protocols

Liebau

Pogorzelski

Salt

et al. 2017

Otology &Amp; Neurotology

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Objective Controlled and uncontrolled studies with primary intratympanic (IT) or combined intratympanic and systemic application of glucocorticosteroids for idiopathic sudden hearing loss (ISSHL) were analyzed by means of a meta-analysis in an attempt to establish optimal local drug delivery protocols. Study Design A total of 25 studies with 28 treatment groups between January 2000 and June 2014 were selected that adequately described drug delivery protocols. Cochlear drug levels were calculated by a validated computer model of drug dispersion in the inner ear fluids based on the concentration and volume of glucocorticoids applied, the time the drug remained in the middle ear, and on the specific timing of injections. Various factors were compared with hearing outcome, including baseline data, individual parameters of the application protocols, calculated peak concentration (Cmax), and total dose (Area under the curve, AUC). Results There was no dependence of hearing outcome on individual parameters of the application protocol, Cmax or AUC. Final hearing threshold was notably independent of delay of treatment. Conclusion During primary IT or combined steroid therapy of ISSHL, the tendency towards early treatment having a positive effect on hearing improvement is thought to be a “sham effect”, likely related to spontaneous recovery. Change in pure tone average (PTA) may not be an adequate outcome parameter to assess effectiveness of the intervention, as it depends on the degree of initial hearing loss. Final PTA provides a better alternative.

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Section: Discussionsupporting

confidence: 68%

Hearing Changes After Intratympanically Applied Steroids for Primary Therapy of Sudden Hearing Loss: A Meta-analysis Using Mathematical Simulations of Drug Delivery Protocols

Liebau

Pogorzelski

Salt

et al. 2017

Otology &Amp; Neurotology

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“…Among the factors that could influence hearing outcome, time from onset of HL to the baseline visit was found to be statistically significant (p=0.030). Our study confirms other reports that delaying treatment has negative influence on hearing improvement [2,17] . Other factors, such as age, presence of tinnitus or vertigo, did not impact the hearing threshold in our study.…”

Section: Discussionsupporting

confidence: 82%

“…The concentration used in treatment is often associated with availability and approval of each country or medical center and ranged from 4 mg/mL to 24 mg/mL for DEX. A higher concentration was found to be more effective [17] . The number of applications from single injection to four injections over several days has been reported.…”

Section: Discussionmentioning

confidence: 99%

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The Role of High Dose Intratympanic Dexamethasone as Salvage Therapy for Idiopathic Sudden Sensorineural Hearing Loss

Kordiš

Battelino

2017

Int Adv Otol

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OBJECTIVE:The aim of this study was to assess the efficacy of a single high dose intratympanic (IT) dexamethasone (DEX) as salvage therapy for idiopathic sudden sensorineural hearing loss (ISSNHL) after unsuccessful treatment with oral corticosteroid (CS). MATERIALS and METHODS:This was a prospective open-label study of 59 patients treated with IT DEX after systemic CS therapy has failed. All patients received high dose (24 mg/mL) IT DEX in a single injection through myringotomy. RESULTS:Of the 59 patients, 40.7% showed improvement in their mean pure tone average (PTA) with IT DEX (p=0.005). The difference in the mean PTA after oral CS treatment only from baseline was not statistically significant (p=0.074). The time from onset of hearing loss to the start of therapy was significantly associated with the outcome (p=0.03). CONCLUSION:We determined that high dose IT DEX as salvage therapy was beneficial when the primary treatment with oral CS had failed. An early start of the treatment significantly influenced the improvement of hearing.

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“…The benefits of IT steroids are attributed to a higher perilymph steroid level. Dosing regimens vary from study to study, and higher concentration per dose has also been shown to be efficacious …”

Section: Introductionmentioning

confidence: 99%

Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss

Hara

Zhang

Gandhi

et al. 2018

Laryngoscope Investig Oto

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ObjectiveTo investigate the role of intratympanic (IT) therapy in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL).MethodsThis study was a retrospective review. Patients were treated for ISSNHL from January 1, 2011 to April 12, 2015 with the following: pre/posttreatment audios, treatment initiated ≤90 days and idiopathic etiology. Fifty‐three ISSNHL patients were analyzed in the following subgroups: oral steroids (n = 8), combination oral+IT (n = 39), and IT (n = 6). Main outcomes measured were pre/posttreatment pure tone average (PTA) scores.ResultsThe PTA changes for all treatment groups improved by 8.0 ± 19.5 dB (P = .004); for 31 patients treated ≤2 weeks after onset, PTA improved by 13.8 ± 16.6 dB (P < .001). Multivariable generalized linear model for repeated measures was conducted to investigate the association between PTA changes for treatment groups adjusted for age, gender, time‐to‐treatment, and vertigo. Earlier time‐to‐treatment and older age were statistically correlated towards improved outcomes. As time‐to‐treatment increased by each day, change in PTA decreased by 0.324 (95% CI [0.12, 0.52], P = .002). As age increased by each year, PTA changes increased by 0.802 (95% CI [0.36, 1.24], P < .001). For the oral+IT group, PTA changes for concurrent oral+IT (n = 20, 7.10 dB) and delayed/salvage oral+IT (n = 19, 5.43 dB) were not statistically different (P = .79); earlier time‐to‐treatment (P = .001), and older age (P = .006) remained statistically correlated towards improved outcomes.ConclusionResults suggest outcomes can be improved with early identification and oral steroid therapy by primary care providers. Poorer prognosis for younger patients potentially suggests a need for more aggressive diagnostic and therapeutic management for this subgroup.Level of Evidence3b.

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Dose Effect of Intratympanic Dexamethasone for Idiopathic Sudden Sensorineural Hearing Loss

Cited by 44 publications

References 32 publications

Hearing Changes After Intratympanically Applied Steroids for Primary Therapy of Sudden Hearing Loss: A Meta-analysis Using Mathematical Simulations of Drug Delivery Protocols

Hearing Changes After Intratympanically Applied Steroids for Primary Therapy of Sudden Hearing Loss: A Meta-analysis Using Mathematical Simulations of Drug Delivery Protocols

The Role of High Dose Intratympanic Dexamethasone as Salvage Therapy for Idiopathic Sudden Sensorineural Hearing Loss

Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss

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