How Useful Is Corticosteroid Treatment in Cochlear Disorders?

Abstract

The scientific basis for the administration of corticosteroids classified as glucocorticoids in certain cochlear disorders, such as immune-mediated progressive and idiopathic acute sensorineural hearing loss (SNHL), Ménière’s disease and noise-induced hearing loss (NIHL), was discussed. The current knowledge on the physiological functions of endogenous glucocorticoids and the pharmacological effects of their synthetic analogs was summarized. Emphasis was placed on experimental studies on corticosteroids in the cochleovestibular system and on the therapeutic effects of glucocorticoids on SNHL, Ménière’s disease, NIHL and chronic tinnitus obtained from clinical trials. Glucocorticoids exert numerous profound effects on almost every organ system, including mechanisms involved in anti-inflammatory action and immunosuppression. However, inflammatory tissue alterations are not only elicited by bacterial, viral or other immunopathological processes but also by physically and chemically induced cellular damage, tissue ischemia and hypoxia. Regardless of whether one or more of these insults underlie SNHL, Ménière’s disease and NIHL, glucocorticoids effectively counteract subsequent inflammatory tissue damage in the auditory and vestibular system. This was confirmed in experimental studies on immune-mediated progressive SNHL, and thrombosis-induced and noise-induced cochlear ischemia, hypoxia and hearing loss. Glucocorticoid treatment results of immune-mediated progressive and acute idiopathic SNHL are promising, although placebo-controlled trials on the effect in acute idiopathic SNHL have revealed conflicting data (probably due to the small number of patients). Clinical studies on the effect of systemic glucocorticoid monotherapy on Ménière’s disease and NIHL have not yet been performed. After intratympanic application, relief of vertigo, tinnitus and preservation of hearing in Ménière’s disease was observed in previous studies; however, recently none of these effects have been confirmed in a placebo-controlled trial. Similarly, in contrast to previous reports, chronic tinnitus of various origins did not improve after repetitive glucocorticoid application onto the round window membrane using a micropump connected to an implanted microcatheter.

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

“…Pharmacotherapeutic strategies, most of them tested on animals, include the systemic and/or local use of antioxidants (Michael, 2000), tissue plasminogen activator (Barbieri et al, 2003), neurotrophins (Miller et al, 1997), viral vectors (Lalwani et al, 1996), and corticosteroids (Alexiou et al, 2001;Chandrasekhar, 2001;Hillman et al, 2003). Corticosteroids have received significant attention in the therapy of inner ear diseases because they offer the hope of arresting, alleviating, or curing auditory dysfunction and have been shown to reduce noise-induced cochlear damage and hearing loss (Henry, 1992;Michel et al, 1993;Wang & Libermann, 2002), increase recovery after noise trauma (Lamm & Arnold, 1998;Lamm & Arnold, 1999a), and are the mainstay in the treatment of sudden sensorineural hearing loss (Herr & Marzo, 2005;Lamm & Arnold, 1999b;Wilson et al, 1980). They have also been used during stapesplasty to prevent hearing loss; however, efficacy in this specific surgical intervention on the inner ear is still under debate (Hendershot, 1974;Riechelmann et al, 2000).…”

Corticosteroid Therapy for Hearing and Balance Disorders

“…The spontaneous rate of recovery in sudden hearing loss ranges from 30 to 60% (Mattox and Simmons, 1977), which complicates conclusions about steroid efficacy. Furthermore, the use of intratympanic steroids as primary or salvage treatments also is occasionally questioned (Lamm and Arnold, 1999; Doyle et al, 2004; Piccirillo, 2011), although recent large analyses provide evidence that this delivery method is as effective as systemic delivery (Rauch et al, 2011; Seggas et al, 2011; Spear and Schwartz, 2011; Vlastarakos et al, in press; Stachler et al, 2012). Many small studies conclude steroids are helpful in many cases, but there is always a number of patients who are not helped (Garduno‐Anaya et al, 2005; Haynes et al, 2007; Chen et al, 2010; Raymundo et al, 2010; Kakehata et al, 2011; Li et al, 2011).…”

Novel Slow- and Fast-Type Drug Release Round-Window Microimplants for Local Drug Application to the Cochlea: An Experimental Study in Guinea Pigs

“…In clinical trials, positive experience with systemic or intratympanic glucocorticoid treatment was reported in im-mune-mediated cochleovestibular diseases, Ménière's disease, sudden sensorineural hearing loss and tinnitus [for reviews, see Lamm and Arnold, 1999b;Michel et al, 2000;Alexiou et al, 2001].…”