Intratympanic Dexamethasone and Hyaluronic Acid in Patients with Low-Frequency and Ménière's-Associated Sudden Sensorineural Hearing Loss

Selivanova, Oxana; Gouveris, Haralampos; Victor, Anja; Amedee, Ronald G.; Mann, Wolf J.

doi:10.1097/01.mao.0000185050.69394.48

Cited by 60 publications

(42 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This result is similar to our previous study [9] and Ahn et al's [18] study which showed that early salvage ITDI may provide more rapid hearing improvement than late salvage ITDI, especially at low frequency. In fact, it was reported that intratympanic combined dexamethasone/ hyaluronic acid injection showed hearing improvement in patients with isolated low-frequency idiopathic SSNHL or sensorineural hearing loss from Meniere's disease who have failed intravenous steroid and vasoactive treatments [19]. This phenomenon may be explained by the differential vulnerability of cochlear turns in the sense that apical hair cells are more resistant to toxic stimuli including ototoxic drugs or noise than basal hair cells [20,21].…”

Section: Discussionmentioning

confidence: 92%

The efficiency of intratympanic dexamethasone injection as a sequential treatment after initial systemic steroid therapy for sudden sensorineural hearing loss

Lee

Choi

Park

et al. 2011

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

The effect of intratympanic steroid injection is controversial as salvage or initial treatment option for sudden sensorineural hearing loss (SSNHL) and almost unknown if it is consecutively to use after initial systemic steroids. This study aimed to analyze the efficiency of intratympanic dexamethasone injection (ITDI) as a sequential treatment in the patients who failed initial systemic steroid treatments for SSNHL. Forty-six patients with SSNHL who did not respond to initial systemic steroids were prospectively included in the study. The patients were randomly classified into two groups; the ITDI group (21 patients) did not take four sequential ITDI within 2 weeks after systemic steroids, and the control group (25 patients) took any more medications. Hearing improvement was defined as a 10 dB or more decrease in the pure tone average (PTA) of the four-frequencies (0.5, 1, 2, and 3 kHz). Hearing improvement was observed in 10 (47.6%) of 21 ITDI patients and in 4 (16.0%) of 25 control patients (P = 0.027). An improvement of the mean PTA was 11.4 dB in the ITDI group and 1.7 dB in the control group (P = 0.004). The ITDI group showed significant hearing improvement at low frequency (500 Hz) than the control group. The patients with 70 or more dB in PTA before ITDI showed significant hearing improvement than the other patients with better PTAs (P = 0.038). The sequential ITDI, which is performed immediately after initial systemic steroid therapy, may be a simple, effective second-line treatment of choice for the patients who show poor response to initial treatments for SSNHL.

show abstract

Section: Discussionmentioning

confidence: 92%

The efficiency of intratympanic dexamethasone injection as a sequential treatment after initial systemic steroid therapy for sudden sensorineural hearing loss

Lee

Choi

Park

et al. 2011

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…In a guinea pig model, 1 h after IT treatment, perilymph levels of dexamethasone were 20% higher when used in the presence of HA (9.5 mg/ml) compared with dexamethasone alone [Chan-drasekhar et al, 2000]. Although these results were not statistically significant, follow-up human clinical trials using IT dexamethasone combined with HA (0.2 mg/ml) reported significant improvement in hearing in specific subgroups of patients with ISSHL or Ménière's disease Selivanova et al, 2005]. However, these were not controlled trials, making it unclear whether HA played a role in these results.…”

mentioning

confidence: 87%

“…These include repeated transtympanic injections [Chandrasekhar et al, 2000;Chandrasekhar, 2001;Ho et al, 2004;Gouveris et al, 2005;Selivanova et al, 2005], instillation through ventilation tubes [Parnes et al, 1999;Parnes, 2004, 2005], and continuous infusion (up to 28 days) through microcatheters temporarily implanted in the round window niche [Kopke et al, 2001;Plontke et al, , 2009Salt and Plontke, 2005].…”

mentioning

confidence: 99%

Hyaluronic Acid Hydrogel Sustains the Delivery of Dexamethasone across the Round Window Membrane

Borden¹,

Saunders

Berryhill

et al. 2010

Audiol Neurotol

View full text Add to dashboard Cite

Background: The use of intratympanic (IT) steroids for the treatment of inner ear disorders is promising, but the clinical challenges of prolonged middle ear drug application have proven burdensome, and a sustainable delivery system is yet to be developed. Method: In this study, a guinea pig model was used to determine if dexamethasone in combination with a hyaluronic-acid (HA)-based hydrogel is an efficient, stable and sustainable dexamethasone delivery system to the inner ear. For each animal, right and left middle ear bullae were randomly selected to be filled with dexamethasone alone or dexamethasone-HA (Dex-HA) gel. Perilymph samples were collected at different time points and dexamethasone levels were determined using an ELISA. Results: Dexamethasone was measurable in the perilymph samples up to 72 h after treatment. At 24 h after treatment, the perilymph dexamethasone concentrations were significantly higher (p = 0.01) in the ears treated with Dex-HA gel than in those treated with dexamethasone alone. While the perilymph dexamethasone concentration had decreased at 48 h after treatment with Dex-HA gel, the levels were still higher than those observed at 24 h in ears treated with dexamethasone alone. A high variability in dexamethasone concentration was observed between the samples, and the variability between matched ears receiving different treatments was remarkably lower than the variability within each treatment group, suggesting that individual parameters might play a major role in perilymph dexamethasone concentration. There was no statistically significant correlation between dexamethasone concentration and sex, weight or laterality. Conclusions: Our results show that the Dex-HA gel used in this study provides an effective and sustained dexamethasone release mechanism that might be utilized to treat conditions such as sudden sensorineural hearing loss. This could potentially reduce the morbidity and costs associated with IT treatment.

show abstract

“…A very rapid chemical conversion within the cochlea from drug salt to active drug occurs within 15 min [Hargunani et al, 2006] and dexamethasone is completely removed from the inner ear in under 24 h [Parnes et al, 1999;Chandrasekhar et al, 2000;Liu et al, 2004;Hargunani et al, 2006]. Third, transtympanic delivery of steroids is already in otologic practice [Gianoli and Li, 2001;Ho et al, 2004;Gouveris et al, 2005;Selivanova et al, 2005]. Fourth, the round window is accessible during cochlear implant surgery.…”

Section: Introductionmentioning

confidence: 99%

Effects of Round Window Dexamethasone on Residual Hearing in a Guinea Pig Model of Cochlear Implantation

James

Eastwood²,

Richardson³

et al. 2007

Audiol Neurotol

132

152

View full text Add to dashboard Cite

To study electric acoustic stimulation, we have developed a model of guinea pig cochlear implantation via a cochleostomy. Thirty minutes prior to implantation, a hyaluronic acid/carboxymethylcellulose bead, loaded with either dexamethasone or normal saline, was placed upon the round window membrane. Animals that did not receive beads acted as controls. Pure-tone auditory brainstem response thresholds were estimated before and after electrode insertion, and 1 and 4 weeks later. Selected cochlear histology was performed. Results: Dexamethasone could be detected in the cochlea for 24 h after cochlear implantation. Thresholds were elevated across frequencies in all animals immediately after surgery. These thresholds recovered completely at and below 2 kHz, and partially at higher frequencies by 1 week after implantation. At 32 kHz, but not the lower frequencies, the presence of dexamethasone had a significant protective effect upon hearing, which increased in magnitude over time. The protection was greatest in difficult implantations where an intractable resistance to electrode insertion was met. There was a persistent foreign body reaction at the site of implantation of saline-treated implanted ears but not in the dexamethasone-treated implanted ears. Conclusion: Short-term preoperative delivery of dexamethasone through the round window can protect residual hearing during cochlear implantation, especially during technically difficult surgery.

show abstract

Intratympanic Dexamethasone and Hyaluronic Acid in Patients with Low-Frequency and Ménière's-Associated Sudden Sensorineural Hearing Loss

Cited by 60 publications

References 17 publications

The efficiency of intratympanic dexamethasone injection as a sequential treatment after initial systemic steroid therapy for sudden sensorineural hearing loss

The efficiency of intratympanic dexamethasone injection as a sequential treatment after initial systemic steroid therapy for sudden sensorineural hearing loss

Hyaluronic Acid Hydrogel Sustains the Delivery of Dexamethasone across the Round Window Membrane

Effects of Round Window Dexamethasone on Residual Hearing in a Guinea Pig Model of Cochlear Implantation

Contact Info

Product

Resources

About