Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy

Abstract

The purpose of this prospective study was to test whether intratympanic application of dexamethasone/hyaluronic acid improves hearing outcome in patients with pantonal idiopathic sudden sensorineural hearing loss (ISSHL), in patients with sudden deafness or sudden profound SHL and in patients with predominant high-frequency ISSHL who are refractory to intravenous steroid and vasoactive therapy. The study took place in an academic tertiary referral hospital involving 21 patients with pantonal ISSHL, 10 patients with sudden deafness or sudden profound SHL and 9 patients with a high-frequency ISSHL. Intratympanic dexamethasone/hyaluronic acid was administered in the affected ear. Hearing was evaluated by means of standard pure-tone audiometry. The differences between pure-tone hearing thresholds by air conduction before intravenous therapy and before the beginning of the intratympanic therapy, as well as before and after intratympanic therapy, were calculated. Statistical analysis was performed by means of the Wilcoxon's test for paired samples. Intratympanic injection of dexamethasone/hyaluronic acid results in a significant global (pantonal) improvement in hearing in patients with pantonal ISSHL. It also effects improvement in hearing at selected frequencies (namely at 1.5 and 3 kHz) in patients with a predominant high-frequency ISSHL and at selected frequencies (namely at 0.5, 0.75 and 1 kHz) in patients with sudden deafness or sudden profound SHL. Neither systemic nor local side effects were observed. Intratympanic administration of dexamethasone/hyaluronic acid provides a safe and efficacious therapeutic option for the treatment of patients with pantonal and high-frequency ISSHL who don't respond to intravenous steroid and vasoactive therapy.

Local inner-ear drug delivery and pharmacokinetics

“…In animal experiments, fibrin glue was employed to stabilize the applied volume as a gel (45), while in man hyaluronic acid (14,79,80) or resorbable gelatine-sponges (81) have been used. Despite this, the doses, dosing intervals and therapeutic durations required to achieve a specific therapeutic goal are hard to predict.…”

“…Gentamicin is toxic to the sensory cells of the balance system and thereby suppresses the vertigo in these patients by partially ablating their vestibular system. There are also an increasing number of clinical reports related to the local application of glucocorticoids for acute hearing loss (9,10,11,12,13,14,15,16), glucocorticoids for Menière's disease (17,18,19,20) or for tinnitus (21,22,23,24,25). Other substances that have been tested in humans include local anaesthetics, neurotransmitters and neurotransmitter antagonists (26,27).…”

Cochlear microdialysis for quantification of dexamethasone and fluorescein entry into scala tympani during round window administration

“…There are a growing number of clinical reports with regard to local treatments with corticosteroids in cases of acute hearing loss of various causes (Chandrasekhar, 2001;Gian-oli and Li, 2001;Gouveris et al, 2005;Ho et al, 2004;Lautermann et al, 2005;Lefebvre and Staecker, 2002;Plontke et al, 2005;Silverstein et al, 1996;Parnes et al, 1999), of Meniere's disease (Itoh and Sakata, 1991;Sennaroglu et al, 2001;Shea and Ge, 1996;Silverstein et al, 1998) and of tinnitus (Cesarani et al, 2002;Coles et al, 1992;Sakata et al, 1997;Shulman and Goldstein, 2000;Silverstein et al, 1996). In addition, a number of investigational drugs show promising results with respect to protection when locally applied to the RWM Chen et al, 2003b;Hight et al, 2003;Keithley et al, 1998).…”

Metilprednisolona intratimpânica como terapia de resgate na surdez neurossensorial súbita

“…Other authors have also described the use of intratympanic corticosteroids for the treatment of SHL. 9,[12][13][14][15][16][17][18][19][20][21][23][24][25][26][27] Although its efficacy alone has not been proved definitively, intratympanic corticosteroid therapy for SHL is becoming more widely used. The variability among treatment protocols for SHL also applies to intratympanic corticosteroid therapy.…”

“…13,15,16 Most studies about intratympanic corticosteroids for treating SHL report having attempted this mode of therapy after systemic corticosteroid therapy has failed. 9,[12][13][14][15][16][17][18][19][20][21][25][26][27] Two studies evaluated the effects of intratympanic corticosteroids as adjuvant therapy to systemic corticosteroids in SHL patients. 23,24 There are several advantages of using intratympanic corticosteroids (see Frame I).…”