Intratympanic Triamcinolone and Dexamethasone in the Treatment of Ménière's Syndrome

Jumaily, Mejd; Faraji, Farhoud; Mikulec, Anthony A.

doi:10.1097/mao.0000000000001311

Cited by 12 publications

(10 citation statements)

References 35 publications

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“…In former studies, IT triamcinolone was not evaluated in ISSNHL but it was rated to be helpful in the treatment of Ménière's disease [28]. Due to the small group size, our results do not reach statistical significance.…”

Section: Discussioncontrasting

confidence: 56%

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Roßberg

Goetz

Timm

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose To evaluate temporal bone cone-beam CT in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) being treated with primary and secondary intratympanic (IT) triamcinolone and to possibly correlate these results to the clinical outcome. Methods Retrospective analysis of patients treated with IT triamcinolone for ISSNHL at our department in 2018. Pre-and post-therapeutic audiologic examinations included four-tone average (FTA) at 0.5, 1, 2 and 3 kHz. Using a clinical questionnaire, pre-therapeutic CBCT scans were re-evaluated looking at items, which might interfere with adequate drug diffusion into the inner ear (e.g. bony overhangs or secondary membranes at the round or oval window). Results Thirty-one patients were included. Twenty-four (77%; group A) had experienced ineffective systemic steroid therapy before and seven (23%; group B) received primary IT injections. Four group A-patients (21%) and two group B-patients (33%) showed a post-therapeutic FTA improvement of more than 15 dB HL. Bony overhangs at the round window niche (RWN) were present in seven cases (26%), a secondary membrane at the RWN in four (15%) and soft tissue in eight (30%) cases, respectively. Conclusion Most patients present radiological findings in CBCT imaging, which might interfere with drug diffusion through the RW membrane. Interestingly, soft or bony tissue obstructing the RWN or the OWN was found in 50% of patients, who showed improvement of hearing. We conclude that radiologic 'tiny' findings are either clinically irrelevant or improvement in hearing is independent from intratympanic drug delivery.

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Section: Discussioncontrasting

confidence: 56%

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Roßberg

Goetz

Timm

et al. 2020

Eur Arch Otorhinolaryngol

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“…Our lack of TM complications or permanent injury with IT injection was consistent with reports in the literature describing its relative safety. 45 However, because multiple IT injections do add theoretical risk to TM injury and may subsequently impact low-frequency PTA, [46][47][48] the investigation of novel treatments that may decrease the number of necessary IT injections, such as the described migraine prophylactic medications, is important. The lack of TM complications following IT injections in our studied cohort can be attributed to: 1) application of a very small amount of phenol (approximately the size of a 25 Ga needle) on the TM to minimize the chance of Laryngoscope 00: 2020…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Migraine Medications in the Treatment of Sudden Sensorineural Hearing Loss

et al. 2020

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Objectives/Hypothesis: To examine the hearing outcomes of patients with sudden sensorineural hearing loss (SSNHL) treated with oral and intratympanic (IT) steroid only or a combination of steroid and migraine treatment. Our hypothesis was that adjuvant migraine medications may improve outcomes in SSNHL. Methods: A retrospective chart review at a tertiary otology center was conducted to identify patients with SSNHL who received oral steroid and IT dexamethasone injection(s) with or without migraine medications (a combination of nortriptyline and topiramate). Results: A total of 47 patients received oral steroid and IT dexamethasone injection(s) only, and 46 patients received oral steroid and IT dexamethasone injection(s) as well as migraine lifestyle changes plus a combination of nortriptyline and topiramate. There were no significant differences in demographics and baseline audiometric data between the two groups. Both groups demonstrated improvements in pure tone average (PTA) and hearing thresholds at 250 Hz and 8000 Hz posttreatment. However, compared to steroid-only group, the adjuvant migraine medications group had significantly greater improvements in hearing thresholds at the lower frequencies (250 Hz, 500 Hz, 1000 Hz). Patients in the latter cohort also had greater improvement in PTA (P = .01) and received fewer IT injections (P = .04) PTA improvement of ≥ 10 dB was observed in 36 patients (78%) in the adjuvant migraine medications group and 22 patients (46%) in the control group (P < .001). Conclusion: In multimodal treatment of SSNHL, supplementing oral and IT steroid with migraine medications may result in greater improvements in lower frequency hearing thresholds and PTA. Furthermore, adjuvant migraine treatment can lead to decrease in number of IT injections, thus reducing procedure-related risks and complications.

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“…These properties (readily entering the ear, being metabolized there to a form that is eliminated slowly and which therefore becomes widely distributed throughout the ear) could make triamcinolone-acetonide a better candidate for local therapy of hearing disorders. Intratympanic triamcinolone-acetonide suspension (applied form verified with the authors) has been used clinically in patients with Ménierè’s syndrome and reported to be a safe and potentially effective procedure for vertigo control (Jumaily et al, 2017). It has also been used as a standard therapy for secondary (salvage) treatment of idiopathic sudden sensorineural hearing loss in some institutions including in one the authors (SKP), (Loader et al 2013, Plontke 2017).…”

Section: Comparisons Between Drugsmentioning

confidence: 99%

Pharmacokinetic principles in the inner ear: Influence of drug properties on intratympanic applications

2018

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Local drug delivery to the ear has gained wide clinical acceptance, with the choice of drug and application protocol in humans largely empirically-derived. Here, we review the pharmacokinetics underlying local therapy of the ear using the drugs commonly used in clinical practice as examples. Based on molecular properties and perilymph measurements interpreted through computer simulations we now better understand the principles underlying entry and distribution of these and other drugs in the ear. From our analysis, we have determined that dexamethasone-phosphate, a pro-drug widely-used clinically, has molecular and pharmacokinetic properties that make it ill-suited for use as a local therapy for hearing disorders. This polar form of dexamethasone, used as a more soluble agent in intravenous preparations, passes less readily through lipid membranes, such as those of the epithelia restricting entry at the round window membrane and stapes. Once within the inner ear, dexamethasone-phosphate is cleaved to the active form, dexamethasone, which is less polar, passes more readily through lipid membranes of the blood-perilymph barrier and is rapidly eliminated from perilymph without distributing to apical cochlear regions. Dexamethasone-phosphate therefore provides only a brief exposure of the basal regions of the cochlea to active drug. Other steroids, such as triamcinolone-acetonide, exhibit pharmacokinetic properties more appropriate to the ear and merit more detailed consideration.

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Intratympanic Triamcinolone and Dexamethasone in the Treatment of Ménière's Syndrome

Cited by 12 publications

References 35 publications

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Adjuvant Migraine Medications in the Treatment of Sudden Sensorineural Hearing Loss

Pharmacokinetic principles in the inner ear: Influence of drug properties on intratympanic applications

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