Preservation of Hearing Following Cochlear Implantation Using Different Steroid Therapy Regimens: A Prospective Clinical Study

Abstract

BackgroundA prospective clinical study was conducted to assess different regimens of steroid therapy and preservation of hearing following cochlear implantation.Material/MethodsStudy participants were ≥18 years-of-age, with a cochlear duct length ≥27.1 mm measured by computed tomography (CT), with hearing sound levels in the range of 10–120 decibels (dB) and sound frequencies of 125–250 hertz (Hz); sound levels of 35–120 dB and frequencies of 500–1,000 Hz; sound levels of 75–120 dB and frequencies of 2,000–8,000 Hz. Study exclusion criteria included diseases with contraindications for steroid therapy or medications that increased the effects of steroids. Patients had cochlear implantation and were divided into three treatment groups: intravenous (IV) steroid therapy (standard steroid therapy): combined oral and IV steroid therapy (prolonged steroid therapy); and a control group (cochlear implantation without steroid therapy). Hearing preservation was established by pure tone audiometry based on the pre-operative and postoperative average hearing thresholds according to the formula developed by the HEARRING Network.ResultsThere were 36 patients included in the study. In all cases, the cochlear implant electrode was inserted via the round window approach with a straight electrode length of 28 mm. Patients with combined oral and IV steroid therapy (prolonged steroid therapy) had better results when compared with patients with intravenous (IV) steroid therapy (standard steroid therapy) and the control group.ConclusionsProlonged steroid therapy using combined oral and IV steroids stabilized hearing thresholds and preserved hearing in adult patients following cochlear implantation.

Dose-Dependent Transient Decrease of Impedances by Deep Intracochlear Injection of Triamcinolone With a Cochlear Catheter Prior to Cochlear Implantation–1 Year Data

“…In the longer term, however, only minimal efficacy was shown (5). Other studies have therefore concentrated on the use of prolonged steroid therapy using combined oral and intravenous steroids to stabilize and preserved hearing in cochlear implantation (6). Another approach proven more effective than single-dose steroids was the use of a perioperative oral steroid taper on low frequency hearing preservation (7).…”

“…Another approach proven more effective than single-dose steroids was the use of a perioperative oral steroid taper on low frequency hearing preservation (7). Hence, it has already been shown clinically that a perioperative steroid application has, to some extend, a positive effect on residual, low frequency hearing (5)(6)(7)(8).…”

Long-Term in vivo Release Profile of Dexamethasone-Loaded Silicone Rods Implanted Into the Cochlea of Guinea Pigs

“…Many experimental studies in animals have demonstrated that the use of corticosteroids is able to preserve hearing thresholds, increase the survival of hair cells and spiral ganglia, and decrease the formation of new fibrotic tissue within implanted cochlea (20)(21)(22)(23)(24)(25)(26)(27). Clinical studies demonstrate lower impedances and improved preservation of low-frequency residual hearing in patients when corticosteroids are used in CI surgery (28)(29)(30)(31)(32)(33)(34). The efficacy is attributed to the anti-apoptotic and anti-inflammatory properties of glucocorticoids, by inhibiting immune cells and decreasing the release of inflammatory factors.…”

Role of Glucocorticoids in Hearing Preservation in Partial Deafness Treatment

“…Hearing sound levels of 35-120 dB and frequencies of 500-1000 Hz 3. Hearing sound levels of 75-120 dB and frequencies of 2000-8000 Hz [18] Exclusion criteria included suffering from severe diseases when the steroid treatment could worsen the patient's condition or when there would be a possibility of interaction between medication intake by patients and steroids. Nonparametric tests were used in the study due to discrepancies in the number of participants between all subgroups, small number of participants in the study, and violation of normal distribution of pure tone audiometry results [18].…”