Response: Effectiveness of Intratympanic Dexamethasone Injection in Sudden-Deafness Patients as Salvage Treatment

Ho, Guan‐Min

doi:10.1097/01.mlg.0000149771.42368.61

Cited by 70 publications

(166 citation statements)

References 3 publications

Supporting

Mentioning

147

Contrasting

Unclassified

Order By: Relevance

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2006

View full text Add to dashboard Cite

Before new drugs for the treatment of inner ear disorders can be studied in controlled clinical trials, it is important that their pharmacokinetics be established in inner ear fluids. Microdialysis allows drug levels to be measured in perilymph without the volume disturbances and potential cerebrospinal fluid contamination associated with fluid sampling. The aims of this study were to show: (i) that despite low recovery rates from miniature dialysis probes, significant amounts of drug are removed from small fluid compartments, (ii) that dialysis sampling artifacts can be accounted for using computer simulations and (iii) that microdialysis allows quantification of the entry rates through the round window membrane (RWM) into scala tympani (ST). Initial experiments used microdialysis probes in small compartments in vitro containing sodium fluorescein. Stable concentrations were observed in large compartments (1000 μl) but significant concentration declines were observed in smaller compartments (100, 10 and 5.6 μl) comparable to the size of the inner ear. Computer simulations of these experiments closely approximated the experimental data. In in vivo experiments, sodium fluorescein 10 mg/ml and dexamethasone-dihydrogen-phosphate disodium salt 8 mg/ml were simultaneously applied to the RWM of guinea pigs. Perilymph concentration in the basal turn of ST was monitored using microdialysis. The fluorescein concentration reached after 200 min application (585 ± 527 μg/ml) was approximately twice that of dexamethasone phosphate (291 ± 369 μg/ml). Substantial variation in concentrations was found between animals by approximately a factor of 34 for fluorescein and at least 41 for dexamethasone phosphate. This is, to a large extent, thought to be the result of the RWM permeability varying in different animals. It was not caused by substance analysis variations, because two different analytic methods were used and the concentration ratio between the two substances remained nearly constant across the experiments and because differences were apparent for the repeated samples obtained in each animal. Interpretation of the results using computer simulations allowed RWM permeability to be quantified. It also demonstrated, however, that cochlear clearance values could not be reliably obtained with microdialysis because of the significant contribution of dialysis to clearance. The observed interanimal variation, e.g., in RWM permeability, is likely to be clinically relevant to the local application of drugs in patients.

show abstract

Section: Introductionmentioning

confidence: 99%

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

et al. 2006

View full text Add to dashboard Cite

show abstract

“…This was also noted by Parnes et al who treated 37 patients affected by several inner ear disorders [10] and by Ho et al in 39 cases [24]. The absence of relationship between start of treatment and outcome is very important allowing to perform an ITS as salvage therapy also after several days of delay and further diagnostic exams as imaging.…”

Section: Discussionmentioning

confidence: 73%

Sudden Sensorineural Hearing Loss: Results of intratympanic steroids as salvage treatment

Stefano

Costantino

Marchese

et al. 2013

American Journal of Otolaryngology

View full text Add to dashboard Cite

Objective: The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone to treat sudden sensorineural hearing loss as salvage therapy. Materials and methods: A prospective study was conducted on patients affected by idiopathic sudden hearing loss who were treated before with some systemic therapy, but without recovery of the hearing The patients able to undergo the study, but who refused salvage treatment were considered as control group. A solution of Dexamethasone 4 mg/ml was then injected through the posterior-inferior quadrant filling completely the middle ear.The follow-up in the following 6 months included an audiogram every month. Results: The number of patients treated with salvage therapy was 36. The patients who refused treatment were further 10. The salvage treatment was done with a mean delay of 24.3 days from the onset of symptoms. Mean hearing threshold after the onset of sudden hearing loss at PTA was 66.5 dB. After the failed treatment the mean PTA was 59.6 dB. The mean PTA after the intratympanic steroid administration was 46.8 dB, with a mean improvement of 12.8 dB. No hearing change was noted in the 10 patients who refused salvage therapy. The patients that assumed systemic steroid as first therapy showed a better PTA threshold after the salvage intratympanic treatment (p < 0.01). A significant difference (p < 0.05) of hearing recovery was evidenced between non-smoker patients and those with smoking habit. Conclusions: Our data showed that a salvage treatment with intratympanic dexamethasone should be suggested to all patients who failed the first systemic treatment. The systemic steroid therapy done before the salvage treatment seems to exert a protective role for the inner ear, as shown by our series. On the contrary the smoke habit is a negative prognostic factor in the hearing recovery.

show abstract

“…On the other hand Ho et al [11] administered weekly intratympanic steroids for three consecutive weeks to the 39 patients who had not recovered despite oral steroid therapy. In that study, a total of 14 patients received the standard treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[4,11,18,25,26] The most widely accepted concept is that the treatment outcome will be better when treatment is initiated within the first 7-10 days. [4,18] In a study including 326 patients, Huy and Sauvaget [16] found no difference in treatment outcome between day 1 and day 6 when the treatment was initiated within the first week.…”

Section: Discussionmentioning

confidence: 99%

“…[9,10] However, the effect of medical therapy on prognosis is controversial, because up to 65% of the cases recover spontaneously. [11,12] The present study aimed to evaluate the effect of early initiation of treatment and the effectiveness of treatment protocols directed to eliminate the etiologic factors. We also evaluated the effect of various prognostic factors on the course of the disease in order to contribute to the literature.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The importance of the first three days and other diagnostic indicators in sudden hearing loss

Tüzemen

Kasapoğlu²,

Hizalan³

et al. 2016

Kulak Burun Bogaz Ihtis Derg

View full text Add to dashboard Cite

Objectives: This study aims to compare different therapy methods used for sudden sensorineural hearing losses, to determine the prognostic factors and particularly to investigate the importance of starting the therapy within the first three days of the prognosis. Patients and Methods:Between January 1995 and December 2008, the files of 213 patients who were treated in our clinic were reviewed. A total of 155 patients who met the inclusion criteria were included in the study. The study groups were classified according to the prognostic and audiometric factors. Results:With regard to the effectiveness of treatment options, post-treatment audiometric improvement was significantly better in the patients treated with carbogen in addition to the medical therapy compared to the other groups (p=0.018). In terms of the patient characteristics at the time of admission, having vertigo, presence of a descending type audiogram curve and severe hearing loss affected the success of treatment negatively, while mild hearing loss and presence of an ascending type audiogram curve had a positive effect. The recovery rate was higher in patients who were admitted within the first three days (p=0.005). Conclusion:It was found that starting the therapy within the first three days and adding the carbogen to the conventional medical treatment may improve the outcome of the treatment.Keywords: Carbogen; first three days; prognosis; sudden hearing loss. ÖZAmaç: Bu çalışmada ani sensörinöral işitme kayıpları için kullanılan farklı tedavi yöntemleri karşılaştırıldı, prognostik faktörler belirlendi ve özellikle prognozun ilk üç gününde tedaviye başlamanın önemi araştırıldı. Bulgular:Tedavi seçeneklerinin etkililiği ile ilgili olarak, tıbbi terapiye ek olarak karbojen ile tedavi edilen hastalarda tedavi sonrası odyometrik iyileşme diğer gruplarla karşılaştırıldığında anlamlı olarak daha iyiydi (p=0.018). Başvuru sırasında hasta özellikleri açısından baş dönmesi, odyogramda alçalan eğri ve ciddi işitme kaybı tedavinin başarısını olumsuz etkilerken, hafif işitme kaybı ve odyogramda yük-selen eğrinin varlığı tedavi için olumlu bir etkiye sahiptir. İlk üç gün içinde başvuran hastalarda iyileşme oranı daha yüksekti (p=0.005). Sonuç:Tedaviye ilk üç gün içinde başlamanın ve konvansiyonel tıbbi tedaviye karbojenin eklenmesinin tedavinin sonucunu iyileştire-bileceği gözlendi.Anahtar Sözcükler: Karbojen; ilk üç gün; prognoz; ani işitme kaybı.

show abstract

Response: Effectiveness of Intratympanic Dexamethasone Injection in Sudden-Deafness Patients as Salvage Treatment

Cited by 70 publications

References 3 publications

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

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

Sudden Sensorineural Hearing Loss: Results of intratympanic steroids as salvage treatment

The importance of the first three days and other diagnostic indicators in sudden hearing loss

Contact Info

Product

Resources

About