Round Window Niche Drilling with Intratympanic Steroid Is a Salvage Therapy of Sudden Hearing Loss

Yu, Shaohua; Jiang, Huai; Chen, Yu Bin; Chu, Yu Guo; Chen, Sui Jun; Chen, Xi Ming; He, Wu; Zheng, Yi; Zhang, Zhi Gang

doi:10.1159/000493086

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…After assessing the remaining 99 full-text articles, 41 studies were excluded for the following reasons: foreign language (n = 3), case reports (n = 3), review or meta-analysis (n = 10), and no mention of complications (n = 25). Finally, 58 studies 1-5,9-61 were included in the systemic review and meta-analysis including 25 randomized controlled trials, 10 prospective studies, and 22 retrospective case-controlled studies ( Table 1 ). A total of 2824 patients served as participants in the meta-analysis wherein 2567 received ITSI via TC (54 articles) and 257 received ITSI via VT (4 articles).…”

Section: Resultsmentioning

confidence: 99%

Tympanic Membrane Perforation After Intratympanic Steroid Injection: A Systematic Review and Meta‐analysis

Kim

Lee

et al. 2021

Otolaryngol.--head neck surg.

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Objective We investigated the incidence of tympanic membrane (TM) perforations induced after intratympanic steroid injection (ITSI) in patients with sudden sensorineural hearing loss (SSNHL) through a systematic review and meta-analysis. Data Sources PubMed, Embase, and MEDLINE. Review Methods Primary database searches were performed, and 1901 records were identified. After removal of 1802 articles through abstract screening, the remaining 99 full-text journals were assessed for eligibility to be included in the study. Fifty-eight studies that used either ventilation tubing (VT) or tympanocentesis (TC) for ITSI were selected for analysis. The subjects were divided into VT and TC groups. The rate of TM perforation after ITSI in 2 groups, sites of ITSI, needle gauge, and influence on residual hearing were investigated. Results The cohorts comprised patients who underwent VT (n = 257, 9.6%) and TC (n = 2415, 90.4%). The proportion of TM perforation after ITSI in each group was 0.073 (95% CI, 0.0469-0.1113) and 0.010 (95% CI, 0.0045-0.0215), respectively, which suggested that the VT group showed a significantly higher TM perforation rate than the TC group ( P < .001). In the subgroup analyses, there was no significant difference in the odds ratio for the rate of TM perforation according to the injection site and needle gauge for TC. The proportion of surgical repair showed no significant difference between the 2 groups. Conclusion ITSI via VT may have a significantly higher risk of TM perforation than ITSI via TC, although those are relatively small overall. ITSI should be performed in the direction to minimize possible adverse effects.

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Section: Resultsmentioning

confidence: 99%

Tympanic Membrane Perforation After Intratympanic Steroid Injection: A Systematic Review and Meta‐analysis

Kim

Lee

et al. 2021

Otolaryngol.--head neck surg.

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“…In our examination, we chose intravenous dexamethasone in an effort to achieve a higher drug concentration, using intratympanic methylprednisolone for its better diffusion coefficient, longer elimination halftime, and its ability to regulate sodium transport and reabsorption in the inner ear. 25 Accumulating evidence has indicated that the early intervention is an important prognostic factor in the therapy of SSNHL. Statistically significantly different response rates (76.1% vs 50%) were established between the early treatment group and the delayed treatment group in a retrospective study with 176 SSNHL patients who received intratympanic steroid injection.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 2 Different Intratympanic Methylprednisolone Injection Schedules in Combination With Intravenous Dexamethasone for Unilateral Sudden Sensorineural Hearing Loss

et al. 2020

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Sudden sensorineural hearing loss is a common otologic disease in clinic. Systemic and intratympanic steroid treatment have been proved to be effective, but the regimens vary from center to center. The purpose of the study is to analyze the effects of the combined application of intravenous dexamethasone and intratympanic methylprednisolone injection in different time strategies for the treatment of unilateral sudden sensorineural hearing loss. A retrospective chart review was performed for the period from March 2016 to June 2018 at our Department of Otorhinolaryngology—Head and Neck Surgery. A total number of 61 patients who met the academy criteria for unilateral sudden hearing loss were included and grouped based on the time to introduce intratympanic methylprednisolone. All the patients received intravenous dexamethasone 10 mg once daily for 5 days, followed 5 mg once daily for the next 7 days. Intratympanic methylprednisolone (40 mg) was injected every other day 4 times into all patients. This regimen was commenced on day 1 in group 1 and on day 6 in group 2. The pre and posttreatment pure-tone audiograms were analyzed. Sixty-one patients met our inclusion criteria. No significant differences were observed between patients’ demographics or pretreatment hearing thresholds. In the 3 months posttreatment pure-tone audiogram assessment, the mean hearing threshold improvement were similar between groups with no frequency specificity. The curative rate in both groups were similar and satisfying. Two patients with diabetes mellitus had persistent small perforations. Some patients had other transient discomfort that disappeared before discharge. The different timing of initiation of intratympanic methylprednisolone injection does not significantly affect the outcome of the treatment for sudden sensorineural hearing loss. Thus, we suggest that intratympanic steroid injection should not be applied as a first-line method except for patients who do not respond early to systemic steroid therapy.

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“…Yet, the oral or intravenous steroids are not recommended for pregnant patients because the prenatal exposure can cause detrimental effects in the fetus. Intratympanic dexamethasone injection is otherwise safe and efficient due to high-precision delivery to the cochlear fluids without systematic absorption, high local concentration, and long duration of medication action that regulates sodium transport and reabsorption in the inner ear [ 21 ]. Fu et al[ 22 ] conducted a prospective study on intratympanic dexamethasone for SSNHL in pregnancy with a curative rate (CR + PR) of 33%, and their single dosage was 4 mg at various times of injections according to the pure-tone audiogram improvements[ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Intratympanic dexamethasone injection for sudden sensorineural hearing loss in pregnancy

Lyu

Zeng

Zhou

et al. 2020

WJCC

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BACKGROUND As sudden sensorineural hearing loss (SSNHL) rarely occurs in pregnant women, there is a lack of knowledge and relevant research on its management. AIM To investigate the effect of intratympanic dexamethasone injection in the treatment of pregnant patients with SSNHL. METHODS A retrospective chart review was made for the period between June 2017 and August 2019 at our Department of Otorhinolaryngology-Head and Neck Surgery. Pregnant women who met the criteria for SSNHL were included and grouped based on the therapeutic modalities. The treatment group received intratympanic dexamethasone (2.5 mg) q.o.d. for a total of four times, while the control group received no medication other than bed rest and medical observations. All the patients were under close care of obstetricians. Pure-tone audiograms were performed before and after treatment. RESULTS Eleven patients who met the inclusion criteria were assigned to the treatment group ( n = 7) and the control group ( n = 4). The mean age of patients was 31.2 ± 3.8 years; the right ear was affected in seven (63.64%) cases. Two patients (18.2%) suffered from vertigo, 10 (90.9%) suffered from tinnitus and 6 (54.5%) suffered from aural fullness. The time from onset to clinic visit was relatively short, with a mean time of 1.3 ± 0.9 d. All the women were within the second or third trimester; the average gestation period was 26.0 ± 6.2 wk. The pure-tone averages at onset between the two groups were similar. After one wk of therapy, the treatment group had a curative rate of 57.1% and a significantly better hearing threshold and greater improvement compared to the control group (all P < 0.05). Some patients experienced transient discomfort from intratympanic injections that disappeared after getting rest, while none had permanent complications. All patients delivered healthy full-term neonates with an average Apgar score of 9.7 ± 0.5. CONCLUSION Intratympanic dexamethasone injections can be used as a first-line therapy in pregnant women with SSNHL.

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Round Window Niche Drilling with Intratympanic Steroid Is a Salvage Therapy of Sudden Hearing Loss

Cited by 8 publications

References 24 publications

Tympanic Membrane Perforation After Intratympanic Steroid Injection: A Systematic Review and Meta‐analysis

Tympanic Membrane Perforation After Intratympanic Steroid Injection: A Systematic Review and Meta‐analysis

Comparison of 2 Different Intratympanic Methylprednisolone Injection Schedules in Combination With Intravenous Dexamethasone for Unilateral Sudden Sensorineural Hearing Loss

Intratympanic dexamethasone injection for sudden sensorineural hearing loss in pregnancy

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