Short Term Results of Intra Tympanic Gentamicin and Dexamethasone on Hearing and Tinnitus in Meniere’s disease: A Case Control Study

Abstract

Objective: The role of this study was to evaluate the effectiveness of intra tympanic administration of Gentamicin(40 mgs/ml) and Dexamethasone 0.5 ml(4 mgs/ml) on hearing and tinnitus of patients who had recurrent acute attacks of vertigo, tinnitus and hearing loss. Study Design: 60 consecutive patients of Meniere's disease were randomly divided into 3 groups of twenty patients each. Group A included 20 patients who received intra tympanic gentamicin, Group B included 20 patients who received intra tympanic dexamethasone and Group C included 20 patients who received intra tympanic normal saline 0.5 ml. The mean pure tone thresholds at speech frequencies were noted before treatment and 2 weeks, 3 months and 6 months after treatment. Tinnitus was surveyed with a set questionnaire (Tinnitus Handicap Inventory). Results: The mean PTA at speech frequencies for Group A worsened from 50 dB to 62 dB which was statistically significant. Two ears developed profound sensorineural hearing loss. The mean tinnitus handicap inventory grade of group A was 4. Mean was 2 at the end of 6 months which indicates significant reduction of the tinnitus score. Group B patients had a mean PTA at speech frequencies of 42 dB. There was no gain in 12 patients and less than 10 dB in the remaining eight patients and no worsening of hearing was seen. The mean tinnitus handicap inventory grade in Group B was 2.5 and was 2 at 6 months after treatment. Group C patients had a mean PTA of 48 dB before treatment and were same after treatment however the tinnitus handicap grade was 2.5 before the treatment and 2.0 after treatment. Conclusion: Intra tympanic gentamicin is more effective in controlling tinnitus as compared to dexamethasone and placebo and there was no marked difference in control of tinnitus between placebo and steroids. There is significant hearing loss with IT Gentamicin and no marked difference between steroid and placebo on hearing.

Dexamethasone (DXM)‐Coated Poly(lactic‐co‐glycolic acid) (PLGA) Microneedles as an Improved Drug Delivery System for Intracochlear Biodegradable Devices

“…However, IT injections deliver significantly smaller amounts of drug to the inner ear due to minimal diffusion through the RWM and drainage of the drugs out of the ear via the Eustachian tube. [ 12 ] Additionally, the pharmacokinetic profile of the drugs administered intratympanically to the inner ear are highly dependent on the physiochemical property of the drug itself. [ 37 ] Drug delivery materials were subsequently developed which were placed on or near the RWM, yet when these materials are displaced, the drug delivery is compromised.…”

“…[9] To address these issues, studies have repeatedly shown that dexamethasone (DXM), a corticosteroid, combats HC death by altering the expression levels of apoptosis related genes. [10][11][12][13][14][15] While systemic forms of drug delivery of DXM are available, undesirable side effects are common and the effective dose may not reach the ear when given systemically. [16] Other currently available treatment methodologies and strategies, apart from new drug development, include intratympanic (IT) injections of drugs, cochlear implants, stem cell therapies, manipulation of gene expression, viral vectors, thermosensitive gels, nanoparticles, and placement of drug delivery materials on the surface of the round window membrane (RWM), amongst others.…”