Tympanotomy with sealing of the round window as surgical salvage option in sudden idiopathic sensorineural hearing loss

Loader, Benjamin; Atteneder, Claudia; Kaider, Alexandra; Franz, Peter

doi:10.3109/00016489.2013.829921

Cited by 11 publications

(5 citation statements)

References 16 publications

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“…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). Animals treated with dexamethasone or triamcinolone-acetonide delivered intratympanically in hydrogels were found to have reduced inflammation but no significant improvement post-implantation hearing (Honeder et al, 2015).…”

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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Section: Comparisons Between Drugsmentioning

confidence: 99%

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

2018

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“…A tympanoscopy (middle ear exploration) is a standard otological procedure and has been applied for many years in combination with “sealing” of the RW niche in patients with ISSHL ( Loader et al, 2013 ; Kampfner et al, 2014 ) and for removal of possible RWM obstructions in patients with ISSHL ( Plontke, 2018 ) or with Meniere’s disease ( Crane et al, 2009 ) who have failed therapy with (“blind”) intratympanic injections. All patients in our institution, who this individual treatment attempt was offered to, had quasi lost a sensory organ (complete hearing loss or non-serviceable hearing in the affected ear) and failed other guideline-conform therapies.…”

Section: Discussionmentioning

confidence: 99%

Safety and audiological outcome in a case series of tertiary therapy of sudden hearing loss with a biodegradable drug delivery implant for controlled release of dexamethasone to the inner ear

et al. 2022

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BackgroundIntratympanic injections of glucocorticoids have become increasingly common in the treatment of idiopathic sudden sensorineural hearing loss (ISSHL). However, due to their fast elimination, sustained applications have been suggested for local drug delivery to the inner ear.Materials and methodsThe study is based on a retrospective chart review of patients treated for ISSHL at a single tertiary (university) referral center. We included patients who were treated with a solid, biodegradable, poly(D,L-lactic-co-glycolic acid) (PLGA)-based drug delivery system providing sustained delivery of dexamethasone extracochlear into the round window niche (n = 15) or intracochlear into scala tympani (n = 2) for tertiary therapy of ISSHL in patients without serviceable hearing after primary systemic and secondary intratympanic glucocorticoid therapy. We evaluated the feasibility and safety through clinical evaluation, histological examination, and functional tests [pure-tone threshold (PTA), word recognition scores (WRS)].ResultsWith adequate surgical preparation of the round window niche, implantation was feasible in all patients. Histologic examination of the material in the round window niche showed signs of resorption without relevant inflammation or foreign body reaction to the implant. In patients where the basal part of scala tympani was assessable during later cochlear implantation, no pathological findings were found. In the patients with extracochlear application, average preoperative PTA was 84.7 dB HL (SD: 20.0) and 76.7 dB HL (SD: 16.7) at follow-up (p = 0.08). The preoperative average maximum WRS was 14.6% (SD: 17.9) and 39.3% (SD: 30.7) at follow-up (p = 0.11). Six patients (40%), however, reached serviceable hearing. The two patients with intracochlear application did not improve.ConclusionThe extracochlear application of the controlled release system in the round window niche and – based on limited observations - intracochlear implantation into scala tympani appears feasible and safe. Due to the uncontrolled study design, conclusions about the efficacy of the treatment are limited. These observations, however, may encourage the initiation of prospective controlled studies using biodegradable controlled release implants as drug delivery systems for the treatment of inner ear diseases.

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“…Patients with acute severe to profound sensorineural hearing loss can benefit from treatment with ExT. [3][4][5][6]22 However, as it is an invasive procedure, it should be an ultima ratio when patients do not respond to intravenous and intratympanic cortisone treatment. Our study demonstrates that sealing of the round window membrane during ExT does not impede subsequent CI that remains a viable treatment option when hearing does not recover sufficiently over time.…”

Section: Discussionmentioning

confidence: 99%

Cochlear Implantation Following Explorative Tympanotomy in Patients With Sudden Sensorineural Hearing Loss: Surgical Features and Audiological Outcomes

et al. 2021

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Objective: To investigate the anatomical status of the round window niche and hearing outcome of cochlear implantation (CI) after explorative tympanotomy (ExT) with sealing of the round window membrane in patients with sudden sensorineural hearing loss at a tertiary referral medical center. Methods: Between January 1, 2007, and July 30, 2020, 1602 patients underwent CI at our department. Out of these, all patients previously treated by ExT with sealing of the round window membrane because of unilateral sudden hearing loss were included in the study. A retrospective chart review was conducted concerning method of round window membrane sealing, intraoperative findings during CI, postoperative imaging, and hearing results. Results: Twenty one patients (9 females; 8 right ears; 54.3 years [± 12.9 years]) underwent ExT with sealing of the round window membrane with subsequent CI after 26.6 months (± 32.9 mo) on average. During CI, in 76% of cases (n = 16), the round window niche was blocked by connective tissue due to the previous intervention but could be removed completely in all cases. The connective tissue itself and its removal had no detrimental effects on the round window membrane. Postoperative computed tomography scan showed no electrode dislocation. Mean postoperative word recognition score after 3 months was 57.4% (± 17.2%) and improved significantly to 73.1% (± 16.4%, P = .005) after 2 years. Conclusion: Performing CI after preceding ExT, connective tissue has to be expected blocking the round window niche. Remaining tissue can be removed safely and does not alter the round window membrane allowing for a proper electrode insertion. Short- and long-term hearing results are satisfactory. Consequently, ExT with sealing of the round window membrane in patients with sudden sensorineural hearing loss does not impede subsequent CI that can still be performed safely.

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Tympanotomy with sealing of the round window as surgical salvage option in sudden idiopathic sensorineural hearing loss

Cited by 11 publications

References 16 publications

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

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

Safety and audiological outcome in a case series of tertiary therapy of sudden hearing loss with a biodegradable drug delivery implant for controlled release of dexamethasone to the inner ear

Cochlear Implantation Following Explorative Tympanotomy in Patients With Sudden Sensorineural Hearing Loss: Surgical Features and Audiological Outcomes

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