Intratympanic infliximab is a safe and effective rescue therapy for refractory immune-mediated hearing loss
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To determine the efficacy and safety of the intratympanic infiltration of infliximab at the hearing threshold of patients in follow-up for refractory immune-mediated hearing loss.
17 patients were collected with relapses, despite maintenance treatment with oral azathioprine associated or not with oral prednisone at low doses (between 5 and 7.5 ml/day) or refractory relapses to previous intratympanic corticoid treatment being 19 affected ears infiltrated. We measured the hearing threshold by Pure-Tone Average (PTA) 500–3000 Hz, 125–8000 Hz and 250–8000 Hz in pre-infiltration (baseline) and follow-up 3 weeks post-infiltration with auditory threshold at frequencies 125–8000 Hz.
The average age was 50.68 years (±15.23 years). After the administration of intratympanic infliximab, an improvement of the hearing threshold was showed in the Pure-Tone Average (PTA) calculated at 500–3000 Hz (p = 0.004), 125–8000 Hz (p = 0.001) and 250–8000 Hz (p = 0.006). An immediate improvement in low frequencies also was observed: 125, 250 and 500 Hz (p = 0.009, p = 0.002 and p < 0.001 respectively) also at 1000 Hz (p = 0.004) and a persistence of the effect at 3 months in the low frequencies: 125 Hz (p = 0.020), 250 Hz (p = 0.006) and 500 Hz (p = 0.002).
Infliximab intratympanic infiltration improves the hearing threshold in patients with immune-mediated hearing loss. The effect of improving the hearing threshold is higher in low frequencies and persists within 3 months of the infiltration. The administration of intratympanic infliximab is an effective and safe technique.
KeywordsHearing loss Hearing disorders Infliximab Injection intratympanic Audiometry pure tone Auditory threshold
The authors acknowledge support of physicians and nurses of the Otolaryngology and Rheumatology services of Torrejón Hospital that have collaborated in the attention of the patients of the study.
NMC designed and carried out the study, analysed data and wrote the paper; NMC and LSV designed and performed experiments at the centre in Spain; NMC and LSV collected and analysed data from the centre; NMC, DVD and AGF provided statistical analysis and critical revision. All authors contributed equally to this work. NMC, DVD and AGF reviewed data from all sites and provided interpretive analysis; NMC, LSV and AGF wrote the main paper. All authors discussed the results and implications and commented on the manuscript at all stages.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Hospital research committee (Torrejón Hospital research committee INF-HUT-2019) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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