Advertisement

Early Intratympanic Methylprednisolone in Sudden SNHL: A Frequency-wise Analysis

  • Anita BhandariEmail author
  • Satish Jain
Original Article
  • 23 Downloads

Abstract

Sudden sensorineural hearing loss is a dire medical emergency which must be treated at the earliest to get better long term hearing results. Our study aims to determine the efficacy of intratympanic steroid (Methylprednisolone) on auditory outcomes in patients of sudden sensorineural hearing loss and study the relation between time of onset of hearing loss to start of therapy and frequency-wise recovery of hearing loss. A prospective cohort clinical study with 33 patients with sudden hearing loss of 30 dB or more were treated with the intratympanic injection of methylprednisolone and the effect of the drug was observed. In this study, 33 patients with sudden onset (unilateral or bilateral) of hearing loss were treated with intratympanic methylprednisolone. The duration at which the drug was administered and the age of the participants was taken into consideration. Main outcome measures included audiometry results at low, medium and high hearing loss frequencies. The specific frequency at which the hearing improvement took place was tabulated. It was observed that hearing improved significantly if the steroid is injected within the first 4 days of onset (p < 0.05) at all the frequencies. A gain of 15 dB or more was achieved in more than 78% patients after injecting methylprednisolone intratympanically. A statistically significant association was found between recovery rate and frequency of hearing loss with patients showing greater improvement at low hearing loss frequency in comparison to mid and high frequencies (p < 0.05). The drug efficacy does not change with the age of the patient.

Keywords

Sudden hearing loss Methylprednisolone Intratympanic injection Audiometric gain Frequency Onset Age 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Wilson WR, Byl FM, Laird N (1980) The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double-blind clinical study. Arch Otolaryngol 106(12):772–776CrossRefGoogle Scholar
  2. 2.
    Jaffe B (1973) Clinical studies in sudden deafness. Adv Otorhinolaryngol 20:221–228Google Scholar
  3. 3.
    WilsonVetriR L et al (1983) Viral and epidemiological studies of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg 91:650–653Google Scholar
  4. 4.
    Pearlman HB, Kimura R, Fernandez C (1959) Experiments on temporary obstruction of the internal auditory artery. Laryngoscope 69:591–613Google Scholar
  5. 5.
    Fisch UF (1983) Management of sudden deafness. Otolaryngol Head Neck Surg 91:3–8CrossRefGoogle Scholar
  6. 6.
    Goodhill V, Harris I, Brockman S et al (1973) Sudden deafness and labyrinthine window ruptures. Ann Otol Rhinol Laryngol 82:2–12CrossRefGoogle Scholar
  7. 7.
    Gussen R (1981) sudden hearing loss associated with cochlear membrane rupture: two human temporal bone reports. Arch Otolaryngol 107(598–600):2Google Scholar
  8. 8.
    Filipo R, Covelli E, Balsamo G, Attanasio G (2010) Intratympanic prednisolone therapy for sudden sensorineural hearing loss: a new protocol. Acta Otolaryngol 130(11):1209–1213.  https://doi.org/10.3109/00016481003793766 CrossRefGoogle Scholar
  9. 9.
    HoHG LH, Shu MT, Yang CC, Tsai HT (2004) Effectiveness of intratympanic dexamethasone injection in sudden-deafness patients as salvage treatment. Laryngoscope 114:1184–1189CrossRefGoogle Scholar
  10. 10.
    Slattery WH, Fisher LM, Iqbal Z, Friedman RA, Liu N (2005) Intratympanic steroid injection for treatment of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg 133:251–259CrossRefGoogle Scholar
  11. 11.
    Battista RA (2005) Intratympanic dexamethasone for profound idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 132:902–905CrossRefGoogle Scholar
  12. 12.
    Choung YH, Park K, Shin YR, Cho MJ (2006) Intratympanic dexamethasone injection for refractory sudden sensorineural hearing loss. Laryngoscope 116:747–752CrossRefGoogle Scholar
  13. 13.
    Dallan I, Bruschini L, Nacci A, Bruschini P, Traino C, Rognini F et al (2006) Trans tympanic steroids as a salvage therapy in sudden hearing loss: preliminary results. ORL J Otorhinolaryngol Relat Spec 68:247–252CrossRefGoogle Scholar
  14. 14.
    Xenellis J, Papadimitriou N, Nikolopoulos T, Maragoudakis P, Segas J, Tzagaroulakis A et al (2006) Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: a control study. Otolaryngol Head Neck Surg 134:940–945CrossRefGoogle Scholar
  15. 15.
    Haynes DS, O’ Malley M, Cohen S, Watford K, Labadie RF (2007) Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy. Laryngoscope 117:3–15CrossRefGoogle Scholar
  16. 16.
    Roebuck J, Chang CY (2006) Efficacy of steroid injection on idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 135:276–279CrossRefGoogle Scholar
  17. 17.
    Plaza G, Herráiz C (2007) Intratympanic steroids for treatment of sudden hearing loss after failure of intravenous therapy. Otolaryngol Head Neck Surg 137:74–78CrossRefGoogle Scholar
  18. 18.
    Kiliç R, Safak MA, O˘guz H, Kargin S, Demirci M, Samim E et al (2007) Intratympanic methylprednisolone for sudden sensorineural hearing loss. Otol Neurotol 28:312–316CrossRefGoogle Scholar
  19. 19.
    Ahn JH, Han MW, Kim JH, Chung JW, Yoon TH (2008) Therapeutic effectiveness over time of intratympanic dexamethasone as salvage treatment of sudden deafness. Acta Otolaryngol 128:128–131CrossRefGoogle Scholar
  20. 20.
    Battaglia A, Burchette R, Cueva R (2008) Combination therapy (intratympanic dexamethasone + high-dose prednisone taper) for the treatment of idiopathic sudden sensorineural hearing loss. Otol Neurotol 29:453–460CrossRefGoogle Scholar
  21. 21.
    Rarey KE, Luttge WG (1989) Presence of type I and type 2/IB receptors for adreno corticosteroid hormones in the inner ear. Hear Res 41:217–221CrossRefGoogle Scholar
  22. 22.
    Stockroos RJ, Albers FW, Schirm J (1998) The etiology of idiopathic sudden sensorineural hearing loss. Experimental herpes simplex virus infection of the inner ear. Am J Otol 19:447–452Google Scholar
  23. 23.
    Nagura M, Iwasaki S, Wu R, Mizuta K, Umemura K, Hoshino T (1999) Effects of corticosteroid, contrast medium and ATP on focal microcirculatory disorders of the cochlea. Eur J Pharmacol 366:47–53CrossRefGoogle Scholar
  24. 24.
    Tabuchi K, Oikawa K, Uemaetomari I, Tsuji S, Wada T, Hara A (2003) Glucocorticoids and dehydroepiandrosterone sulfate ameliorate ischemia-induced injury of the cochlea. Hear Res 180:51–56CrossRefGoogle Scholar
  25. 25.
    Lamm K, Arnold W (1998) The effect of prednisolone and non-steroidal anti-inflammatory agents on the normal and noise- damaged guinea pig inner ear. Hear Res 115:149–161CrossRefGoogle Scholar
  26. 26.
    Yao X, Buhi WC, Alvarez IM, Curtis LM, Rarey KE (1995) De novo synthesis of glucocorticoid hormone regulated inner ear proteins in rats. Hear Res 86:183–188CrossRefGoogle Scholar
  27. 27.
    Lin DW, Trune DR (1997) Breakdown of stria vascularis blood-labyrinth barrier in C3H/lpr autoimmune disease mice. Otolaryngol Head Neck Surg 117:1–8CrossRefGoogle Scholar
  28. 28.
    Trune DR, Wobig RJ, Kempton JB, Hefeneider SH (1999) Steroid treatment improves cochlear function in the MRL.MpJ-Fas (lpr) autoimmune mouse. Hear Res 137:160–166CrossRefGoogle Scholar
  29. 29.
    Shirwany NA, Seidman MD, Tang W (1998) Effect of trans tympanic injection of steroids on cochlear blood flow, auditory sensitivity, and histology in the guinea pig. Am J Otol 19:230–235Google Scholar
  30. 30.
    El-Hennawi DM, El-Deen MHB, Abou-Halawa AS, Nadeem HS, Ahmed MR (2005) Efficacy of intratympanic methylprednisolone acetate in treatment of drill-induced sensorineural hearing loss in guinea pigs. J Laryngol Otol 119:2–7CrossRefGoogle Scholar
  31. 31.
    Yilmaz I, Yilmazer C, Erkan AN, Aslan SG, Ozluoglu LN (2005) Intratympanic dexamethasone injection effects on transient- evoked otoacoustic emission. Am J Otololaryngol 26:113–117CrossRefGoogle Scholar
  32. 32.
    Araujo MFS, Oliveira CA, Bahmad F Jr (2005) Intratympanic dexamethasone injections as a treatment for severe, disabling tinnitus. Does it work? Arch Otolaryngol 131:113–117CrossRefGoogle Scholar
  33. 33.
    Fukushima M, Kitahara T, Uno Y, Fuse Y, Doi K, Kubo T (2002) Effects of intratympanic injection of steroids on changes in rat inner ear aquaporin expression. Acta Otolaryngol 122:600–606CrossRefGoogle Scholar
  34. 34.
    Sone M, Hayashi H, Yamamoto H, Tominaga M, Nakashima T (2003) A comparative study of intratympanic steroid and NO synthase inhibitor for treatment of cochlear lateral wall damage due to acute otitis media. Eur J Pharmacol 482:313–318CrossRefGoogle Scholar
  35. 35.
    Himeno C, Komeda M, Izumikawa M, Takemura K, Yagi M, Weiping Y et al (2002) Intra-cochlear administration of dexamethasone attenuates aminoglycoside ototoxicity in the guinea pig. Hear Res 167:61–70CrossRefGoogle Scholar
  36. 36.
    Sharma D, Shekhar D, Kumar D, Pal D, Bajpayi D (2017) Role of intratympanic methylprednisolone in sudden sensorineural hearing loss. A clinical study. IOSR J Dent Med Sci 16(05):43–47CrossRefGoogle Scholar
  37. 37.
    Kumar D, Singh D, Thakur D (2018) Intratympanic steroid treatment for idiopathic sudden sensorineural hearing loss after failure of intravenous therapy. IOSR J Dent Med Sci 17(2):28–31Google Scholar
  38. 38.
    Chandrasekhar SS, Rubinstein RY, Kwartler JA, Gatz M, Connelly PE, Huang E et al (2003) Dexamethasone pharmacokinetics in the inner ear: comparison of route of administration and use of facilitating agents. Otolaryngol Head Neck Surg 122:521–528Google Scholar
  39. 39.
    Bachmann G, Su J, Zumegen C, Wittekindt C, Michel O (2001) Permeabilitat derrunden Fenster membrane fur Prednisolon-21-Hydrogensuccinat. Prednisolongehalt der Perilymphe nach lokaler Applikation vs. system ischer injektion. HNO 49:538–542CrossRefGoogle Scholar
  40. 40.
    Saijo S, Kimura RS (1981) Distribution of HRP in the inner ear after injection into the middle ear cavity. Acta Otolaryngol 97:593–610CrossRefGoogle Scholar
  41. 41.
    Salt AN, Ohyama K, Thalmann R (1991) Radial communication between the peri lymphatic scalae of the cochlea I: estimation by tracer perfusion. Hear Res 56:29–36CrossRefGoogle Scholar
  42. 42.
    Salt AN, Ohyama K, Thalmann R (1991) Radial communication between the peri lymphatic scalae of the cochlea 2: estimation by bolus injection of tracer into the sealed cochlea. Hear Res 56:37–43CrossRefGoogle Scholar
  43. 43.
    Plontke S, Zenner HP (2002) Pharmacokinetic considerations in intratympanic drug delivery to the inner ear. Acta Otorhinolaryngol Belg 56:369–370Google Scholar
  44. 44.
    Salt AN, Ma Y (2001) Quantification of solute entry into cochlear perilymph through the round window membrane. Hear Res 154:88–97CrossRefGoogle Scholar
  45. 45.
    Shaia FT, Sheehy J (1976) Sudden sensorineural hearing impairment: a report of 1220 cases. Laryngoscope 86:389–398CrossRefGoogle Scholar
  46. 46.
    Fuse T, Aoyagi M, Funakubo T, Sakakibara A, Yoshida S (2010) Short term outcome and prognosis of acute low-tone sensorineural hearing loss by administration of steroid. ORL J Otorhinolaryngol Relat Spec 64:6–10CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Vertigo & Ear ClinicJaipurIndia
  2. 2.Jain ENT HospitalJaipurIndia

Personalised recommendations