Intratympanic dexamethasone and hyaluronic acid in patients with low-frequency and Ménière's-associated sudden sensorineural hearing loss.
BACKGROUND
Steroids are widely used for the treatment of cochleovestibular disorders. Direct steroid application in the middle ear cavity, when combined with a round window membrane permeability-modulating substance, increases the level of the steroid reaching the target cells. We measured hearing in patients with idiopathic isolated low-frequency sensorineural hearing loss and in patients with sudden sensorineural hearing loss and a history of Ménière's disease. Contradictory reports about effectiveness of intratympanic steroid therapy on vertigo control and hearing improvement in patients with Ménière's disease exist in the literature.


METHODS
Eighteen patients with isolated low-frequency idiopathic sudden sensorineural hearing loss and 21 patients with sudden sensorineural hearing loss and a history of Ménière's disease were prospectively evaluated. The acute effect of the intratympanic application of dexamethasone with hyaluronic acid on hearing outcome after failure of an initial standard treatment with intravenous steroid and vasoactive substances was assessed. Evaluation was based on standard pure-tone audiometry findings.


RESULTS
After intratympanic injection of dexamethasone and hyaluronic acid, 14 of the 18 patients with isolated low-frequency sensorineural hearing loss showed a significant improvement in hearing. After intratympanic therapy, 15 patients with a previous history of Ménière's disease and idiopathic isolated low-frequency sensorineural hearing loss showed an improvement in hearing on pure-tone audiometry, four remained unchanged, and two showed a tendency toward a slight deterioration.


CONCLUSIONS
Intratympanic combined dexamethasone/hyaluronic acid application provides a reliable and safe therapeutic option for improvement of hearing in patients with isolated low-frequency idiopathic sudden sensorineural hearing loss or sensorineural hearing loss resulting from Ménière's disease who have failed intravenous steroid and vasoactive treatments.
Selivanova
Oksana A
OA
Department of Otolaryngology, Head and Neck Surgery, University of Mainz Medical School, Mainz, Germany. selivanova@hno.klinik.uni-mainz.de
Gouveris
Haralampos
H
Victor
Anja
A
Amedee
Ronald G
RG
Mann
Wolf
W
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy / Q000209:etiology; D003639:Hearing Loss, Sudden / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D015552:Injections, Intralesional; D008297:Male; D008575:Meniere Disease / Q000150:complications*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane
D000276:Adjuvants, Immunologic; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D006820:Hyaluronic Acid