Transtympanic steroids in refractory sudden hearing loss. Personal experience.
The treatment of choice for sudden sensorineural hearing loss is still lacking. Many drugs have been used over the years, with varying results and steroids have proven to be effective in clinical trials, albeit systemic administration is associated with untoward side-effects and cannot be used in all patients. The transtympanic approach presents two main advantages: first, it allows higher concentrations in the inner ear environment and, second, it minimizes systemic absorption. Aim of the present investigation was to establish the effectiveness of transtympanic steroid treatment for sudden sensorineural hearing loss in patients in whom conventional treatment had failed. For this purpose, a prospective, non-randomized study was designed to evaluate hearing improvement in sudden sensorineural hearing loss patients treated with transtympanic steroids. A solution of methyl-prednisolone and sodium bicarbonate was administered, via a transtympanic injection, in 10 patients. Hearing levels were evaluated before treatment and on days 1, 7 and 30, thereafter. Improvement in hearing was observed in 70% of patients, moreover, in patients not usually considered amenable to this kind of treatment. Transtympanic steroid treatment is an effective and safe option for patients with sudden sensorineural hearing loss when conventional treatment regimens have failed. Further studies are needed to define the optimal dosage, route of administration and type of steroids.
Dallan
I
I
2nd ENT Unit, Azienda Ospedaliera Universitaria Pisan, Italy. iacopodallan@tiscali.it
Bruschini
L
L
Nacci
A
A
Fattorp
B
B
Traino
A C
AC
Rognini
F
F
Ferraro
G
G
Bruschini
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D001301:Audiometry, Pure-Tone; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000188:drug therapy*; D003639:Hearing Loss, Sudden / Q000188:drug therapy*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D010431:Pentoxifylline / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use*; D014432:Tympanic Membrane / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014665:Vasodilator Agents; D017693:Sodium Bicarbonate; D010431:Pentoxifylline; D008775:Methylprednisolone