title: How long should patients remain in the supine treatment position after intratympanic dexamethasone injection?
abstract: OBJECTIVE
  Intratympanic dexamethasone injection (ITDI) is a widely accepted treatment for patients with sudden hearing loss. We investigated the appropriate patient wait time in the supine treatment position after ITDI.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  In an in vivo animal study, 24 mice were injected intratympanically with dexamethasone. Perilymphatic fluid was sampled at 5, 10, 15, 20, 25, and 30 minutes postinjection. The dexamethasone concentration was analyzed using high-performance liquid chromatography. In a separate prospective clinical study, 79 patients with refractory sudden hearing loss underwent intratympanic injection. After the injection, patients remained in the supine position with the head rotated 45° to the unaffected side. Patients were divided into two groups according to the wait time in this treatment position postinjection: 30 minutes (n = 47) and 10 minutes (n = 32). Final hearing assessments were conducted 2 months after salvage treatment.
  
  
  RESULTS
  In the in vivo animal study, the perilymphatic concentration of dexamethasone showed no significant increase after 10 minutes. In the clinical setting, hearing improvement according to Siegel's criteria was similar in the 30-minute (14/47) and 10-minute (10/32) groups (P = 0.999). No significant differences in relative hearing gain was observed between the two groups (13.80 ± 19.9 dB and 12.57 ± 14.9 dB, respectively; P = 0.766).
  
  
  CONCLUSIONS
  We suggest that 10 minutes is a sufficient time to remain in the supine treatment position after ITDI in patients with sudden hearing loss.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Otorhinolaryngology, Keimyung University College of Medicine, Daegu, Republic of Korea.
authors.forename: Soon H
authors.initials: SH
authors.lastname: Park
authors.forename: Changhun
authors.initials: C
authors.lastname: Park
authors.forename: Jin Y
authors.initials: JY
authors.lastname: Seo
authors.forename: Jae H
authors.initials: JH
authors.lastname: Cho
authors.forename: In S
authors.initials: IS
authors.lastname: Moon
mesh_terms: D000818:Animals; D001301:Audiometry, Pure-Tone; D003907:Dexamethasone / Q000008:administration & dosage*; D004195:Disease Models, Animal; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing / Q000502:physiology*; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy* / Q000503:physiopathology; D003639:Hearing Loss, Sudden / Q000188:drug therapy* / Q000503:physiopathology; D007267:Injections; D051379:Mice; D008813:Mice, Inbred ICR; D011446:Prospective Studies; D016683:Supine Position; D013997:Time Factors; D016896:Treatment Outcome; D014432:Tympanic Membrane
chemical_list: D003907:Dexamethasone
keywords: Intratympanic; position; sudden hearing loss