title: [Intratympanic injection therapy for therapy refractory acute hearing loss: A safe option for secondary treatment].
abstract: BACKGROUND
  High-dose corticosteroids are currently recommended for idiopathic sudden sensorineural hearing loss (ISSNHL) treatment. Intratympanic injections (ITI) are of growing importance, especially in cases of therapy resistance. The selection of patients for this procedure in SSNHL has not been adequately examined so far.
  
  
  METHODS
  A total of 77 patients with ISSNHL after ineffective systemic pretreatment underwent intratympanic administration of dexamethasone and hyaluronic acid. Improvement after treatment was determined by pure tone audiometry for both ears before and of the treated ear after ITI.
  
  
  RESULTS
  In this study 34 female and 43 male patients with mean age of 57 years showed a pre-ITI hearing loss of 35 dB in the lower frequencies and 69 dB in the higher frequencies. The mean hearing gain was 10 dB and the response rate was 62%. Absolute hearing gain revealed significant improvements at 500 Hz, 1 kHz and 2 kHz. Under inclusion of contralateral thresholds there were hardly any differences up to 4 kHz. In a detailed analysis of responders moderate improvements could be observed even in higher frequencies. Overall, no relevant adverse events occurred.
  
  
  CONCLUSIONS
  Treatment of ISSNHL resistant to systemic regimens by ITI of steroids provides an option that offers additional prospects of auditory improvement for affected patients. The presented results indicate that these modalities are also valid for patients with pancochlear ISSNHL.
authors.affiliation: Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland. gmhno@t-online.de.
authors.forename: G
authors.initials: G
authors.lastname: Mühlmeier
authors.affiliation: Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Maier
authors.affiliation: Hals-Nasen-Ohren-Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Maier
authors.affiliation: Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Maier
mesh_terms: D000208:Acute Disease; D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D003639:Hearing Loss, Sudden / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D000069555:Injection, Intratympanic / Q000379:methods*; D008297:Male; D008875:Middle Aged; D063127:Secondary Health Care / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000276:Adjuvants, Immunologic; D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D006820:Hyaluronic Acid
keywords: Injections; Pure tone audiometry; Sensorineural hearing loss; Sudden hearing loss; Tympanic membrane