Περίληψη:
BACKGROUND AND OBJECTIVE: Although systemic steroids in sudden
sensorineural hearing loss (SSHL) appears to be the most effective and
the most widely accepted treatment today, a significant number of
patients do not respond to steroid treatment or they cannot receive
steroids for medical reasons. Intratympanic (IT) administration of
steroids appears to be an alternative or additional method of management
without the side effects of intravenous steroids. The aim of this study
is to investigate the effectiveness and safeness of IT administration of
steroids in patients who had not responded to IV treatment and to
compare treatment efficacy with controls.
STUDY DESIGN AND SETTING: Our study consisted of 37 patients with SSHL
who, at the end of 10 days of therapy with intravenous steroids as a 1st
line treatment, had pure-tone 4-frequency (0.5, 1, 2, and 4 kHz) average
(PTA) of worse than 30 dB or worse than 10 dB from the contralateral ear
(defined as failed intravenous treatment). They were randomized into 2
groups, treatment and control. The 19 patients of the treatment group
received approximately 0.5 mL sterile aqueous suspension of
methylprednisolone acetate in a concentration of 80 mg/2 mL by direct
injection. The procedure was carried out 4 times within a 15-day period.
An audiogram was performed before each injection and approximately 1.5
months after the last session.
RESULTS: All patients tolerated the procedure well. No perforation or
infection was noticed in any of the patients at their last visit. With
regard to the 19 patients who received intratympanic treatment, in 9
patients, the PTA threshold improved more than 10 db, in 10 patients
there was no change greater than 10 db, and no patients deteriorated
more than 10 db. In the control group, none of the patients showed any
change greater than 10 db. The difference was statistically significant
(P = 0.002). The treatment group showed an improvement in mean PTA of
14.9 dB, whereas the control group showed a deterioration of 0.8 dB, and
this difference also was statistically significant (P = 0.0005). IT
treatment (P = 0.0001), better post-IV PTA (P = 0.0008), and absence of
vertigo (P = 0.02) were good predictors of the outcome. In contrast,
sex, age, affected ear, days to admission, and pattern of the initial
audiogram showed no significant influence on the outcome.
CONCLUSION AND SIGNIFICANCE: IT steroid administration after failed
intravenous steroids is a safe and effective treatment in sudden
sensorineural hearing loss. (c) 2006 American Academy of
Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
Συγγραφείς:
Xenellis, John
Papadimitriou, Nikolaos
Nikolopoulos, Thomas and
Maragoudakis, Paulos
Tzagaroulakis, Antonios
Ferekidis,
Eleutherios
