[Observation on the efficacy of Eustachian tube dilation hormone under the guidance of endoscope in the treatment of sudden deafness].
Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery
To evaluate the efficacy of Eustachian tube dilation hormone under the guidance of otoscope in the treatment of patients with sudden deafness. One hundred and seventy-six patients（185 ears） with sudden deafness treated by otorhinolaryngology head and neck surgery in Shaanxi Provincial People's Hospital from January 2020 to December 2020 were selected. According to the inclusion and exclusion criteria, 176 patients（185 ears） were randomly divided into control group（=86, 90 ears） and study group（=90, 95 ears）. The control group was treated with intratympanic injection of methylprednisolone（methylprednisolone sodium succinate for injection）, and the study group was treated with tympanic tympanoplasty under otoendoscope. The pure tone hearing threshold, effective rate and the incidence of adverse reactions were compared between the two groups before and after treatment. The total effective rate of the study group was 84.21%（80/95）, slightly lower than that of the control group（84.44%）, but there was no significant difference between the two groups. The hearing threshold of pure tone in the two groups was significantly higher than that before treatment, and the average improvement of hearing in the study group（25.47±6.29） dB was slightly lower than that in the control group（27.33±7.55） dB, but there was no significant difference between the two groups（>0.05）. There was no significant difference in the incidence of mild adverse reactions between the two groups（>0.05）. There were no serious adverse reactions. The total effective rate, hearing improvement level and adverse reaction rate of patients with sudden deafness treated with Eustachian tube tympanic dilatation hormone under endoscope are the same as that of tympanic hormone injection.
10.13201/j.issn.2096-7993.2021.05.009
Optimal Head Position Following Intratympanic Injections of Steroids, As Determined by Virtual Reality.
Ungar Omer J,Handzel Ophir,Haviv Limor,Dadia Solomon,Cavel Oren,Fliss Dan M,Oron Yahav
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
OBJECTIVES:To study optimal head position after intratympanic steroid injections to enhance drug bioavailability. STUDY DESIGN:Application of virtual and in vitro models of the intratympanic anatomy. SETTING:The surgical 3-dimensional printing laboratory of a tertiary academic medical center. SUBJECTS AND METHODS:A high-resolution computerized tomographic scan of healthy temporal bone and surrounding soft tissue was segmented and reconstructed to a 3-dimensional model. The tympanic membrane was perforated in the posterior-inferior quadrant. Methylene blue-stained 10-mg/mL dexamethasone was administered to the middle ear cleft, after which a 3-dimensional rotation in space was performed to hypothesize the optimal position in relation to gravity. The same stereolithography file used for the actual model was used for a digital virtual liquid flow simulation. The optimal head position was defined as the one with the maximum vertical distance between the round window membrane and the plane of the aditus ad antrum and eustachian tube orifice. RESULTS:The virtual model yielded the following position of the head as optimal: 53º rotation away from the injected ear in the vertical axis (yaw), 27º rotation toward the noninjected ear in the longitudinal axis (roll), and 10º neck extension in the transverse axis (pitch). CONCLUSIONS:Virtual imaging determined that 53º and 27º yaw and roll, respectively, away and 10º pitch were the optimal position for drug delivery after intratympanic injection to the middle ear and that an erect head position provided optimal passage of steroids from the middle ear to the inner ear.
10.1177/0194599819878699
Noninvasive intratympanic dexamethasone treatment for sudden sensorineural hearing loss.
Zhang Qiuying,Song Haitao,Peng Hao,Yang Xuemei,Zhou Junmei,Huang Weining
Acta oto-laryngologica
CONCLUSION:Noninvasive intratympanic dexamethasone perfusion (IDP) through the eustachian tube is an effective and safe therapy in cases of sudden sensorineural hearing loss (SSNHL). OBJECTIVE:To investigate the effectiveness and safety of noninvasive IDP through the eustachian tube in patients with SSNHL. METHODS:In this prospective study, 74 consecutive patients with SSNHL treated between September 2007 and March 2011 were enrolled: 35 patients fitted the criteria for initial treatment in the study (group I), while 39 patients, who had failed systemic therapy, received salvage treatment (group S). IDP through the eustachian tube was applied four times at 2-day intervals. Pure-tone test and tympanometry were performed before starting treatment, and 24 h and 1 week afterwards. 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 74 patients who received intratympanic treatment, 80.0% (28 of 35) of the patients in group I and 64.1% (25 of 39) patients in group S had improvement in their hearing ability. Patients with simultaneous symptoms reported that the symptoms were relieved as follows: tinnitus, 73.3% (44/60); vertigo, 76.2% (16/21); and stuffy ear, 81.1% (30/37).
10.3109/00016489.2011.649145
Intratympanic Triamcinolone and Dexamethasone in the Treatment of Ménière's Syndrome.
Jumaily Mejd,Faraji Farhoud,Mikulec Anthony A
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
OBJECTIVE:To describe the safety and potential efficacy of intratympanic administration of triamcinolone (40 mg/mL) in the treatment of unilateral Ménière's syndrome. STUDY DESIGN:Single-institution retrospective analysis. SETTING:Tertiary referral neurotology clinic. PATIENTS:Eighteen patients diagnosed with unilateral Ménière's syndrome with vertigo refractory to medical management. INTERVENTION(S):Intratympanic injection of triamcinolone or dexamethasone. OUTCOME MEASURE(S):Kaplan-Meier analysis was implemented to determine the rate of successful vertigo control. Responders were defined as patients who achieved sufficient vertigo control to decline ablative therapy. Nonresponders were defined as those who did not achieve satisfactory vertigo control and required ablative or surgical therapy. Pre- and posttreatment audiogram data was used to evaluate changes in hearing. Patient follow-up data was assessed for complications potentially resulting from intratympanic therapy. RESULTS:No patient experienced profound hearing loss or other serious adverse events as a result of intratympanic triamcinolone therapy. Tympanic membrane perforation occurred in three (18%) patients, all of whom had received three or more previous intratympanic injections. Satisfactory vertigo control with intratympanic triamcinolone therapy was achieved in 14 (78%) of 18 subjects. CONCLUSION:Our results suggest that intratympanic triamcinolone therapy on an as-needed basis is a safe and potentially effective procedure for vertigo control in patients with Ménière's syndrome. These findings warrant the implementation of prospective, controlled trials to investigate its safety and efficacy further.
10.1097/MAO.0000000000001311
Efficiency of a dexamethasone nanosuspension as an intratympanic injection for acute hearing loss.
Jung So-Young,Kim Subin,Kang Zion,Kwon Soonmin,Lee Juhye,Park Joo Won,Kim Kab Sig,Kim Dong-Kee
Drug delivery
Dexamethasone sodium phosphate (Dex-SP) is the most commonly used drug administered via intratympanic injection for the treatment of acute hearing loss, but its penetration efficiency into the inner ear is very low. To address this problem, we evaluated the possibility of administering dexamethasone nanosuspensions via intratympanic injection because hydrophobic drugs might be more effective in penetrating the inner ear. Three types of dexamethasone nanosuspensions were prepared; the dexamethasone nanoparticles in the three nanosuspensions were between approximately 250 and 350 nm in size. To compare the efficiency of Dex-SP and dexamethasone nanosuspension in delivering dexamethasone to the inner ear, the concentrations of dexamethasone in perilymph and cochlear tissues were compared by liquid chromatography-mass spectrometry. The dexamethasone nanosuspensions resulted in significantly higher drug concentrations in perilymph and cochlear tissues than Dex-SP at 6 h; interestingly, animals treated with nanosuspensions showed a 26-fold higher dexamethasone concentrations in their cochlear tissues than animals treated with Dex-SP. In addition, dexamethasone nanosuspension caused better glucocorticoid receptor phosphorylation than Dex-SP both and , and in the ototoxic animal model, the nanosuspension showed a significantly better hearing-protective effect against ototoxic drugs than Dex-SP. In the safety evaluation, the nanosuspension showed no toxicity at concentrations up to 20 mg/mL. In conclusion, a nanosuspension of dexamethasone was able to deliver dexamethasone to the cochlea very safely and efficiently and showed potential as a formula for intratympanic injection.
10.1080/10717544.2021.2021320
Visualization of Endolymphatic Hydrops in Patients With Unilateral Idiopathic Sudden Sensorineural Hearing Loss With Four Types According to Chinese Criterion.
Qin Huan,He Baihui,Wu Hui,Li Yue,Chen Jianyong,Wang Wei,Zhang Fan,Duan Maoli,Yang Jun
Frontiers in surgery
The aim of this study is to evaluate the possible value of endolymphatic hydrops (EH) in patients with unilateral idiopathic sudden sensorineural hearing loss (UISSNHL) with four types according to audiometry. Seventy-two patients (40 men and 32 women; age range, 28-78 years; mean age: 50.0 ± 12.9 years) with UISSNHL were admitted retrospectively into this study. Based on the pure tone audiometry before treatment, the hearing loss of all these patients were categorized into four types: low-frequency group (LF-G), high-frequency group (HF-G), flat group (F-G), and total deafness group (TD-G). The average time from symptom onset to the first examination was 6.9 ± 4.4 days (1-20 days). 3D-FLAIR MRI was performed 24 h after intratympanic injection of gadolinium (Gd) within 1 week after the UISSNHL onset. The incidence of EH in the affected ears based on four types of hearing loss were analyzed using the Chi-square test, and the possible relationship with vertigo and prognosis were also assessed. Eleven of 21 patients (52.4%) in LF-G had the highest EH-positive rate, followed by 18.2% in HF-G, 11.8% in F-G, and 17.4% in TD-G. The significant difference was found in the four groups ( = 0.018). The EH rate of LF-G was statistically significantly higher than that of F-G and TD-G ( = 0.009, =0.014), respectively. After being valued by the volume-referencing grading system (VR scores), the EH level was represented by the sum scores of EH. In LF-G, no statistically significant difference was found in the prognosis of ISSNHL patients between with the EH group and the no EH group ( = 0.586). The symptom "vertigo" did not correlate with EH and prognosis. EH was observed in UISSNHL patients by 3D-FLAIR MRI. EH may be responsible for the pathology of LF-G but not related to prognosis. It might be meaningless to assess EH in other hearing loss types, which might be more related to the blood-labyrinth dysfunction.
10.3389/fsurg.2021.682245
Efficacy and Safety of AM-111 in the Treatment of Acute Unilateral Sudden Deafness-A Double-blind, Randomized, Placebo-controlled Phase 3 Study.
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
OBJECTIVE:To confirm the efficacy and safety of AM-111 (brimapitide), a cell-penetrating c-Jun N-terminal Kinase (JNK) inhibitor, in patients suffering from severe to profound acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL). STUDY DESIGN:Prospective, double-blind, randomized, placebo-controlled phase 3 study with follow-up visits on Days 3, 7, 28, and 91. SETTING:Fifty-one European and Asian sites (tertiary referral centers, private ENT practices). PATIENTS:Two hundred fifty-six patients aged 18 to 65 years presenting within 72 hours following ISSNHL onset with mean hearing loss ≥ 40 dB and mean threshold ≥ 60 dB at the 3 worst affected contiguous test frequencies. INTERVENTIONS:Single-dose intratympanic injection of AM-111 (0.4 or 0.8 mg/ml) or placebo; oral prednisolone as reserve therapy if hearing improvement < 10 dB at Day 7. MAIN OUTCOME MEASURES:Hearing improvement to Day 28 was the primary efficacy endpoint; complete hearing recovery, frequency of reserve therapy used, complete tinnitus remission, improvement in word recognition were secondary endpoints. Safety was evaluated by the frequency of clinically relevant hearing deterioration and adverse events. RESULTS:While the primary efficacy endpoint was not met in the overall study population, post-hoc analysis showed a clinically relevant and nominally significant treatment effect for AM-111 0.4 mg/ml in patients with profound ISSNHL. The study drug and the administration procedure were well tolerated. CONCLUSIONS:AM-111 provides effective otoprotection in case of profound ISSNHL. Activation of the JNK stress kinase, AM-111's pharmacologic target, seems to set in only following pronounced acute cochlear injury associated with large hearing threshold shifts.
10.1097/MAO.0000000000002229
Intratympanic injection of dexamethasone for treatment of tinnitus in patients with sudden sensorineural hearing loss.
Yoshida Tadao,Teranishi Masaaki,Iwata Tomoyuki,Otake Hironao,Nakashima Tsutomu
Audiology research
The purpose of this study is to test the effectiveness of intratympanic dexamethasone injections as a treatment for severe tinnitus in idiopathic sudden sensorineural hearing loss (SNHL). We studied 37 patients who received intratympanic dexamethasone injections and 14 control patients who did not receive it, with severe tinnitus after onset of unilateral sudden SNHL. Hearing level did not change during this study in any patient. The relationship between the duration of tinnitus and effectiveness of treatment was investigated in sudden SNHL. We used a visual analogue scale to evaluate 51 patients with severe tinnitus at the stage of stable hearing level after idiopathic sudden sensorineural hearing loss. Forty-one per cent of patients showed significant improvement after treatment. The average period between onset of sudden sensorineural hearing loss and initiation of intratympanic dexamethasone injection was significantly shorter (207 days) in the improved group than in the unchanged group (482 days) (P<0.001). In control group, one of 14 patients presented significant improvement spontaneously. Intratympanic dexamethasone treatment may be effective in treatment of severe tinnitus after sudden SNHL at the stage of stable hearing level, and the shorter the period from onset of sudden deafness to the start of intratympanic dexamethasone treatment, the greater the improvement in tinnitus that can be expected.
10.4081/audiores.2011.e2
[Comparative study of intratympanic Dexamethasone injection for sudden deafness at different time intervals].
Yang P L,Zhang Z P
Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery
Comparative study of intratympanic Dexamethasone injection for sudden deafness at different time intervals. One hundred and sixty cases which had been diagnosed sudden deafness were treated by vasodilatortrophic nerve drugs and high pressure oxygen and the same time dexamethasone injective in the middle ear. Injection time intervals were divided into qd, qod, and twice a week. Contral group is not use dexamethasone. The cure rate of qd and qod groups were higher than twice a week group, and the difference was statistically significant (<0.05). Intratypanic Dexamethasone injection for sudden deafness qd or qod is effective and safe.
10.13201/j.issn.1001-1781.2017.11.002