Intratympanic dexamethasone injection vs methylprednisolone for the treatment of refractory sudden sensorineural hearing loss

Berjis, Nezamoddin; Soheilipour, Saeed; Musavi, Alireza; Hashemi, Seyed Mostafa

Intratympanic dexamethasone injection vs methylprednisolone for the treatment of refractory sudden sensorineural hearing loss

Authors

Department of Otorhinolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: During the past years various drugs have been used for sudden sensorineural hearing loss (SSNHL) treatment including steroids that are shown to be beneficial. Directed delivery of high doses of steroids into the inner ear is suggested for its potential and known as intratympanic steroids therapy (IST). Despite the use of dexamethasone and methylprednisolone as the traditional treatments, there are still debates about the optimal dosage, preferred drug, and the route of administration.
Materials and Methods: We performed a randomized clinical trial study in which 50 patients suffering from SSNHL and resistant to standard therapy were employed. Each patient took 0.5 ml methylprednisolone (40 mg/mg) along with bicarbonate or dexamethasone (4 mg/mL) through direct intratympanic injection. This method was performed and scheduled once every 2 days for three times only for the dexamethasone receiving group. Hearing test was carried out and the results were analyzed according to a four-frequency (0.5, 1.0, 2.0, 3.0 kHz) pure tone average (PTA) and Siegel's criteria.

Results: According to Siegel's criteria, three out of 25 (12%) dexamethasone receiving patients were healed in 1 and 4 (16%), 9 (32%) were respectively recovered in Siegel's criteria 2, 3, and 9 (32%) showed no recovery. In the group receiving methylprednisolone, recovery was found in 6 (24%), 8 (32%), 7 (28%) patients in the Siegel's criteria 1, 2, 3, respectively, and in 4 (16%) patients no recovery was recorded. In methylprednisolone group, hearing was significantly improved compared to the dexamethasone group (P < 0.05). The general hearing improvement rate was 84% in methylprednisolone receiving patients showing a significantly higher improvement than 64% in the dexamethasone group.
Conclusions: Topical intratympanic treatment with methylprednisolone is safe and an effective treatment approach for those SSNHL cases that are refractory to the common therapies by Dexamethasone.

Keywords

References

1.	Haberkamp TJ, Tanyeri HM. Management of idiopathic sudden sensorineural hearing loss. Am J Otol 1999;20:587-95.
2.	Gianoli GJ, Li JC. Transtympanic steroid for treatment of sudden hearing loss. Otolaryngol Head Neck Surg 2001;125:142-6.
3.	Rauch SD. Intratympanic steroids for sensorineural hearing loss. Otolaryngol Clin North Am 2004;37:1061-74.
4.	Wilson WR, Byl FM, Laird N. The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double blind clinical study. Arch Otolaryngol 1980;106:772-6. [PUBMED]
5.	Shimmer BP, Parker KL. Adrenocorticotrophic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Hardman JG, Limbird LE, Molinoff PB, Gilman AG, editors. Goodman and Gilman′s the pharmacological basis of the therapeutics. 9 ^th ed. New York, NY: McGraw-Hill; 1996. p. 1459.
6.	Gross ND, Kempton JB, Trune DR. Spironolactone blocks glucocorticoid-mediated hearing preservation in autoimmune mice. Laryngoscope 2002;112:298-303.
7.	Chandrasekhar SS. Intratympanic dexamethasone for sudden sensorineural hearing loss: Clinical and laboratory evaluation. Otol Neurotol 2001;22:18-23.
8.	Kopke RD, Hoffer ME, Wester D, O′Leary MJ, Jackson RL. Targeted topical steroid therapy in sudden sensorineural hearing loss. Otol Neurotol 2001;22:475-9.
9.	Ho HG, Lin HC, Shu MT, Yang CC, Tsai HT. Effectiveness of intratympanic dexamethasone injection in sudden-deafness patients as salvage treatment. Laryngoscope 2004;114:1184-9.
10.	Silverstein H, Choo D, Rosenberg SI, Kuhn J, Seidman M, Stein I. Intratympanic steroid treatment of inner ear disease and tinnitus (Preliminary Report). Ear Nose Throat J 1996;75:468-76.
11.	Barrs DM, Keyser JS, Stallworth C, McElveen JT Jr. Intratympanic steroid injections for intractable Ménière′s disease. Laryngoscope 2001;111:2100-4.
12.	Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: An animal study followed by clinical application. Laryngoscope 1999;109(Suppl 91):1-17.
13.	Chen CY, Halpin C, Rauch SD. Oral steroid treatment of Sudden sensorineural hearing loss: A ten year retrospective analysis. Otol Neurotol 2003;24:728-33.
14.	Wilson WR, Byl FM, Laird N. The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A doubleblind clinical study. Arch Otolaryngol 1980;106:772-6. [PUBMED]
15.	Slattery WH, Fisher LM, Iqbal Z, Friedman RA, Liu N. Intratympanic steroid injection for treatment of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg 2005;133:251-9.
16.	Haynes DS, O′Malley M, Cohen S, Watford K, Labadie RF. Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy. Laryngoscope 2007;117:3-15.
17.	Cinamon U, Bendet E, Kronenberg J. Steroids, carbogen or placebo for sudden hearing loss: A prospective doubleblind study. Eur Arch Otorhinolaryngol 2001;258:477-80.
18.	Merchant SN, Adams JC, Nadol JB. Pathology and pathophysiology of idiopathic sudden sensorineural hearing loss. Otol Neurotol 2005;26:151-60.
19.	Rarey KE, Luttge WG. Presence of type I and type II/IB receptors for adrenocorticosteroid hormones in the inner ear. Hear Res 1989;41:217-22.
20.	Gloddek B, Lamm K, Arnold W. Pharmacological influence on inner ear endothelial cells in relation to the pathogenesis of sensorineural hearing loss. Adv Otorhinolaryngol 2002;59:75-83.
21.	Stokroos RJ, Albers FW, Schirm J. The etiology of idiopathic sudden sensorineural hearing loss: Experimental herpes simplex virus infection of the inner ear. Am J Otol 1998;19:447-52.
22.	Nagura M, Iwasaki S, Wu R, Mizuta K, Umemura K, Hoshino T. Effects of corticosteroid, contrast medium and ATP on focal microcirculatory disorders of the cochlea. Eur J Pharmacol 1999;366:47-53.
23.	Tabuchi K, Oikawa K, Uemaetomari I, Tsuji S, Wada T, Hara A. Glucocorticoids and dehydroepiandrosterone sulfate ameliorate ischemia-induced injury of the cochlea. Hear Res 2003;180:51-6.
24.	Lamm K, Arnold W. The effect of prednisolone and non-steroidal anti-inflammatory agents on the normal and noise-damaged guinea pig inner ear. Hear Res 1998;115:149-61.
25.	Yao X, Buhi WC, Alvarez IM, Curtis LM, Rarey KE. De novo synthesis of glucocorticoid hormone regulated inner ear proteins in rats. Hear Res 1995;86:183-8.
26.	Lin DW, Trune DR. Breakdown of striavascularis blood-labyrinth barrier in C3H/lpr autoimmune disease mice. Otolaryngol Head Neck Surg 1997;117:530-4.
27.	Trune DR, Wobig RJ, Kempton JB, Hefeneider SH. Steroid treatment improves cochlear function in the MRL. MpJ-Fas(lpr) autoimmune mouse. Hear Res 1999;137:160-6.
28.	Silverstein H, Choo D, Rosenberg SI, Kuhn J, Seidman M, Stein I. Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report). Ear Nose Throat J 1996;75:468-88.
29.	Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: An animal study followed by clinical application. Laryngoscope 1999;109:1-17.
30.	Xenellis J, Papadimitriou N, Nikolopoulos T, Maragoudakis P, Segas J, Tzagaroulakis A, et al. Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: A control study. Otolaryngol Head Neck Surg 2006;134:940-5.
31.	Plontke SK, Löwenheim H, Mertens J, Engel C, Meisner C, Weidner A, et al. Randomized, double blind, placebo controlled trial on the safety and efficacy of continuous intratympanic dexamethasone delivered via a round window catheter for severe to profound sudden idiopathic sensorineural hearing loss after failure of systemic therapy. Laryngoscope 2009;119:359-69.
32.	Ahn JH, Han MW, Kim JH, Chung JW, Yoon TH. Therapeutic effectiveness over time of intratympanic dexamethasone as salvage treatment of sudden deafness. Acta Otolaryngol 2008;128:128-31.
33.	Kiliç R, Safak MA, Oðuz H, Kargin S, Demirci M, Samim E, et al. Intratympanic methylprednisolone for sudden sensorineural hearing loss. Otol Neurotol 2007;28:312-6.
34.	Plaza G, Herr´aiz C. Intratympanic steroids for treatment of sudden hearing loss after failure of intravenous therapy. Otolaryngol Head Neck Surg 2005;133:251-9.
35.	Hong SM, Park CH, Lee JH. Hearing outcomes of daily intratympanic dexamethasone alone as a primary treatment modality for ISSHL. Otolaryngol Head Neck Surg 2009;141:579-83.
36.	Tsai YJ, Liang JG, Wu WB, Ding YF, Chiang RP, Wu SM. Intratympanic injection with dexamethasone for sudden sensorineural hearing loss. J Laryngol Otol 2011;125:133-7.
37.	Alatas N. Use of intratympanic dexamethasone for the therapy of low frequency hearing loss. Eur Arch Otorhinolaryngol 2009;266:1205-12.
38.	Seggas I, Koltsidopoulos P, Bibas A, Tzonou A, Sismanis A. Intratympanic steroid therapy for sudden hearing loss: A review of the literature. Otol Neurotol 2011;32:29-35.
39.	Bird PA, Begg EJ, Zhang M, Keast AT, Murray DP, Balkany TJ. Intratympanic versus intravenous delivery of methylprednisolone to cochlear perilymph. Otol Neurotol 2007;28:1124-30. [PUBMED]
40.	Plontke SK, Biegner T, Kammerer B, Delabar U, Salt AN. Dexamethasone concenration gradients along scala tympani after application to the round window membrane. Otol Neurotol 2008;29:401-6.
41.	Billett TE, Thorne PR, Gavin JB. The nature and progression of injury in the organ of Corti during ischemia. Hear Res 1989;41:189-98.
42.	Sha SH, Taylor R, Forge A, Schacht J. Differential vulnerability of basal and apical hair cells is based on intrinsic susceptibility to free radicals. Hear Res 2001;155:1-8.
43.	Dallan I, De Vito A, Fattori B, Casani AP, Panicucci E, Berrettini S, et al. Intratympanic methylprednisolone in refractory sudden hearing loss: A 27-patient case series with univariate and multivariate analysis. Otol Neurotol 2010;31:25-30.
44.	Yang J, Huang L, Shi J, Li Y, Wu H, Kong W. The effect of intratympanic dexamethasone or methylprednisolone on treatment of sudden sensorineural hearing loss. Lin Chung Er Bi Yan HouTou Jing Wai Ke Za Zhi 2010;24:594-7.

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