Intratympanic Methylprednisolone Injection as First Line Therapy for Idiopathic Sudden Sensorineural Hearing Loss

Main Article Content

Mukul Patar
Rupanjita Sangma

Abstract

Introduction


Steroid therapy is considered to be the gold standard for sudden sensorineural hearing loss (SSNHL). Delivering steroids by intratympanic injection is more efficient than systemic injections with minimum or no side effects. The present study was aimed to evaluate the efficacy and safety of intratympanic methylprednisolone injections as initial first line therapy for unilateral idiopathic SSNHL and the ease of giving it by otoendoscopy.


Materials and Methods


A prospective analysis was performed for the patients diagnosed as unilateral idiopathic SSNHL from April 2014 to April 2016 and receiving intratympanic steroids injections as first line therapy. Patients with unilateral sensorineural hearing loss of at least 30 dB at 3 contiguous frequencies occurring within a period of not more than 3 days are only included. All of the intratympanic steroid (ITS) injections were administered as OPD procedures. Each patient was treated by 3 injections given at 3 days interval. 


Results


A total of 22 patients who underwent primary intratympanic steroid (ITS) injection for unilateral SSNHL during the study period were included in the study. The mean age was 42.22 years (+ 9.79) and age ranged from 27 to 68 years. Patients included in our study came within 2nd to 27th day of occurrence of deafness and the mean duration (days) from onset of disease to start of ITS was 7.86 days. The average hearing gain in our study was 44.22 dB. In the present study 11 patients (50%) showed complete hearing improvement and 10 cases (45.45%) had partial and one (4.54%) showed no hearing recovery at 3 weeks follow up period.


Conclusion


Minimal systemic absorption with minimum or no systemic effects and high percentage of success rate encouraged the surgeons to prefer ITS as primary therapy for idiopathic unilateral SSNHL. It is effective, cheap, well-tolerated and can be performed as OPD procedure. 

Article Details

How to Cite
1.
Patar M, Sangma R. Intratympanic Methylprednisolone Injection as First Line Therapy for Idiopathic Sudden Sensorineural Hearing Loss. BJOHNS [Internet]. 2017Aug.30 [cited 2024Nov.21];25(2):69-74. Available from: https://bjohns.in/journal3/index.php/bjohns/article/view/115
Section
Main article
Author Biographies

Mukul Patar, Jorhat Medical College & Hospital

Associate Professor

Department of ENT

Jorhat Medical College & Hospital

Jorhat, Assam

Rupanjita Sangma, Jorhat Medical College & Hospital

Associate Professor

Department of ENT

Jorhat Medical College

Jorhat, Assam

References

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

Silverstein H, Choo D, Rosenberg SI, Kuhn J, Seidman M. Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report). Ear Nose Throat J. 1996; 75(8):468-71.

Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. Laryngoscope 1999; 109: 1-7

Erichsen S, Bagger-Sjoback D, Curtis L, Zuo Z, Rarey K, Hultcrantz M. Appearance of Glucocorticoid receptors in the inner ear of the Mouse during development. Acta Oto-Laryngol. 1996; 116(5):721-5

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

Slattery WH, Fischer LM, Iqbal Z, Friedman RA, Liu N. Intratympanic steroid for the treatment of sudden hearing loss. Otolaryngol Head Neck Surg. 2005; 133: 251-9

Kuhn M, Heman – Ackah SE, Shaikh JA, Roehm PC. Sudden sensorineural hearing loss : A review of diagnosis, treatment & prognosis. Trends Amplif. 2011; 15; 91-105

Conlin AE, Parnes LS. Treatment of Sudden Sensorineural Hearing Loss: II. A Meta-analysis. Arch. Otolaryngol Head Neck Surg. 2007; 133(6): 582-6

Conlin AE, Parnes LS. “Treatment of sudden sensorineural hearing loss: I. A systematic review”. Arch Otolaryngol Head Neck Surg. 2007; 133(6): 573-81

Banerjee A, Parnes LS. Intratympanic corticosteroids for sudden idiopathic sensorineural hearing loss. Otol. Neurotol. 2005; 26: 878-81

Ho G.M, Lin H.G, Shu M.T. Effectiveness of intratympanic dexamethasone injection in sudden deafness patients as salvage treatment. Laryngoscope 2004; 114:1184-9

Gouveris H, Selivanova O, Mann W. Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy. Eur Arch Otorhinolaryngol. 2005; 262:131-4

Lauterman J, Sudhoff H, Junker R. Transtympanic corticoid therapy for acute profound loss. Eur Arch Otorhinolaryngol. 2005; 1-9

Kakehata S, Sasaki A, Oji K, Futai K, Ota S, et al. Comparison of intratympanic and intravenous dexamethasone treatment on sudden sensorineural hearing loss with diabetes. Otol Neurotol. 2006; 27(5): 604-8

Ljiljana C, Mile S, Milan B. J., Zoran M, Katarina S, Dragoslava D. Intratympanic steroid treatment as a Primary Therapy in Idiopathic Sudden Sensorineural Hearing Loss. Int. Adv. Otol. 2009; 5(3): 334-9

Shirwany NA, Seidman MD, Tang W. Effects of transtympanic injection of steroids on cochlear blood flow, auditory sensitivity and histology in the guinea pig. Am J Otol. 1998; 19(2): 230-5

Chandrasekhar SS, Rubinstein RY, Kwartler JA, Gatz M, Connelly PE. Dexamethasone pharmacokinetics in the inner ear: Comparison of route of administration and use of facilitating agents. Otolaryngol Head Neck Surg. 2000; 122(4): 521-8

Yilmaz I, Yilmazer C, Erkan AN, Aslan SG, Ozluoglu LN. Intratympanic dexamethasone injection effects on transient-evoked otoacoustic emission. Am J Otolaryngol. 2005; 26(2): 113-7

Dallan I, Bruschini L, Nacci A, Bruschini P, Traino C. Transtympanic steroids as a salvage therapy in sudden hearing loss: preliminary results. ORL 2006; 68(5): 185-90

Topak M, Sahin-Yilmaz A, Ozdoganoglu T, Yilmaz HB, Ozbay M. Intratympanic methylprednisolone injection for subjective tinnitus. J Laryngol Otol. 2009; 123(11): 1221-5

Gundogan O, Pinar E, Imre A, Ozturkcan S, Cokmez O. Therapeutic efficacy of the combination of intratympanic methylprednisolone and oral steroid for idiopathic sudden deafness. Otol Neurotol. 2013; 149(5): 753-8.