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Intratympanic steroids

Alec N Salt, Stefan K Plontke
Local drug delivery to the ear has gained wide clinical acceptance, with the choice of drug and application protocol in humans largely empirically-derived. Here, we review the pharmacokinetics underlying local therapy of the ear using the drugs commonly used in clinical practice as examples. Based on molecular properties and perilymph measurements interpreted through computer simulations we now better understand the principles underlying entry and distribution of these and other drugs in the ear. From our analysis, we have determined that dexamethasone-phosphate, a pro-drug widely-used clinically, has molecular and pharmacokinetic properties that make it ill-suited for use as a local therapy for hearing disorders...
March 11, 2018: Hearing Research
Hasan Demirhan, Ali Rıza Gökduman, Bahtiyar Hamit, Müge Fethiye Yürekli Altındağ, Özgür Yiğit
OBJECTIVE: The primary objective is to investigate the contribution of intratympanic steroids in the primary treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). The secondary objective is to compare methylprednisolone (MP) and dexamethasone in terms of their effectiveness and injection-site pain. METHODS: Two hundred and four patients with ISSNHL, 144 patients underwent systemic steroid therapy (SST) alone and 60 patients underwent combined therapy (CT)...
March 7, 2018: Acta Oto-laryngologica
Elisabeth Mamelle, Naila El Kechai, Victor Adenis, Yann Nguyen, Olivier Sterkers, Florence Agnely, Amélie Bochot, Jean Marc Edeline, Evelyne Ferrary
OBJECTIVES: Intratympanic injection of corticosteroids membrane after noise-induced hearing loss is an accepted alternative to general administration. We investigated the effect on hearing of a hyaluronic acid gel with liposomes loaded with dexamethasone (DexP) administered into the middle ear. METHODS: An acute acoustic trauma was performed to 13 guinea pigs for a period of 1 h on Day -2. Two 2 days after the noise trauma, the animals were then assigned randomly to four experimental groups: control without gel, gel injection, gel-containing free DexP, gel-containing DexP loaded into liposomes...
March 5, 2018: Acta Oto-laryngologica
Anwuli Anyah, Devin Mistry, Erin Kevern, Kenneth Markiewicz
Objectives To determine how long after symptom onset that the average patient with an idiopathic sudden sensorineural hearing loss (ISSNHL) presents to the otolaryngology clinic.  In late presentations, to determine the time to presentation cutoff after which intervention may not be effective.  To evaluate the effectiveness of oral steroids versus a combination of oral and intratympanic steroid therapy in late presentations of ISSNHL.  Methods and procedures Sixty-four patients met inclusion criteria after chart review of 2,037 patients seen at Metro Health Hospital from 2006 to 2016 for sensorineural hearing loss...
December 14, 2017: Curēus
Nasrin Yazdani, Farzaneh Nejadian, Nima Rezazadeh, Reza Hoseinabadi, Ebrahim Karimi, Reza Gharibi, Sasan Dabiri
Despite some proposed roles for the diagnostic impact of the cervical vestibular evoked myogenic potential test in the patients with Meniere's disease, the role of this test as an objective instrument in following up the patients with Meniere's disease who underwent. Intratympanic steroid injection is not cleared. In a prospective study, thirty-one adult patients with definite one-sided Meniere's disease with vertigo as main complaint refractory to medical treatments for three months, were selected. Patients underwent three times of intratympanic dexamethasone injection with one-week intervals...
January 2018: Acta Medica Iranica
Hideaki Suzuki, Tetsuro Wakasugi, Takuro Kitamura, Hiroki Koizumi, Ba Hung Do, Toyoaki Ohbuchi
OBJECTIVE: We studied the effect of intratympanic steroid administration with different total injection times on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: The subjects were 191 consecutive patients (192 ears) with ISSNHL (hearing level ≥40 dB, interval between onset and treatment ≤30 days). They received systemic prednisolone (100 mg followed by tapered doses) combined with intratympanic injection of dexamethasone (4 mg/ml)...
February 1, 2018: Annals of Otology, Rhinology, and Laryngology
Dan Lai, Fei Zhao, Nasim Jalal, Yun Zheng
BACKGROUND AND OBJECTIVE: Glucocorticoids are the standard treatment for idiopathic sudden sensorineural hearing loss (ISSNHL), but whether intratympanic or systemic therapy is superior remains controversial. Previous meta-analyses of this question have omitted key clinical trials or included observational studies. METHODS: English-language randomized controlled trials in OvidSP, PubMed, Embase, CINAHL, and the Cochrane Library comparing intratympanic versus systemic glucocorticoid therapy for ISSNHL were meta-analyzed using RevMan 5...
December 2017: Medicine (Baltimore)
J Nevoux, M Barbara, J Dornhoffer, W Gibson, T Kitahara, V Darrouzet
OBJECTIVE: To present the international consensus for recommendations for Ménière's disease (MD) treatment. METHODS: Based on a literature review and report of 4 experts from 4 continents, the recommendations have been presented during the 21st IFOS congress in Paris, in June 2017 and are presented in this work. RESULTS: The recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy...
January 12, 2018: European Annals of Otorhinolaryngology, Head and Neck Diseases
Rosh K V Sethi, Iman Ghanad, Vivek Kanumuri, Barbara Herrmann, Elliott D Kozin, Aaron K Remenschneider
OBJECTIVE: Mobile hearing applications (apps) are available for hearing testing, personal sound amplification, as well as hearing aid modulation. Hearing testing apps are gaining popularity, especially in resource-limited settings. The reliability of mobile hearing testing apps, however, is not well characterized. PATIENTS/INTERVENTIONS: A case study of a single patient with a complaint of sudden hearing loss presenting to a tertiary-care hospital. MAIN OUTCOME MEASURE: Comparison of a mobile hearing testing app results with standard audiogram...
January 2018: Otology & Neurotology
Michael Tsounis, George Psillas, Miltiadis Tsalighopoulos, Victor Vital, Nicolas Maroudias, Konstantinos Markou
PURPOSE: The purpose of this prospective, randomized, multicenter clinical trial was to compare the therapeutic efficacy of systemic versus intratympanic versus combined administration of steroids in the treatment of idiopathic sudden sensorineural hearing loss. METHODS: 102 patients with an up to 14 days history of idiopathic sudden sensorineural hearing loss were randomized to 1 of 3 arms and followed prospectively. Group A (35 patients) received prednisolone intravenously followed by methylprednisolone orally, whereas Group B (34 patients) were administered intratympanic methylprednisolone...
January 2018: European Archives of Oto-rhino-laryngology
Sait Serdar Gumrukcu, İlhan Topaloglu, Ziya Salturk, Belgin Tutar, Yavuz Atar, Güler Berkiten, Ayşe Enise Göker
AIM: Aim of the study was to evaluate the effect of intratympanic steroid treatment on hearing based on oto-acoustic emission. METHODS: A total of 16 healthy female Wistar albino rats weighing were used in this study. They were divided in to 2 groups and each group was exposed to noise at 110dB for 25min to induce acoustic trauma. Intratympanic dexamethasone was administered to the middle ears of animals in the experimental group on the same day as exposure to noise...
January 2018: American Journal of Otolaryngology
Jin Youp Kim, Jae Joon Han, Woong Sang Sunwoo, Ja-Won Koo, Seung-Ha Oh, Min-Hyun Park, Young Ho Kim
OBJECTIVE: Although many studies have investigated sudden sensorineural hearing loss (SSNHL) in adults, there were few studies on SSNHL in the pediatric population; especially research on treatment and prognosis of pediatric SSNHL was limited. The aim of this study was to evaluate clinical characteristics, treatment outcomes and prognostic factors in children and adolescents with SSNHL. METHODS: A retrospective review of medical records of 67 pediatric patients (67 ears) who had diagnosed with SSNHL at our hospitals was performed to analyze patients' clinical manifestations and audiograms...
September 6, 2017: Auris, Nasus, Larynx
Sabri Baki Eren, Remzi Dogan, Alper Yenigun, Bayram Veyseller, Selahattin Tugrul, Orhan Ozturan, Mehmet Serif Aydin
OBJECTIVE: Methotrexate is a dihydrofolate reductase enzyme inhibitor with very high selectivity, and it is an antiproliferative folic acid antagonist used for the treatment of autoimmune diseases. In this study, our objective was to evaluate the effect of intratympanic Methotrexate application in the inner ear. METHODS: This study was planned as an animal study. This study performed in a tertiary referral center. 24 healthy female rats were used in our study. They were separated into three groups...
September 2017: International Journal of Pediatric Otorhinolaryngology
Gülce Ermutlu, Nilda Süslü, Taner Yılmaz, Sarp Saraç
Corticosteroid treatment has been considered the most effective treatment modality for sudden sensorineural hearing loss so far. Application route of corticosteroids may vary. We have designed a prospective randomized case-controlled clinical trial to evaluate the effectivenesses of the different application routes of steroids in the treatment of SSHL. Thirty-five patients were distributed randomly to two groups which were treated with either 'oral' or 'intratympanic' corticosteroids. Intratympanic steroid administration was performed three times every other day transtympanically...
October 2017: European Archives of Oto-rhino-laryngology
Oak-Sung Choo, Suk Min Yang, Hun Yi Park, Jong Bin Lee, Jeong Hun Jang, Seong Jun Choi, Yun-Hoon Choung
OBJECTIVES/HYPOTHESIS: We compared the clinical characteristics between acute low- and high-frequency hearing loss (LF and HF, respectively) patients, and the efficacy of three different treatment protocols (systemic steroids, intratympanic steroid injection, and combination therapy). STUDY DESIGN: Prospective, randomized controlled study. METHODS: A total of 111 patients diagnosed with LF or HF were treated on an outpatient basis. Each group was randomly divided into three equal subgroups based on therapy: oral steroid, intratympanic dexamethasone injection (IT), and combination therapy...
August 2017: Laryngoscope
Milan Kostal, Jakub Drsata, Milan Bláha, Miriam Lánská, Viktor Chrobok
BACKROUND: Only few therapeutic options exist for patients with refractory sudden idiopathic sensorineural hearing loss (SISHL). Little is known about the efficacy of second-line therapies. Rheopheresis seems to be an effective therapeutic possibility. METHODS: Between 2012 and 2015, 106 patients with SISHL were enrolled in the study, of whom 52 were refractory to initial treatment. As salvage therapy, these patients were offered either 3 sessions of rheopheresis (33 pts) or intratympanic steroid treatment through MicroWick application (19 pts)...
June 29, 2017: Journal of Otolaryngology—Head & Neck Surgery
Massimo Ralli, Giuseppe Nola, Luca Sparvoli, Giovanni Ralli
Enlarged vestibular aqueduct (EVA) syndrome is a common congenital inner ear malformation characterized by a vestibular aqueduct with a diameter larger than 1.5 mm, mixed or sensorineural hearing loss that ranges from mild to profound, and vestibular disorders that may be present with a range from mild imbalance to episodic objective vertigo. In our study, we present the case of a patient with unilateral enlarged vestibular aqueduct and bilateral endolymphatic hydrops (EH). EH was confirmed through anamnestic history and audiological exams; EVA was diagnosed using high-resolution CT scans and MRI images...
2017: Case Reports in Otolaryngology
Diego Zanetti, Federica Di Berardino, Nader Nassif, Luca Oscar Redaelli De Zinis
OBJECTIVE: Many studies over the last decade showed favorable outcomes with intratympanic (IT) steroid treatment, alone as salvage treatment or in combination with conventional systemic therapy (ST). However, in severe to profound sensorineural hearing loss resistant to ST, the optimal infusion mode, the type and concentration of the solution, the preferable drug, its total amount, and the duration and fractionation of the treatment are still debated. Aim of the study was to investigate the feasibility and the outcomes of a direct and constant IT delivery of dexamethasone (DEX) by means of a new indwelling catheter...
May 13, 2017: Auris, Nasus, Larynx
Umberto M Musazzi, Silvia Franzé, Francesco Cilurzo
The sense of hearing is essential for permitting human beings to interact with the environment, and its dysfunctions can strongly impact on the quality of life. In this context, the cochlea plays a fundamental role in the transformation of the airborne sound waves into electrical signals, which can be processed by the brain. However, several diseases and external stimuli (e.g., noise, drugs) can damage the sensorineural structures of cochlea, inducing progressive hearing dysfunctions until deafness. In clinical practice, the current pharmacological approaches to treat cochlear diseases are based on the almost exclusive use of systemic steroids...
May 1, 2017: Drug Delivery and Translational Research
Jason A Beyea, Ryan S Instrum, Sumit K Agrawal, Lorne S Parnes
OBJECTIVE: To assess the efficacy and safety of two different intratympanic dexamethasone (IT Dex) injection protocols for intractable unilateral Ménière's disease. STUDY DESIGN: Prospective case series. SETTING: Tertiary neurotology clinic. PATIENTS: One hundred six consecutive adult patients with definite unilateral Ménière's disease who had failed medical management were studied for an average of 1,061 days. None had previous oral steroid, IT steroid, or ablative treatment...
July 2017: Otology & Neurotology
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