cortisol-succinate--sodium-salt and Hearing-Loss--Sensorineural

Purpose We retrospectively studied the efficacy of intratympanic steroid administration in comparison with hyperbaric oxygen (HBO) therapy for idiopathic sudden sensorineural hearing loss (ISSNHL) with negative prognostic factors. Method We enrolled 301 patients (302 ears) with ISSNHL (average hearing level at 250-4000 Hz ≥ 40 dB; time from onset to treatment ≤ 30 days). From August 2002 to March 2009, 174 patients (174 ears) received systemic steroid plus HBO therapy (HBO group), and from June 2015 to January 2018, 127 patients (128 ears) received systemic plus intratympanic steroid (IT group). Hearing outcomes were evaluated by 6 indices: cure rate, marked-recovery rate (percent of patients with hearing gain ≥ 30 dB), recovery rate (percent of patients with hearing gain ≥ 10 dB), hearing gain, hearing level after treatment, and percent hearing improvement compared to the unaffected contralateral ear. Results The recovery rate was significantly higher in the IT group than in the HBO group (80.5% vs. 68.4%, p = .019). The IT group showed a higher recovery rate than the HBO group in patients aged ≥ 60 years ( p = .010), patients with early (≤ 7 days from onset) treatment ( p = .005), patients with initial hearing levels ≥ 90 dB ( p = .037), and patients with vertigo/dizziness ( p = .040). The IT group also showed higher hearing gain and percent hearing improvement than the HBO group in patients with vertigo/dizziness ( p = .046 and p = .026, respectively). Conclusions Systemic plus intratympanic steroid is more effective for ISSNHL than systemic steroid plus HBO, particularly in patients with negative prognostic factors, such as old age, profound hearing loss, and/or presence of vertigo/dizziness.

Topics: Anti-Inflammatory Agents; Audiometry; Dexamethasone; Female; Glucocorticoids; Hearing Loss, Sensorineural; Hearing Loss, Sudden; Humans; Hydrocortisone; Hyperbaric Oxygenation; Injection, Intratympanic; Male; Middle Aged; Middle Ear Ventilation; Prednisolone; Prognosis; Recovery of Function; Retrospective Studies; Time-to-Treatment; Treatment Outcome; Vertigo

A 53-year-old male with fluctuating low frequency sensorineural hearing loss and tinnitus, but without vertigo, was evaluated by MRI obtained by intratympanic injection of a gadolinium-based contrast agent (GBCA) before and after the administration of isosorbide. The endolymphatic hydrops was semi-quantitatively evaluated by a 3.0-T MR scanner. For quantification, the affected side/contralateral side ratios were calculated. A gadodiamide (a kind of GBCA)-enhanced space surrounding the endolymph in the affected side with a 0.50 ratio (which may have represented endolymphatic hydrops) improved after isosorbide therapy to a 0.98 ratio. Thus, endolymphatic hydrops was demonstrated in a patient with 'atypical' Meniere's disease (MD), suggesting that at least some atypical MD may share similar etiology with, and therefore be a continuum of, MD. Also, therapeutic effects could be visualized by using MRI. Therefore, MRI-based diagnosis of MD-related disease will be a powerful tool not only because of its precision but also its usefulness for therapeutic evaluation.

Topics: Anti-Inflammatory Agents; Contrast Media; Diuretics, Osmotic; Drug Therapy, Combination; Endolymph; Endolymphatic Hydrops; Gadolinium DTPA; Hearing Loss, Sensorineural; Humans; Hydrocortisone; Image Enhancement; Image Processing, Computer-Assisted; Isosorbide; Magnetic Resonance Imaging; Male; Meniere Disease; Middle Aged; Perilymph; Tinnitus

We report a 44-year-old Japanese woman who presented with fluctuating hearing loss. She suffered from aortitis syndrome (AS) since she was 30-year-old and took daily tablets of prednisolone (10mg). Pure tone audiometry showed bilateral high-tone sensorineural hearing loss. Although her hearing recovered with higher doses of steroids, she was concerned about the systemic side effects of frequent administration of high doses of steroids. Thus, she underwent intratympanic injection of dexamethasone at the time of worsening of hearing. Her hearing has been maintained by intratympanic injection of dexamethasone. Intratympanic injection of steroids may be an alternative treatment for hearing loss associated with AS.

Topics: Administration, Oral; Adult; Alprostadil; Anti-Inflammatory Agents; Audiometry, Pure-Tone; Dexamethasone; Dose-Response Relationship, Drug; Drug Therapy, Combination; Ear, Middle; Female; Hearing Loss, Sensorineural; Humans; Hydrocortisone; Infusions, Intravenous; Injections; Prednisolone; Retreatment; Takayasu Arteritis