psd-502 and Meniere-Disease

The objective of the study is to compare the pain level of three methods of intratympanic (IT) injections using prospective, randomized clinical study in a tertiary care center. 39 patients with Ménière's disease and 30 patients with sudden sensorineural hearing loss are included. Excluded were patients treated for a chronic pain or those who took any pain killer for the last 24 h. Each patient received one IT injection a week, for three consecutive weeks. Three methods of IT injections were compared, with the application of EMLA cream on the tympanic membrane filling the external auditory canal 60 min before the procedure, with subcutaneous injection of lidocaine 1% with 1:100,000 epinephrine in the external auditory canal, and finally with an IT injection without any previous anesthesia. The pain intensity was immediately measured at 5 min, and then 45 min after the procedure, each time using four pain rating scales (visual analogue scale, numerical rating scale, verbal rating scale and categorical rating scale). No difference in pain intensity between the three methods of IT injections was detected by the visual analogue scale and numerical rating scale (p > 0.05). 45.8% of patients preferred the IT injection without previous anesthesia. However, methylprednisolone has been associated with pain intensity greater than that of gentamicin 45 min after the injection (p < 0.05). The IT injection performed without any previous anesthesia is an interesting option since it has not been shown to be more painful than the other methods of injections, and spares the patient from disadvantages associated with the anesthesia.

Topics: Adolescent; Adult; Aged; Anesthetics, Local; Anti-Bacterial Agents; Anti-Inflammatory Agents; Female; Gentamicins; Hearing Loss, Sudden; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Meniere Disease; Methylprednisolone; Middle Aged; Pain; Pain Measurement; Prilocaine; Prospective Studies; Tympanic Membrane

The objective of this study was to quantify the anaesthetic effect of EMLA cream during transtympanic electrocochleography (TTECochG) and thereby to determine if the application of EMLA should be recommended in routine practice of electrocochleography (ECochG). ECochG provides useful information in patients with inner ear fluid disorders. A major concern regarding transtympanic positioning of the electrode in ECochG is patient discomfort. Previous work has suggested that EMLA cream may make this technique more tolerable to patients. A prospective randomized study was performed evaluating the discomfort associated with unilateral TTECochG in a group where EMLA cream was used to anaesthesize the tympanic membrane (n = 24), and in a group where no anaesthesia was used (n = 22). A statistically significant difference was evident between the discomfort ratings of the groups (P < 0.0001, Mann-Whitney U test), the discomfort being greater in the no anaesthesia group. EMLA cream has thus been shown to alleviate the level of discomfort associated with TTECochG and so to be an acceptable modification of this technique.

Topics: Adult; Aged; Anesthesia, Local; Anesthetics, Local; Audiometry, Evoked Response; Electrodes; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Meniere Disease; Middle Aged; Ointments; Pain Measurement; Prilocaine; Prospective Studies; Tympanic Membrane