1
|
Hoch S, Kremper L, Rudhart SA, Stuck BA. [Role of intratympanic glucocorticoid treatment in sudden hearing loss]. HNO 2024; 72:291-302. [PMID: 38351342 DOI: 10.1007/s00106-024-01424-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 03/24/2024]
Abstract
Idiopathic sudden sensorineural hearing loss (ISSNHL) is one of the most common diseases in otolaryngology. Its etiology remains unknown. Furthermore, there is only a low level of evidence for the efficacy of established treatment modalities. In addition to systemic glucocorticoids, intratympanic corticosteroid treatment (ICT) has become increasingly important for treatment of ISSNHL. Different application strategies and treatment regimens have been described; however, uniform standards do not yet exist. ICT may be used for primary treatment as well as salvage therapy. Current data from meta-analyses show no benefit of intratympanic versus systemic primary therapy for sudden hearing loss (moderate evidence) but suggest a benefit of intratympanic secondary treatment over no treatment or placebo (high effect size, low evidence). Regarding combination of systemic and local glucocorticoid therapy in primary treatment of hearing loss, there may be a small benefit over systemic treatment alone (low effect size, low evidence).
Collapse
Affiliation(s)
- Stephan Hoch
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
| | - Luisa Kremper
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Stefan Alexander Rudhart
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Boris Alexander Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| |
Collapse
|
2
|
Plontke SK, Girndt M, Meisner C, Fischer I, Böselt I, Löhler J, Ludwig-Kraus B, Richter M, Steighardt J, Reuter B, Böttcher C, Langer J, Pethe W, Seiwerth I, Jovanovic N, Großmann W, Kienle-Gogolok A, Boehm A, Neudert M, Diensthuber M, Müller A, Dazert S, Guntinas-Lichius O, Hornung J, Vielsmeier V, Stadler J, Rahne T. High-Dose Glucocorticoids for the Treatment of Sudden Hearing Loss. NEJM EVIDENCE 2024; 3:EVIDoa2300172. [PMID: 38320514 DOI: 10.1056/evidoa2300172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
High-Dose Glucocorticoids for Sudden Hearing LossThis trial compared courses of high-dose intravenous prednisolone or high-dose oral dexamethasone versus standard-dose oral prednisone in adults with idiopathic sudden sensorineural hearing loss. At 30 days, systemic high-dose glucocorticoid therapy was not superior to a lower-dose regimen with respect to change in hearing threshold, and it was associated with a higher risk of side effects.
Collapse
Affiliation(s)
- Stefan K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Halle (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine, University Medicine Halle, Halle (Saale), Germany
| | - Christoph Meisner
- Robert Bosch Society for Medical Research, Robert Bosch Hospital, Stuttgart, Germany
| | - Imma Fischer
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Iris Böselt
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jan Löhler
- Scientific Institute for Applied Oto-Rhino-Laryngology of the German Professional Association of ENT Surgeons, Bad Bramstedt, Germany
| | - Beatrice Ludwig-Kraus
- Department of Laboratory Medicine, Central Laboratory, University Hospital Halle, Halle (Saale), Germany
| | - Michael Richter
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jörg Steighardt
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Bernd Reuter
- Department of Otorhinolaryngology/Plastic Surgery, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Christoph Böttcher
- Department of Otorhinolaryngology/Plastic Surgery, SRH Zentralklinikum Suhl, Suhl, Germany
- ENT Practice, Bad Neustadt, Germany
| | - Jörg Langer
- ENT Department, AMEOS Clinic Halberstadt, Halberstadt, Germany
| | - Wolfram Pethe
- ENT Department, AMEOS Clinic Halberstadt, Halberstadt, Germany
| | - Ingmar Seiwerth
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Halle (Saale), Germany
| | - Nebojsa Jovanovic
- Department of Otorhinolaryngology, Head and Neck Surgery, Plastic Surgery, University Hospital of Giessen and Marburg, Giessen, Germany
| | - Wilma Großmann
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner," Rostock University Medical Center, Rostock, Germany
| | | | - Andreas Boehm
- ENT Department, Hospital St. Georg gGmbH, Leipzig, Germany
| | - Marcus Neudert
- Department of Otorhinolaryngology, Head and Neck Surgery, Technical University Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany
| | - Marc Diensthuber
- Department of Otorhinolaryngology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Andreas Müller
- Department Otorhinolaryngology/Plastic Surgery, SRH Wald-Klinikum Gera gGmbH, Gera, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth Hospital, Ruhr University Bochum, Bochum, Germany
| | | | - Joachim Hornung
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Joachim Stadler
- Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich-Braun-Klinikum gGmbH, Zwickau, Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Halle (Saale), Germany
| |
Collapse
|
3
|
Rozbicki P, Usowski J, Siewiera J, Jurkiewicz D. The Influence of Steroid Therapy on the Treatment Results in Patients with Sudden Sensorineural Hearing Loss. J Clin Med 2022; 11:jcm11206085. [PMID: 36294406 PMCID: PMC9605235 DOI: 10.3390/jcm11206085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/28/2022] Open
Abstract
Oral, intravenous, or intratympanic steroid therapy (ST) are commonly applied methods of pharmacotherapy in Sudden Sensorineural Hearing Loss (SSNHL). There are vast discrepancies on the recommended initial dose and the duration of ST in medical reports. The aim of the research is a retrospective comparison of patients’ examination results with different therapeutical strategies. The medical records of 218 patients treated for SSNHL at the Military Institute of Medicine were subjected to retrospective analysis by comparison of the results of pure tone audiometry prior to and after treatment with steroid therapy (first-dose delay, mass of first dose, duration of treatment). Postponement of implementation of ST to 5 days resulted in a significant improvement of hearing across all frequencies. The implementation of ST sequentially in periods (5th−10th day; >10th day) resulted in a statistically insignificant improvement of hearing in the following frequencies: 250 Hz, 1000 Hz, 1500 Hz, 2000 Hz, 3000 Hz, 4000 Hz. There was a statistical improvement of hearing within all frequencies analyzed for the initial dose of prednisone above 50 mg. For an initial dose below 50 mg, in 4000 Hz, the improvement of hearing was statistically insignificant. The research demonstrated a significant influence of steroid therapy on treatment results in patients with Sudden Sensorineural Hearing Loss.
Collapse
Affiliation(s)
- Paweł Rozbicki
- Department of Otolaryngology and Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland
- Correspondence: ; Tel.: +48-261-816-471
| | - Jacek Usowski
- Department of Otolaryngology and Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Jacek Siewiera
- Department of Hyperbaric Medicine, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland
| |
Collapse
|
4
|
Plontke SK, Girndt M, Meisner C, Böselt I, Ludwig-Kraus B, Richter M, Rahne T. Efficacy and safety of systemic, high-dose glucocorticoid therapy for idiopathic sudden sensorineural hearing loss : Study protocol for a three-armed, randomized, triple-blind, multicenter trial (HODOKORT). HNO 2022; 70:30-44. [PMID: 35725822 PMCID: PMC9208545 DOI: 10.1007/s00106-022-01184-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systemic glucocorticosteroids ("steroids") are widely used worldwide as a standard of care for primary therapy of idiopathic sudden sensorineural hearing loss (ISSHL). The German ISSHL guideline recommends high-dose steroids without evidence from randomized controlled trials (RCTs) and refers solely to retrospective cohort studies. This RCT aims to assess the efficacy (improvement in hearing) and safety (especially systemic side effects) of high-dose steroids versus standard of care (standard dose systemic steroids) for the treatment of unilateral ISSHL, when given as a primary therapy. METHODS The study is designed as a multicenter (approximately 40 centers), randomized, triple-blind, three-armed, parallel group, clinical trial with 312 adult patients. The interventions consist of 5 days of 250 mg/day intravenous prednisolone (intervention 1) + oral placebo, or 5 days of 40 mg/day oral dexamethasone (intervention 2) + intravenous placebo. The control intervention consists of 60 mg oral prednisolone for 5 days followed by five tapering doses + intravenous placebo. The primary efficacy endpoint is the change in hearing threshold in the three most affected contiguous frequencies between 0.25 and 8 kHz 1 month after ISSHL. Secondary endpoints include further measures of hearing improvement including speech audiometry, tinnitus, quality of life, blood pressure, and altered glucose tolerance. DISCUSSION There is an unmet medical need for an effective medical therapy of ISSHL. Although sensorineural hearing impairment can be partially compensated by hearing aids or cochlear implants (CI), generic hearing is better than using hearing aids or CIs. Since adverse effects of a short course of high-dose systemic corticosteroids have not been documented with good evidence, the trial will improve knowledge on possible side effects in the different treatment arms with a focus on hyperglycemia and hypertension. TRIAL REGISTRATION EudraCT (European Union Drug Regulating Authorities Clinical Trials Database) Nr. 2015-002602-36; Sponsor code: KKSH-127.
Collapse
Affiliation(s)
- Stefan K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Matthias Girndt
- Department of Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christoph Meisner
- Robert Bosch Society for Medical Research, Robert Bosch Hospital, Stuttgart, Germany
| | - Iris Böselt
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Michael Richter
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| |
Collapse
|
5
|
Rollema C, van Roon EN, Ekhart C, van Hunsel FPAM, de Vries TW. Adverse Drug Reactions of Intranasal Corticosteroids in the Netherlands: An Analysis from the Netherlands Pharmacovigilance Center. Drugs Real World Outcomes 2022; 9:321-331. [PMID: 35661117 PMCID: PMC9392821 DOI: 10.1007/s40801-022-00301-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Intranasal corticosteroids are one of the cornerstone treatment options for allergic rhinitis and chronic sinusitis complaints. Safety information in the summary of product characteristics may not be representative for observations in daily clinical practice. The Netherlands Pharmacovigilance Center (Lareb) collects post-marketing safety information, using spontaneous reporting systems. OBJECTIVE Our objective was to analyse reports of adverse drug reactions associated with intranasal corticosteroids reported in the Dutch spontaneous reporting database of the Netherlands Pharmacovigilance Center Lareb to obtain insight into real-world safety data. METHODS We retrospectively examined all adverse drug reactions of intranasal corticosteroids reported to the Netherlands Pharmacovigilance Center Lareb, entered into the database from 1991 until 1 July, 2020. RESULTS In total, 2263 adverse drug reactions after intranasal corticosteroid use were reported in 1258 individuals. Headache (n = 143), epistaxis (n = 124) and anosmia (n = 57) were reported most frequently. Nasal septum perforation (reporting odds ratio 463.2; 95% confidence interval: 186.7-1149.7) had the highest reporting odds ratio, followed by nasal mucosal disorder (reporting odds ratio 104.5; 95% confidence interval 36.3-301.3) and hyposmia (reporting odds ratio 90.8; 95% confidence interval 45.1-182.7). Moreover, 101 (4.5%) reports were classified as serious by Lareb, including reports of Cushing's syndrome, adrenal cortical hypofunction and growth retardation. CONCLUSIONS Many side effects are consistent with the safety information in the summary of product characteristics of intranasal corticosteroids. Several serious (systemic) side effects are reported and it is important to realise that intranasal corticosteroids may contribute to the development. Healthcare providers and patients should be aware of the potential (individual) adverse drug reactions of intranasal corticosteroids. This information could help in discussing treatment options.
Collapse
Affiliation(s)
- Corine Rollema
- Department of Clinical Pharmacy and Pharmacology, Medical Centre Leeuwarden, Henri Dunantweg 2, P.O. Box 888, 8901 BR, Leeuwarden, The Netherlands.
| | - Eric N van Roon
- Department of Clinical Pharmacy and Pharmacology, Medical Centre Leeuwarden, Henri Dunantweg 2, P.O. Box 888, 8901 BR, Leeuwarden, The Netherlands
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Corine Ekhart
- Netherlands Pharmacovigilance Center Lareb, 's-Hertogenbosch, The Netherlands
| | | | - Tjalling W de Vries
- Department of Paediatrics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| |
Collapse
|
6
|
Skarżyńska MB, Kołodziejak A, Gos E, Sanfis MD, Skarżyński PH. Effectiveness of Various Treatments for Sudden Sensorineural Hearing Loss-A Retrospective Study. Life (Basel) 2022; 12:96. [PMID: 35054488 PMCID: PMC8779405 DOI: 10.3390/life12010096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 12/19/2022] Open
Abstract
(1) Background: A retrospective clinical study was conducted to compare the effectiveness of different pharmacological and non-pharmacological regimens for treating sudden sensorineural hearing loss (SSNHL). (2) Methods: Adult patients (n = 130) diagnosed with sudden sensorineural hearing loss (SSNHL) and hospitalized between 2015 and 2020 were enrolled in this study. Depending on the treatment regimen applied, patients were divided into five groups. Inclusion criteria were as follows: (i) hearing loss of sudden onset; (ii) hearing loss of at least 30 dB at three consecutive frequencies; (iii) unilateral hearing loss; (iv) age above 18 years. Exclusion criteria were as follows: (i) no follow-up audiogram; (ii) bilateral hearing loss; (iii) recognized alternative diagnosis such as tumor, disorder of inner ear fluids, infection or inflammation, autoimmune disease, malformation, hematological disease, dialysis-dependent renal failure, postdural puncture syndrome, gene-related syndrome, mitochondrial disease; and (iv) age below 18 years. (3) Results: Complete recovery was found in 14% of patients (18/130) and marked improvement was found in 6% (8/130), giving an overall success rate of 20%. The best results were obtained in the second group (i.e., patients given intratympanic glucocorticoid + prolonged orally administered glucocorticoid) where the success rate was 28%. In general, the older the patient, the smaller the improvement in hearing, a correlation that was statistically significant. (4) Conclusions: In treating SSNHL, the highest rate of hearing recovery-28%-was in the group of patients given intratympanic corticoid plus prolonged treatment with orally administered glucocorticoid.
Collapse
Affiliation(s)
- Magdalena B Skarżyńska
- Institute of Sensory Organs, Nadarzyn, 05830 Warsaw, Poland
- Center of Hearing and Speech Medincus, Nadarzyn, 05830 Warsaw, Poland
| | - Aleksandra Kołodziejak
- World Hearing Center, Department of Teleaudiology and Screening, Institute of Physiology and Pathology of Hearing, Nadarzyn, 05830 Warsaw, Poland
| | - Elżbieta Gos
- World Hearing Center, Department of Teleaudiology and Screening, Institute of Physiology and Pathology of Hearing, Nadarzyn, 05830 Warsaw, Poland
| | - Milaine Dominici Sanfis
- Child and Adolescent Health Program, Faculty of Medical Sciences, University of Campinas, Campinas 13083970, Brazil
| | - Piotr H Skarżyński
- Institute of Sensory Organs, Nadarzyn, 05830 Warsaw, Poland
- World Hearing Center, Department of Teleaudiology and Screening, Institute of Physiology and Pathology of Hearing, Nadarzyn, 05830 Warsaw, Poland
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, 02091 Warsaw, Poland
| |
Collapse
|
7
|
Essawy WM. Effectiveness of oral corticosteroids (prednisolone) in sensorineural hearing loss post COVID-19. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022; 38:162. [PMCID: PMC9748904 DOI: 10.1186/s43163-022-00347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Numerous infections can result in neurological symptoms, including anosmia, facial paralysis, and abrupt sensorineural hearing loss (SSNHL). During the earlier SARS pandemic, coronaviruses were linked to a loss of smell and taste due to brain damage. Purpose To clinically detect corticosteroid treatment effectiveness in SSNHL post-COVID-19 infection and to detect the factors that affect the prognosis for these patients for better diagnosis and earlier management. Subjects and method Subjects included 20 subjects diagnosed by PCR as COVID-19 virus positive, complaining of sudden onset hearing loss post viral infection in different durations. All subjects had basic audiological evaluation done pre-treatment and repeated after 1 week, 2 weeks, and 1 month after treatment with methylprednisolone 21-acetate tablets. Results Onset of hearing loss post-COVID infection ranged from 1 to 3 months. As regards the improvement recognized with treatment course, thirteen patients (65%) of all twenty patients showed complete improvement at 1 month after starting treatment, and seven patients (35%) showed no improvement even after 1 month. Conclusion SSNHL has been widely recognized in the context of COVID-19 to date. Early corticosteroid therapy could help in the recovery of hearing, especially if the beginning of therapy was early in the first 2 weeks.
Collapse
Affiliation(s)
- Wessam Mostafa Essawy
- grid.412258.80000 0000 9477 7793Audio-vestibular Unit, Department of Otorhinolaryngology, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
8
|
Evaluating the Efficacy of Intratympanic Dexamethasone in Protecting Against Irreversible Hearing Loss in Patients on Cisplatin-Based Cancer Treatment: A Randomized Controlled Phase IIIB Clinical Trial. Ear Hear 2021; 43:676-684. [PMID: 34483247 DOI: 10.1097/aud.0000000000001119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the efficacy of long-term high-dose intratympanic dexamethasone in protecting the hearing capacity of cancer patients undergoing cisplatin-based ototoxic treatment. DESIGN A randomized controlled phase IIIB clinical trial to evaluate the efficacy of dexamethasone in protecting against hearing loss in patients undergoing cisplatin treatment. The subjects participating in the clinical trial were patients with a neoplastic disease whose treatment protocol included cisplatin. The average dose of cisplatin was 444.87 mg (SD 235.2 mg). Treatment consisted of intratympanically administering dexamethasone via a passive diffusion device called Microwick (8 mg/24 h dose) from the start of treatment with cisplatin to 3 weeks after the last cycle. Patients were administered the medication to one ear, and the contralateral ear was used as the control. The treated ears were randomly chosen using a computer system (randomization). The hearing threshold was evaluated using pure tone audiometry before each cisplatin cycle. RESULTS Thirty-four patients were recruited over a 2-year period at a reference tertiary hospital, of whom 11 were excluded. Forty-six ears were analyzed (23 treated and 23 control ears). When treatment was completed, the audiometric analysis showed a higher hearing threshold in the study group than in the control group. Differences were statistically significant at frequencies of 500, 1000, and 6000 Hz: 4.9 dB (1.1 to 8.7), 5.5 dB (0.8 to 10.3), and 16 dB (3.2 to 28.7), respectively, (p < 0.05, 95% confidence interval), but were not clinically significant according to the ASHA hearing loss criteria. Both 8.69% infection complications during treatment and 34.8% permanent perforation at 6 mo were detected after device removal. CONCLUSIONS Long-term high-dose intratympanic dexamethasone treatment did not prevent cisplatin-induced hearing loss.
Collapse
|
9
|
Chen X, Zhang Q, Yang C, Liu Y, Li L. GRβ Regulates Glucocorticoid Resistance in Sudden Sensorineural Hearing Loss. Curr Pharm Biotechnol 2021; 22:1206-1215. [PMID: 33032506 DOI: 10.2174/1389201021666201008163534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent years, the incidence of sudden deafness has gradually increased, with a very limited understanding of its etiology and pathogenesis. Glucocorticoids are the first choice of the treatment, but some hormone-resistant patients are not sensitive to glucocorticoid therapy. The pathogenesis is not yet known. In this study, we aim to construct the HEI-OC1 cell line stably overexpressing Glucocorticoid Receptor Beta (GRβ), and identify its exact role in the cases of glucocorticoidresistant sudden deafness. METHODS We used the endotoxin lipopolysaccharide-stimulated cochlear hair cells (HEI-OC1) to investigate the relationship of inflammation factor IL-2, TNF alpha, and SRp30c with the high expression GRβ. We built a stable GRβ high expression HEI-OC1 cell line and clarified its effects on the therapeutic effect of dexamethasone. MTT assay, colony formation assay, CCK-8 assay, Western blot, and RT-qPCR were utilized for characterizations. RESULTS Dexamethasone reduced the LPS-induced inflammatory response from HEI-OC1 cells (p<0.05), detected by MTT assay. Dexamethasone could protect HEI-OC1 cells, but its protective effect was weakened due to the transfection of SRp30c over-expression plasmid (p<0.05). The transfection of SRp30c over-expression plasmid in HEI-OC1 cells could elevate the expressions of GRβ (p<0.05). CONCLUSION We clarified the mechanisms of high expression of GRβ in glucocorticoid-resistant sudden sensorineural hearing loss, and proved that the inhibition of SRp30c may act as a new treatment way of glucocorticoid-resistant sudden sensorineural hearing loss.
Collapse
Affiliation(s)
- Xubo Chen
- Department of Otolaryngology, Head and Neck Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Qi Zhang
- College of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese medicine, Nanchang, Jiangxi, 330004, China
| | - Chunping Yang
- Department of Otolaryngology, Head and Neck Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Yuehui Liu
- Department of Otolaryngology, Head and Neck Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Lihua Li
- Department of Otolaryngology, Head and Neck Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| |
Collapse
|
10
|
White PM. Perspectives on Human Hearing Loss, Cochlear Regeneration, and the Potential for Hearing Restoration Therapies. Brain Sci 2020; 10:brainsci10100756. [PMID: 33092183 PMCID: PMC7589617 DOI: 10.3390/brainsci10100756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 12/23/2022] Open
Abstract
Most adults who acquire hearing loss find it to be a disability that is poorly corrected by current prosthetics. This gap drives current research in cochlear mechanosensory hair cell regeneration and in hearing restoration. Birds and fish can spontaneously regenerate lost hair cells through a process that has become better defined in the last few years. Findings from these studies have informed new research on hair cell regeneration in the mammalian cochlea. Hair cell regeneration is one part of the greater problem of hearing restoration, as hearing loss can stem from a myriad of causes. This review discusses these issues and recent findings, and places them in the greater social context of need and community.
Collapse
Affiliation(s)
- Patricia M White
- Department of Neuroscience, Ernest J. Del Monte Institute for Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
| |
Collapse
|
11
|
Kordiš Š, Vozel D, Hribar M, Urbančič NB, Battelino S. The Outcome of Prompt Concomitant Single-Dose High-Concentration Intratympanic and Tapered Low-Dose Oral Systemic Corticosteroid Treatment for Sudden Deafness. J Int Adv Otol 2020; 16:201-206. [PMID: 32784158 DOI: 10.5152/iao.2020.8341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To investigate the efficacy of prompt concomitant corticosteroid treatment with single application of high-concentration intratympanic (IT) dexamethasone and tapered low-dose systemic methylprednisolone of an idiopathic sudden sensorineural hearing loss (ISSNHL). MATERIALS AND METHODS Between September 2017 and September 2019, 86 adult patients met the criteria for the diagnosis of ISSNHL at baseline evaluation. The patients received immediate concomitant treatment with single high-concentration (24 mg/mL) IT dexamethasone and low-dose (48 mg) oral methylprednisolone for 1 week followed by tapered doses. Improvement in pure-tone average (PTA) and word recognition score (WRS) was determined after 1 and 6 months. RESULTS A total of 63 patients met the requirements for the analysis. PTA improved in 71% and WRS improved in 59% of patients with ISSNHL. PTA and WRS were statistically significantly different at different time points during the intervention (p<0.0005). Hearing improved in all measured frequencies from 125 to 8000 Hz until the second follow-up. In 65.4% of patients with tinnitus, the WRS has improved compared with 27.3% without tinnitus (p<0.05). In 69.2% of patients without vertigo, the WRS has improved compared with 41.7% with vertigo (p<0.05). CONCLUSION Prompt concomitant single high-concentration IT and low-dose systemic corticosteroid treatment is efficient in recovering hearing loss and speech discrimination in ISSNHL. Tinnitus positively predicts hearing outcome. Vertigo negatively predicts speech discrimination recovery.
Collapse
Affiliation(s)
- Špela Kordiš
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia;University of Ljubljana School of Medicine, Ljubljana, Slovenia
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia;University of Ljubljana School of Medicine, Ljubljana, Slovenia
| | - Manja Hribar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia;University of Ljubljana School of Medicine, Ljubljana, Slovenia
| | - Nina Božanić Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia;University of Ljubljana School of Medicine, Ljubljana, Slovenia
| |
Collapse
|
12
|
Molnár A, Maihoub S, Tamás L, Szirmai Á. Intratympanically administered steroid for progressive sensorineural hearing loss in Ménière's disease. Acta Otolaryngol 2019; 139:982-986. [PMID: 31498001 DOI: 10.1080/00016489.2019.1658898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Ménière's disease is characterised by episodic rotational vertigo, sensorineural hearing loss, tinnitus, and vegetative symptoms. Objectives: The aim of our study is to follow-up the effects of the intratympanic steroid treatment of hearing loss in MD. Material and methods: A group of 105 clinically diagnosed MD patients were enrolled in this investigation. Long-term follow-up was carried out, and pure tone speech audiometry results of the subjects before and after application of steroid were contrasted. Statistical analysis was carried out using the IBM SPSS V24 software. Results: Based on the audiograms in this population, all stages of hearing loss were presented (from slight to profound). In most of the cases (68.6%), after intratympanic dexamethasone treatment, stagnation in the hearing profile was achieved. Moreover, there was a smaller group demonstrating hearing improvement after the treatment (12.4%). According to logistic regression [p = .001; Odds ratio: 2.75 (95% CI 1.068-4.442,)], there was a strong correlation between hearing improvement and dexamethasone treatment (all patients were treated with intratympanic dexamethasone, while improvement without steroid treatment could never be attained). Conclusions and significance: Intratympanically administered dexamethasone is a potent agent to prevent the progression of hearing loss in MD.
Collapse
Affiliation(s)
- András Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Stefani Maihoub
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - László Tamás
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Ágnes Szirmai
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| |
Collapse
|
13
|
Cochlear Glucocorticoid Receptor and Serum Corticosterone Expression in a Rodent Model of Noise-induced Hearing Loss: Comparison of Timing of Dexamethasone Administration. Sci Rep 2019; 9:12646. [PMID: 31477769 PMCID: PMC6718671 DOI: 10.1038/s41598-019-49133-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/14/2019] [Indexed: 12/20/2022] Open
Abstract
Glucocorticoid (GC) is a steroid hormone secreted from the adrenal cortex in response to stress, which acts by binding to cytoplasmic glucocorticoid receptors (GRs). Dexamethasone (DEX) is a synthetic GC exhibiting immunosuppressive effects in both human and rodent models of hearing loss. While clinical evidence has shown the effectiveness of DEX for treatment of various inner ear diseases, its mechanisms of action and the optimal timing of treatment are not well understood. In the present study, intergroup comparisons were conducted based on the time point of treatment with DEX: (1) pretreatment; (2) posttreatment; and (3) pre&post-noise. The pre&post DEX treatment group showed a significant improvement in threshold shift at 1 day post-noise exposure as compared to the TTS (transient threshold shift)-only group at 8 and 16 kHz. Both TTS and PTS (permanent threshold shift) significantly reduced cochlear GR mRNA expression and increased serum corticosterone and cochlear inflammatory cytokines. The pre&post DEX treatment group showed a significant decrease in serum corticosterone level as compared to other DEX treatment groups and TTS-treated group at 3 days after acoustic trauma. Our results suggest that the timing of DEX administration differentially modulates systemic steroid levels, GR expression and cochlear cytokine expression.
Collapse
|
14
|
Singh A, Kumar Irugu DV. Sudden sensorineural hearing loss - A contemporary review of management issues. J Otol 2019; 15:67-73. [PMID: 32440269 PMCID: PMC7231990 DOI: 10.1016/j.joto.2019.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 01/24/2023] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is an enigmatic entity, with obscure pathophysiology and debatable efficacy of the treatment agents used. An underlying cause is identified in only 10-15% of cases. The management of the remaining patients, classified as 'idiopathic', is empirical, and is conventionally with systemic steroids, vasodilator therapy, rheological agents, and antioxidants, to list a few amongst the host of the agents employed for the treatment. The availability of conflicting outcomes and lack of conclusive evidence has resulted in the propagation of consensus-based treatment protocols. In the present review, we discuss the various controversial issues and newer developments in the management of idiopathic SSNHL. The current review aims to present a narrative outlook of the updated evidence base available from PUBMED, augmented with relevant designated publications.
Collapse
Affiliation(s)
- Anup Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta- the Medicity, Gurugram, Haryana, India
| | - David Victor Kumar Irugu
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
15
|
Sequential versus Combination Treatment Using Steroids and Diuretics for Acute Low-Frequency Sensorineural Hearing Loss: A Noninferiority Trial. Otol Neurotol 2019; 40:305-311. [PMID: 30741894 DOI: 10.1097/mao.0000000000002154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Acute low-frequency hearing loss (ALHL) is typically treated with combination therapy, including steroids and diuretics. To avoid unnecessary use of steroids we proposed a method of sequential administration using these two drugs, and compared the efficacy of our protocol with that of existing combination treatments. METHODS A prospective, randomized, open-label, single-blind, noninferiority clinical trial was conducted to investigate whether the effectiveness of sequential treatment is noninferior to that of combination treatment for ALHL. Ninety-two patients with ALHL received either steroids and diuretics simultaneously for 2 weeks (combination group), or diuretics for 2 weeks followed by steroids for another 2 weeks if they did not respond to diuretic treatment (sequential group). The primary outcome measure was a change in mean hearing threshold at three frequencies (125, 250, and 500 Hz) at 4 weeks after treatment. RESULTS The mean hearing threshold of the low frequencies improved 20.0 and 17.2 dB in the combination and the sequential group, respectively. The 95% lower confidence interval was -8.0 dB and noninferiority was established at p < 0.05. At 4 weeks after treatment, the complete recovery rate was 80.5 and 82.9% in the combination and sequential groups, respectively. CONCLUSION This is the first study on ALHL treatment following the establishment of Consolidated Standards of Reporting Trials (CONSORT). The sequential treatment is not inferior to combination treatment for ALHL, and therefore may be a better treatment guideline for ALHL considering that patients receive less steroid exposure and smaller restrictions in diuretic use compared with steroids.
Collapse
|
16
|
Plontke SK. Diagnostics and therapy of sudden hearing loss. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2018; 16:Doc05. [PMID: 29503670 PMCID: PMC5818684 DOI: 10.3205/cto000144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article reviews recent aspects of diagnostics, differential diagnostics, and evidence in systemic and local therapy of idiopathic sudden sensorineural hearing loss (ISSHL). Since a number of disorders can be accompanied by sudden hearing loss, a meaningful and targeted diagnostic strategy is of utmost importance. An important differential diagnosis of sudden hearing loss are intralabyrinthine schwannomas (ILS). The incidence of ILS is probably significantly underestimated. This may be due to the lack of awareness or lack of explicit search for an intralabyrinthine tumor on MRI or an inappropriate MRI technique for the evaluation of sudden hearing loss ("head MRI" instead of "temporal bone MRI" with too high slice thicknesses). Therefore, the request to the radiologist should specifically include the question for (or exclusion of) an ILS. With special MRI techniques, it is possibly today to visualize an endolymphatic hydrops. The evidence in the therapy of ISSHL is - with respect to the quality and not quantity of studies - unsatisfying. The value of systemically (low dose) or intratympanically applied corticosteroids in the primary treatment of ISSHL is still unclear. In order to investigate the efficacy and safety of high dose corticosteroids as primary therapy for ISSHL, a national, multicenter, three-armed, randomized, triple-blind controlled clinical trial is currently performed in Germany (http://hodokort-studie.hno.org/). After insufficient recovery of the threshold with systemic therapy of ISSHL, intratympanic corticosteroid therapy appears to be associated with a significantly higher chance of an improved hearing threshold than no therapy or placebo. Both, hearing gain and final hearing threshold, however, appear to be independent from the onset of secondary therapy. Based on currently available data from clinical studies, no recommendation can be made with respect to the type of corticosteroid and specifics of the intratympanic application protocol.
Collapse
Affiliation(s)
- Stefan K. Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
17
|
Reduction of permanent hearing loss by local glucocorticoid application : Guinea pigs with acute acoustic trauma. HNO 2017; 65:59-67. [PMID: 27878601 DOI: 10.1007/s00106-016-0266-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND High-intensity noise exposure from impulse and blast noise events often leads to acute hearing loss and may cause irreversible permanent hearing loss as a long-term consequence. Here, a treatment regime was developed to limit permanent damage based on a preclinical animal model of acute noise trauma. AIM To develop clinical trials for the treatment of acute noise traumas using approved drugs. The otoprotective potential of glucocorticoids applied locally to the inner ear was examined. MATERIALS AND METHODS A series of experiments with different impulse noise exposures were performed. Permanent hearing loss and hair cell density were assessed 14 days after exposure. Hearing and hair cell preservation were investigated as a function of the glucocorticoid dose. RESULTS After impulse noise exposure, local application to the round window of the cochlea of high-dose prednisolone (25 mg/ml) or methylprednisolone (12.5 mg/ml) resulted in a statistically significant reduction in hearing loss compared with the control group. CONCLUSION The local application of high doses of the drugs to the round window of the cochlea appears to be an effective treatment for acute noise trauma.
Collapse
|
18
|
Shim HS, Kim JS, Kim MG. Comparative Analysis of the Combined Therapeutic Effects of Lipoprostaglandin E 1 on Sudden Idiopathic Sensorineural Hearing Loss. J Audiol Otol 2017; 21:33-38. [PMID: 28417106 PMCID: PMC5392007 DOI: 10.7874/jao.2017.21.1.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/03/2016] [Accepted: 07/04/2016] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives Viral and vascular disorders are considered to be a major cause of idiopathic sudden sensorineural hearing loss (ISSNHL). Lipoprostaglandin E1 (lipo-PGE1) has vasodilating activity and has been used to treat ISSNHL. The purpose of this study was to determine the specific therapeutic effects of lipo-PGE1 and compare them to other treatment modalities for ISSNHL. Subjects and Methods The study group had 1,052 patients diagnosed with ISSNHL. All were treated with steroid, carbogen inhalation, stellate ganglion block (SGB), or PGE1. The CP group (steroid, carbogen inhalation, and PGE1 injection; 288 patients) was treated with lipo-PGE1 and carbogen inhalation, the CS group (steroid, carbogen inhalation, and stellate ganglion block; 232 patients) with steroid, carbogen inhalation, and SGB, the C group (steroid and carbogen inhalation; 284 patients) with steroid and carbogen, and the control group (steroid only; 248 patients) with steroid only. Patients in the groups receiving lipo-PGE1 received a continuous infusion of 10 µL lipo-PGE1. Results The overall recovery rate after treatment was 52.2%, and recovery rates by group were 67.7% in the CP group, 54.3% in the CS group, 52.1% in the C group, and 32.2% in the control group. Therefore, the therapeutic results in groups treated with lipo-PGE1 were better than results in other groups. The difference was statistically significant. Conclusions The study results suggested that the CP group received effective treatment modalities for ISSNHL. The combined therapy of lipo-PGE1 with carbogen inhalation in patients with ISSNHL was more beneficial than other treatment modalities.
Collapse
Affiliation(s)
- Haeng Seon Shim
- Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Joon Soo Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Myung Gu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| |
Collapse
|
19
|
Weiss D, Böcker AJ, Koopmann M, Savvas E, Borowski M, Rudack C. Predictors of hearing recovery in patients with severe sudden sensorineural hearing loss. J Otolaryngol Head Neck Surg 2017; 46:27. [PMID: 28376930 PMCID: PMC5379569 DOI: 10.1186/s40463-017-0207-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/27/2017] [Indexed: 11/20/2022] Open
Abstract
Background Sudden sensorineural hearing loss (SSHL) is a disease, which severely affects the patient’s social and relational life. The underlying pathomechanisms have not been finally clarified yet and outcome is not predictable. Methods We conducted a retrospective study in order to identify parameters that influence hearing recovery. The data base contains results of basic otoneurological tests and clinical parameters of 198 patients with idiopathic SSHL of at least 60 dB in at least four frequencies, diagnosed and treated at the University Hospital of Münster, Germany, between 1999 and 2015. Hearing recovery was measured by pure tone audiometry. Results Multivariate linear and logistic regression analyses indicate that the chance as well as the magnitude of hearing recovery is higher for patients with normal caloric testing than for patients with pathological caloric testing. However, for the subgroup of patients who attained a hearing recovery, the caloric testing result was not found to influence the magnitude. Instead, the magnitude was noticeably lower for patients within this subgroup who had a previous hearing loss. Furthermore, we found indications that the magnitude is higher for men than for women and that receiving a high-dose steroid therapy is associated with a higher chance and magnitude of a hearing recovery. Conclusions We conclude that SSHL associated with disorders of the vestibular system or previous hearing loss represent special sub-entities of SSHL that may be caused by unique pathophysiological mechanisms and are associated with worse outcome. Furthermore, our data support the importance of elevated dosage of steroids in SSHL therapy.
Collapse
Affiliation(s)
- Daniel Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Münster, Kardinal-von-Galen-Ring 10, Münster, 48149, Germany.
| | - Armin Julius Böcker
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Münster, Kardinal-von-Galen-Ring 10, Münster, 48149, Germany
| | - Mario Koopmann
- Practice for Otorhinolaryngology, Head and Neck Surgery, Meckenemstrasse 26, Bocholt, 46395, Germany
| | - Eleftherios Savvas
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Münster, Kardinal-von-Galen-Ring 10, Münster, 48149, Germany
| | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstrasse 56, Münster, 48149, Germany
| | - Claudia Rudack
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Münster, Kardinal-von-Galen-Ring 10, Münster, 48149, Germany
| |
Collapse
|
20
|
Müller M, Tisch M, Maier H, Löwenheim H. Begrenzung chronischer Hörverluste durch lokale Glukokortikoidgabe. HNO 2016; 64:831-840. [DOI: 10.1007/s00106-016-0256-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
21
|
Narozny W, Kuczkowski J, Kot J, Stankiewicz C, Sicko Z, Mikaszewski B. Prognostic Factors in Sudden Sensorineural Hearing Loss: Our Experience and a Review of the Literature. Ann Otol Rhinol Laryngol 2016; 115:553-8. [PMID: 16900810 DOI: 10.1177/000348940611500710] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We investigated prognostic factors in sudden sensorineural hearing loss (SSNHL). Methods: Our study group consisted of 133 patients with SSNHL who were treated at our department between 1980 and 2000. Eighty-one of them (group B) were treated between 1980 and 1996; they received vasodilators and small doses of steroids. The others (52 patients; group A) were treated between 1997 and 2000; they received vasodilators, steroids at high doses, and hyperbaric oxygen. A multivariate stepwise linear regression was used to identify the prognostic factors that were related to hearing improvement as measured by objective change of gain in the overall average (0.5, 1, 2, 4, 6, 8 kHz), the pure tone average (0.5, 1, 2 kHz), the high tone average (4, 6, 8 kHz), and the pure middle tone average (0.5, 1, 2, 4 kHz). The following factors were included in the analysis: group (method of treatment), age, gender, seasonal occurrence of disease, presence of tinnitus and vestibular symptoms, time delay before first visit, type of initial audiogram, and type of caloric reaction. In group A, an additional analysis was conducted to include the results of certain laboratory tests: blood morphology parameters, erythrocyte sedimentation rate, glucose level, coagulogram, lipidogram, thyroid-stimulating hormone, autoantibodies (antimitochondrial antibodies, smooth muscle antibodies, and anti-brush border antibodies), and immunoglobulins G, A, and M. Values for p of less than .05 were considered significant. Results: Our analysis suggests the presence of the following prognostic factors for SSNHL: method of SSNHL treatment (better results in group A); time delay before the start of treatment (better results when treatment started within 10 days of the first symptoms of SSNHL); and type of caloric reactions (worse results in patients with canal paresis). In group A, the factors for poor prognosis for absolute hearing improvement were as follows: delayed treatment, labyrinth responsiveness disorders, and decreased level of thyroid-stimulating hormone. In group A, better hearing improvement was observed in those patients in whom SSNHL was diagnosed in the spring. Conclusions: A short time delay before starting treatment (within 10 days), treatment with high doses of steroids and hyperbaric oxygen, preserving complete caloric function of the labyrinths, normal function of the thyroid, and seasonal occurrence of the disease in the spring were positive prognostic factors for hearing recovery in SSNHL.
Collapse
Affiliation(s)
- Waldemar Narozny
- Department of Otorhinolaryngology, Medical University of Gdansk, 7 Debinki Str, 80-211 Gdansk, Poland
| | | | | | | | | | | |
Collapse
|
22
|
Fitzgerald DC, McGuire JF. Intratympanic Steroids for Idiopathic Sudden Sensorineural Hearing Loss. Ann Otol Rhinol Laryngol 2016; 116:253-6. [PMID: 17491522 DOI: 10.1177/000348940711600405] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We undertook to evaluate the effectiveness of intratympanic (IT) steroid injections for treating idiopathic sudden sensorineural hearing loss (ISSHL) by performing a retrospective case series study in a private otology practice. Methods: A total of 21 eligible patients with ISSHL were included. We defined ISSHL as a hearing loss of 20 dB or more at at least 3 consecutive audiometric frequencies that develops within 72 hours or less and cannot be attributed to any commonly identifiable cause of sudden hearing loss. Three IT injections of 0.4 mL of 62.5 mg/mL methylprednisolone solution were administered 1 week apart. The end point for the study was a clinically significant change in audiometric values, with a positive response determined to be a 10-dB or greater improvement in the 4-tone pure tone average and/or a 15% or greater improvement in the word discrimination score. Audiometric data were recorded just before therapy and 1 week after the last IT treatment. The potentially confounding variables recorded included age, sex, “prompt treatment” (defined as treatment within 14 days from onset), concurrent or prior treatment with oral steroids, and severity of hearing loss. Results: The overall response rate to the IT steroid protocol was 67% (14 of 21 patients), with a 95% confidence interval of 43% to 85%. Backward stepwise logistic regression identified “prompt treatment” as the only variable that significantly affected the outcome. The response rate of the “prompt treatment” cohort was 91% (10 of 11 patients), with a 95% confidence interval of 59% to 100%. Conclusions: These findings support the use of IT steroids as an early intervention in the treatment of ISSHL.
Collapse
Affiliation(s)
- Dennis C Fitzgerald
- Department of Otolaryngology, Washington Hospital Center, Washington, DC, USA
| | | |
Collapse
|
23
|
Jin Y, Lu M. Acupuncture as a primary and independent treatment in the acute phases of sudden sensorineural hearing loss: Case Report. Medicine (Baltimore) 2016; 95:e4062. [PMID: 27368045 PMCID: PMC4937959 DOI: 10.1097/md.0000000000004062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sudden sensorineural hearing loss (SSHL) is an otological emergency defined as a rapid hearing loss, seriously affects patient's social life. To data, no study has reported the treatment by acupuncture alone in the acute phase. In this report, Acupuncture and Moxibustion therapy of excitation-focus transfer is outlined.The patient was a 26-year-old young woman who had an SSHL coupled with ear fullness. The patient had no past medical history, but she had undergone variable emotions and had a history of excessive noise exposure. The patient refused to receive any medicine especially steroids and hyperbaric oxygen therapy. She just only received acupuncture treatment.Her symptoms and outcome measurements were improved every week and completely recovered after the last week.Even though the article presents a single case and is based on self-reports, there are very clear trends on how patients with SSHL responded to acupuncture treatments.
Collapse
Affiliation(s)
- Yuanyuan Jin
- Department of Acupuncture and Moxibustion, Zhejiang Hospital, Beijing University of Traditional Chinese Medicine
- Correspondence: Yuanyuan Jin, Department of Acupuncture and Moxibustion, Zhejiang Hospital, Beijing University of Traditional Chinese Medicine, No.12, Ling yin Road, Xi hu District, Hangzhou 310013, China (e-mail: )
| | - Ming Lu
- Department of Otolaryngology, Zhejiang The first hospital affiliated to zhejiang university, Xi hu Shang cheng District, Hangzhou, China
| |
Collapse
|
24
|
Narozny W, Kuczkowski J, Mikaszewski B. Steroids Promote Recovery in Sudden Hearing Loss. Otolaryngol Head Neck Surg 2016; 134:1068. [PMID: 16730561 DOI: 10.1016/j.otohns.2005.10.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Accepted: 10/18/2005] [Indexed: 11/26/2022]
|
25
|
Chang NC, Ho KY, Kuo WR. Audiometric Patterns and Prognosis in Sudden Sensorineural Hearing Loss in Southern Taiwan. Otolaryngol Head Neck Surg 2016; 133:916-22. [PMID: 16360514 DOI: 10.1016/j.otohns.2005.09.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES: To investigate factors affecting the prognosis of sudden sensorineural hearing loss (SSNHL). STUDY DESIGN AND SETTING: This is a retrospective study of patients with SSNHL hospitalized at an academic medical center. All patients in this study were treated with prednisolone and dextran. We compared a new 7-pattern classification for audiometric pattern and prognosis analysis with Sheehy classification. RESULTS: We analyzed 148 affected ears in 146 patients. Occurrence of SSNHL was associated with changes in season. The best prognosis was with the midtone pattern of the 7-pattern classification and with the low-tone pattern of Sheehy classification. The older patients, those with vertigo, or those treated after 6 days had a poor prognosis. There was no significant association between ESR level and prognosis. CONCLUSIONS: SSNHL patients with midtone loss have the best prognosis. This study of the audiometric patterns and prognostic factors of SSNHL allow us to better predict its outcome. EBM RATING: B-2
Collapse
Affiliation(s)
- Ning-Chia Chang
- Department of Otolaryngology, Kaohsiung Medical University, Chung-Ho Memorial Hospital, Taiwan
| | | | | |
Collapse
|
26
|
|
27
|
Günel C, Başal Y, Toka A, Eryılmaz A, Kurt Ömürlü İ. Efficacy of low-dose intratympanic dexamethasone for sudden hearing loss. Auris Nasus Larynx 2015; 42:284-7. [DOI: 10.1016/j.anl.2015.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 10/24/2022]
|
28
|
Zhang X, Xu X, Ma W, Zhang Q, Tong B, Yu H, Xu M, Ren T, Rosenhall U, Anniko M, Duan M. A clinical study of sudden deafness. Acta Otolaryngol 2015; 135:1030-5. [PMID: 26106936 DOI: 10.3109/00016489.2015.1060629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Sudden Sensorineural Hearing Loss (SSHL) was commonly seen in middle aged people. Tinnitus was reported by 87.2% of the patients, and dizziness or vertigo were reported by 48.5%. The most common concomitant disorder of SSHL was hyperlipidemia. OBJECTIVE A retrospective register study with SSHL was performed in Xi'an, China, from 2000-2009. RESULTS Of 617 inpatients, the right ear was affected in 267 cases, the left ears in 282 cases, and both ears in 68 cases. The most common age of patients was 41-50 years. There were 20.4% SSHL patients with hypertension, coronary artery disease, or diabetes, and 49.6% patients with hyperlipidemia. Auditory Brainstem Responses (ABR) were performed in 460 patients (504 ears) before treatment, and the ABR threshold of 56.4% ears was > 90 dB. The constituent ratio of patients with an ABR threshold over 90 dB was greater in the vertigo group than the other group. CT and/or MRI scans were available in 277 cases, of which 40 cases (14.4%) were abnormal.
Collapse
Affiliation(s)
- Xiaotong Zhang
- Department of Otolaryngology, the Second Affiliated Hospital of Medical College, Xi'an Jiao Tong University , Xi'an, Shaanxi (710004) , PR China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Effect of intratympanic dexamethasone, memantine and piracetam on cellular apoptosis due to cisplatin ototoxicity. The Journal of Laryngology & Otology 2012; 126:1091-6. [PMID: 22947376 DOI: 10.1017/s0022215112001855] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed to contribute to the literature on the prevention and treatment of ototoxicity due to various drugs and chemicals. MATERIAL AND METHODS This study compared the histological effects of intratympanic dexamethasone, memantine and piracetam on cellular apoptosis due to cisplatin ototoxicity, in 36 rats. RESULTS Dexamethasone and memantine had significant effects on the stria vascularis, organ of Corti and spiral ganglion (p < 0.05). Although piracetam decreased the apoptosis rate, this effect was not statistically significant (p > 0.05). CONCLUSION Dexamethasone and memantine were found superior to piracetam in reducing apoptosis due to cisplatin ototoxicity. Further studies of this subject are needed, incorporating electron microscopy and auditory brainstem response testing.
Collapse
|
31
|
Wang CT, Chou HW, Fang KM, Lai MS, Cheng PW. Treatment Outcome of Additional Dextran to Corticosteroid Therapy on Sudden Deafness. Otolaryngol Head Neck Surg 2012; 147:1125-30. [DOI: 10.1177/0194599812458219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective This study aimed to investigate whether adding low-molecular-weight dextran to oral steroids in patients with idiopathic sudden sensorineural hearing loss resulted in better hearing outcomes than those in patients receiving oral corticosteroids alone. Study Design Historical cohort study. Setting Tertiary teaching hospital. Subjects and Methods The authors reviewed the clinical records of 166 patients with idiopathic sudden sensorineural hearing loss. Therapeutic effectiveness was measured by the gain of pure-tone averages and 4 categories of hearing outcome (complete recovery, marked recovery, mild improvement, or no improvement). To manage potential confounding factors associated with treatment allocation, the authors matched the subjects from each group according to the propensity score (ie, the predicted probability that they would receive a specific treatment). Results The authors identified 50 pairs of propensity score–matched subjects (n = 100) without significant difference of all clinical factors ( P > .05). Subsequent analyses demonstrated that the average hearing gain in subjects receiving additional dextran to oral steroid was 31.7 ± 21.5 dB, which did not differ from 33.0 ± 21.8 dB in subjects receiving steroids alone ( P = .76). Difference of hearing outcomes between the 2 groups was also nonsignificant ( P = .92). Conclusion Matching propensity scores successfully balanced the heterogeneity between the dextran and steroid groups. Analytical results demonstrated that adding low-molecular-weight dextran to oral corticosteroids was not associated with greater hearing gain or better hearing outcome in idiopathic sudden sensorineural hearing loss.
Collapse
Affiliation(s)
- Chi-Te Wang
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Graduate Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Oriental Institute of Technology, Taipei, Taiwan
| | - Hsu-Wen Chou
- Graduate Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kai-Min Fang
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Oriental Institute of Technology, Taipei, Taiwan
| | - Mei-Shu Lai
- Graduate Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Center of Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Oriental Institute of Technology, Taipei, Taiwan
| |
Collapse
|
32
|
Yin CS, Park HJ, Nam HJ. Acupuncture for refractory cases of sudden sensorineural hearing loss. J Altern Complement Med 2011; 16:973-8. [PMID: 20704516 DOI: 10.1089/acm.2009.0542] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the effect of acupuncture on the treatment of refractory sensorineural hearing loss (SSHL), treatment of which remains a major clinical challenge. DESIGN The study design was descriptive research to document the effect of acupuncture in a series of SSHL cases. SETTING The study was conducted in the outpatient clinic of Kyung Hee University Hospital. SUBJECTS The subjects analyzed were 17 patients with refractory SSHL of more than 3 weeks after a failed trial of conventional treatment including corticosteroids. INTERVENTIONS Acupuncture sessions were performed twice a week using a modified Saam acupuncture formula and such acupoints as GV14, GV15, and others, in addition to usual patient care educations. MAIN OUTCOME MEASURES Improvement was defined as increased hearing threshold from initial measurement by more than 20 dB in at least two contiguous frequencies of audiometric testing. An audiogram pattern was also analyzed. RESULTS The average refractory period before acupuncture treatment was 213.9 days (range 22-1460). First follow-up measurement after 9.5 times of acupuncture treatment for 29.9 days showed improvement in 4 of 16 cases examined (25.0%) and second follow-up measurement after 18.7 times of acupuncture treatment for 70.4 days in another 4 of 12 cases examined (33.3%). A total improvement rate after day 70.4 post initial visit was 47.1% (8 of 17 cases). As to the audiogram pattern, an ascending or midhumping pattern was related to a good prognosis, while a descending pattern was not. CONCLUSIONS These findings suggest that acupuncture might be effective in refractory sensorineural hearing loss with failure of conventional therapy.
Collapse
Affiliation(s)
- Chang Shik Yin
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Republic of Korea
| | | | | |
Collapse
|
33
|
Kim MG, Jung YG, Eun YG. Effect of steroid, carbogen inhalation, and lipoprostaglandin E1 combination therapy for sudden sensorineural hearing loss. Am J Otolaryngol 2011; 32:91-5. [PMID: 20022673 DOI: 10.1016/j.amjoto.2009.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 10/06/2009] [Accepted: 10/20/2009] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of combined therapy with steroid, carbogen inhalation, and lipoprostaglandin E(1) (lipo-PGE(1)) treatment and compare the results with other treatment modalities in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). SUBJECTS AND METHODS The study group consisted of 670 patients diagnosed with unilateral ISSNHL. Two hundred patients (DCP group) were treated with steroid, lipo-PGE(1) and carbogen inhalation combination therapy, 194 patients (DC group) with steroid and carbogen inhalation, and 276 patients (D group) with steroid medication only. The therapeutic effects of the treatment groups were evaluated 2 months after treatment, using pure tone averages. Siegel's criteria for hearing improvement were used for the assessments. RESULTS The overall recovery rate after treatment was 57.5%. For each group, the recovery rate was as follows: 67.0% in the DCP group, 52.6% in the DC group, and 53.9% in the D group. The DCP group had a significantly better improvement rate than the other 2 groups. In addition, the DCP treatment was better than the other 2 groups for patients: less than 50 years of age, with an initial hearing loss less than 90 dB HL, had treatment started within 1 week from the onset of hearing loss, had tinnitus or an ascending type audiogram, and/or had no vertigo. CONCLUSION Steroid, lipo-PGE(1), and carbogen inhalation therapy was more effective than the other treatment modalities studied for patients with ISSNHL.
Collapse
|
34
|
Plaza G, Durio E, Herráiz C, Rivera T, García-Berrocal JR. Consensus on diagnosis and treatment of sudden hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/s2173-5735(11)70025-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
35
|
Plaza G, Durio E, Herráiz C, Rivera T, García-Berrocal JR. [Consensus on diagnosis and treatment of sudden hearing loss. Asociación Madrileña de ORL]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 62:144-57. [PMID: 21112580 DOI: 10.1016/j.otorri.2010.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 08/09/2010] [Accepted: 09/03/2010] [Indexed: 12/19/2022]
Abstract
Idiopathic sudden sensorineural hearing loss is an unexplained unilateral hearing loss with onset over a period of less than 72 hours, without other known otological diseases. We present a consensus on the diagnosis, treatment and follow-up of this disease, designed by AMORL, after a systematic review of the literature from 1966 to June 2010. Diagnosis of sudden sensorineural hearing loss is based on mandatory otoscopy, acoumetry, tonal audiometry, speech audiometry, and tympanometry. After clinical diagnosis is settled, and before treatment is started, a full analysis should be done and an MRI should be requested later. Treatment is based on systemic corticosteroids (orally in most cases), helped by intratympanic doses as rescue after treatment failures. Follow-up should be done at day 7, with tonal and speech audiometries, and regularly at 15, 30, and 90 days after start of therapy, and after 12 months. By consensus, results after treatment should be reported as absolute dBs recovered in pure tonal audiometry, as improvement in the recovery rate in unilateral cases, and as improvement in speech audiometry.
Collapse
Affiliation(s)
- Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
36
|
Influence of lipoproteins and fibrinogen on pathogenesis of sudden sensorineural hearing loss. The Journal of Laryngology & Otology 2010; 125:258-61. [PMID: 21054908 DOI: 10.1017/s0022215110002252] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM To evaluate the relationship between lipoproteins, fibrinogen and sudden sensorineural hearing loss in a Croatian population. Since pathological derangement of lipoproteins and fibrinogen could be one of the causes of sudden sensorineural hearing loss, we hypothesised that patients with sudden sensorineural hearing loss would have more abnormal fibrinogen and lipoprotein concentrations, compared with subjects with normal hearing. METHODS Plasma concentrations of cholesterol, fibrinogen and triglycerides in patients with sudden sensorineural hearing loss were compared with those in a control group (i.e. subjects with normal hearing function). RESULTS Patients with sudden sensorineural hearing loss had significantly higher plasma concentrations of cholesterol and low density lipoprotein cholesterol, compared with controls. CONCLUSION Higher cholesterol and low density lipoprotein cholesterol concentrations were found in patients with sudden sensorineural hearing loss, within a Croatian population. Cholesterol and low density lipoprotein cholesterol concentrations may be important factors in the pathogenesis of sudden sensorineural hearing loss, and should be assessed during the investigation of patients with this condition.
Collapse
|
37
|
Tabuchi K, Hara A. [Glucocorticoid treatment for cochlear ischemic and acoustic injuries]. NIHON JIBIINKOKA GAKKAI KAIHO 2010; 113:831-837. [PMID: 21174729 DOI: 10.3950/jibiinkoka.113.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The effect of glucocorticoids on sensorineural hearing loss of sudden onset remains to be controversial although glucocorticoids have been used for treatment of sudden sensorineural hearing loss. We review recent findings about the effect of glucocorticoids on cochlear ischemic and acoustic injuries obtained from animal experiments. Systemically administered glucocorticoids penetrate the blood-cochlear barrier well. Glucocorticoids ameliorated the cochlear ischemic and acoustic injuries at a relatively wide range of doses, and they protect cochlear hair cells in these types of injury. The therapeutic actions of glucocorticoids in cochlear injuries were considered to be mediated via both genomic and non-genomic pathways. Based on the results obtained in acoustic injury, therapeutic time window of glucocorticoids is considered to be short after the onset of injury. These findings obtained from animal experiments are important in considering clinical usage of glucocorticoids for the treatment of sensorineural hearing loss.
Collapse
Affiliation(s)
- Keiji Tabuchi
- Department of Otolaryngology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba
| | | |
Collapse
|
38
|
Trune DR, Kempton JB. Low dose combination steroids control autoimmune mouse hearing loss. J Neuroimmunol 2010; 229:140-5. [PMID: 20800906 DOI: 10.1016/j.jneuroim.2010.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 07/27/2010] [Indexed: 11/25/2022]
Abstract
The severe side effects of glucocorticoids prevent long term management of hearing loss. Alternative steroid treatments that minimize or eliminate these effects would significantly benefit therapeutic control of hearing disorders. A steroid treatment study of autoimmune mouse hearing loss was conducted to determine the efficacy of combining aldosterone and prednisolone at low doses. An assessment also was made of low dose fludrocortisone, a synthetic mineralocorticoid that also has a slight glucocorticoid effect. MRL/MpJ-Fas(lpr) mice were tested for baseline ABR thresholds at 3 months of age and then treated with aldosterone (3.0 μg/kg) or prednisolone (1.0 mg/kg) to determine the lowest effective dose of each. Other mice were given the two steroids in combination at doses of Pred 0.5 mg+Aldo 1.5 μg; Pred 1.0 mg+Aldo 3.0 μg; or Pred 1.5 mg+Aldo 5.0 μg. Mice were retested with ABR at 1 and 2 months to determine the efficacy of the different steroid treatments in controlling hearing loss. Another series of mice were given the synthetic mineralocorticoid fludrocortisone at low (2.8 μg/kg) or high (10 μg/kg) doses and retested at monthly intervals for 3 months. Autoimmune mouse hearing loss developed in untreated controls. This threshold elevation was not prevented by prednisolone at 1 mg/kg or by aldosterone at 3 μg/kg when each was given alone. However, the two steroids combined at these doses effectively controlled hearing loss. The fludrocortisone treatments also were effective at low doses in preventing or reversing the autoimmune mouse hearing loss. This efficacy of combined steroids at low doses suggests the potential for reducing the side effects of glucocorticoids in the therapeutic control of hearing disorders.
Collapse
Affiliation(s)
- Dennis R Trune
- Oregon Hearing Research Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239-3098, USA.
| | | |
Collapse
|
39
|
Heigl F, Hettich R, Suckfuell M, Luebbers CW, Osterkorn D, Osterkorn K, Canis M. Fibrinogen/LDL apheresis as successful second-line treatment of sudden hearing loss: a retrospective study on 217 patients. ATHEROSCLEROSIS SUPP 2009; 10:95-101. [DOI: 10.1016/s1567-5688(09)71820-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
40
|
Trune DR, Kempton JB. Blocking the glucocorticoid receptor with RU-486 does not prevent glucocorticoid control of autoimmune mouse hearing loss. Audiol Neurootol 2009; 14:423-31. [PMID: 19923812 DOI: 10.1159/000241899] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 06/10/2009] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS Glucocorticoids effectively manage autoimmune hearing loss, although the cochlear mechanisms involved are unknown. Previous studies of steroid-responsive hearing loss in autoimmune (lupus) mice showed glucocorticoids and mineralocorticoids were equally effective, suggesting the ion homeostasis functions of glucocorticoids may be as relevant as immunosuppression for control of autoimmune-induced inner ear disease. Therefore, to better characterize the role of the glucocorticoid receptor in autoimmune hearing loss therapy, its function was blocked with the antagonist RU-486 (mifepristone) during glucocorticoid (prednisolone) treatments. METHODS Following baseline auditory brainstem response (ABR) thresholds, MRL/MpJ-Fas(lpr) autoimmune mice were implanted with pellets providing combinations of 1.25 mg/kg of RU-486, 4 mg/kg of prednisolone, or their respective placebos. After 1 month, animals were retested with ABR and blood was collected for immune complex analyses. RESULTS Mice receiving no prednisolone (placebo + placebo and placebo + RU-486) showed continued declines in hearing. On the other hand, mice receiving prednisolone (prednisolone + placebo and prednisolone + RU-486) had significantly better hearing (p < 0.05) than the non-prednisolone groups. Immune complexes were significantly elevated in the placebo + RU-486 group, suggesting RU-486 effectively blocked glucocorticoid receptor-mediated immune suppression. These results showed that blockage of the glucocorticoid receptor with RU-486 did not prevent prednisolone's effects in the ear, suggesting its ion homeostasis actions via the mineralocorticoid receptor were more relevant in hearing control. CONCLUSION The mineralocorticoid receptor-mediated actions of glucocorticoids are potentially relevant in steroid-responsive hearing disorders, implying disrupted cochlear ion transport functions may underlie the vascular problems proposed in some forms of immune-mediated hearing loss.
Collapse
Affiliation(s)
- Dennis R Trune
- Oregon Hearing Research Center, Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239-3098, USA. truned @ ohsu.edu
| | | |
Collapse
|
41
|
Analysis of 60 patients after tympanotomy and sealing of the round window membrane after acute unilateral sensorineural hearing loss. Am J Otolaryngol 2009; 30:157-61. [PMID: 19410119 DOI: 10.1016/j.amjoto.2008.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2007] [Revised: 03/10/2008] [Accepted: 04/07/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This retrospective study was performed to evaluate the effectiveness of tympanotomy and sealing of the round window membrane after unilateral acute hearing loss. DESIGN All patients presenting idiopathic sudden hearing loss, acoustic, or barotrauma were treated with prednisolone and caroverine. Thirty-six patients had a mean pure tone hearing level worse than 70 dB. Recovery was defined as improvement of hearing threshold for 5 frequencies (250, 500, 1000, 2000, and 4000 Hz). If hearing did not improve after conservative treatment, an exploratory tympanotomy and sealing of the round window membrane were suggested. In the last 8 years, 60 patients with idiopathic sudden hearing loss, acoustic, or barotrauma underwent tympanotomy. RESULTS In 40 patients, we observed improvement of hearing level up to complete remission. In 20 patients, no change could be detected. In the group of patients with documented barotrauma, 12 patients showed improved hearing levels. Of 37 patients with idiopathic sudden hearing loss, 26 had an improved hearing after surgery. Most patients were operated on within 14 days (range, 1-60 days), but time of surgery had no influence on outcome in patients with idiopathic hearing loss. In contrast, in patients with barotrauma, time of surgery seems to have an influence on outcome. CONCLUSIONS Tympanotomy and sealing of the round window membrane can be recommended in cases of acute hearing loss after failure of conservative treatment.
Collapse
|
42
|
Abstract
We assessed the relationship between changes in corticosterone concentrations and hearing in mice exposed to noise during the light (inactive) and dark (active) phases. Serum corticosterone concentrations and hearing levels were measured before, and 1, 3, 5, 7, and 10 days after, noise exposure between 8:00-11:00 h and 15:00-18:00 h. Serum corticosterone concentrations were significantly lower at 8:00-11:00 h than at 15:00-18:00 h and were significantly lower before than after noise exposure. In addition, serum corticosterone concentrations were significantly lower at 11:00 h after noise exposure than at 18:00 h before noise exposure. Mice exposed to noise at 8:00-11:00 h showed significantly elevated threshold shifts after noise exposure than did mice exposed to noise at 15:00-18:00 h. Endogenous serum corticosterone concentration has a significant effect on hearing after noise exposure. Noise exposure during the inactive phase of the hypothalamic-pituitary-adrenal axis may be more harmful to the auditory system than noise exposure during the active phase of the hypothalamic-pituitary-adrenal axis.
Collapse
|
43
|
Rheopheresis for idiopathic sudden hearing loss: results from a large prospective, multicenter, randomized, controlled clinical trial. Eur Arch Otorhinolaryngol 2008; 266:943-53. [DOI: 10.1007/s00405-008-0823-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 09/19/2008] [Indexed: 10/21/2022]
|
44
|
Affiliation(s)
- Steven D Rauch
- Department of Otology and Laryngology, Harvard Medical School, Boston, USA.
| |
Collapse
|
45
|
Gheriani H, Khan MH, Charles DA. Steroid Use in Idiopathic Sudden Sensorineural Hearing Loss: What is the Evidence? Libyan J Med 2008; 3:60-1. [PMID: 21516245 PMCID: PMC3074334 DOI: 10.4176/071119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- H Gheriani
- Department of Otolaryngology, Head and Neck Surgery, St Vincent University Hospital, Elm Park, Dublin, Ireland
| | | | | |
Collapse
|
46
|
Hargunani CA, Kempton JB, DeGagne JM, Trune DR. Intratympanic injection of dexamethasone: time course of inner ear distribution and conversion to its active form. Otol Neurotol 2008; 27:564-9. [PMID: 16691147 DOI: 10.1097/01.mao.0000194814.07674.4f] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
HYPOTHESIS Intratympanically injected dexamethasone 21-phosphate is converted to its active form dexamethasone in the inner ear and follows the distribution of the glucocorticoid receptor. BACKGROUND Although dexamethasone is routinely delivered intratympanically for hearing loss, we know little of its inner ear pharmacokinetics. Dexamethasone 21-phosphate is the pharmaceutical compound available for injection, but it must be converted to its biologically active form (dexamethasone) to bind to the glucocorticoid receptor. Therefore, the current study was conducted to determine the time course of dexamethasone 21-phosphate movement from the middle ear into the inner ear, its conversion to dexamethasone, and the distribution of both forms relative to the glucocorticoid receptor. METHODS BALB/c mice were injected intratympanically with the prodrug dexamethasone 21-phosphate and inner ears collected at postinjection times ranging from 5 minutes to 7 days. Ears were immunohistochemically stained for dexamethasone 21-phosphate, dexamethasone, and the glucocorticoid receptor. RESULTS Both forms of dexamethasone were seen in the inner ear within 15 minutes, reaching their highest staining intensity at 1 hour. Neither drug was seen after 24 hours. The strongest staining occurred in the spiral ligament, organ of Corti, spiral ganglion, and vestibular sensory epithelia. Distribution of the drug paralleled locations of the glucocorticoid receptor except in the stria vascularis marginal cells, which stained heavily for the receptor but not the drug. CONCLUSION Dexamethasone rapidly travels from the middle ear into the inner ear and converts to its active form. The drug distribution follows that of the glucocorticoid receptor. However, it probably has little impact on ear tissues after 24 hours.
Collapse
Affiliation(s)
- Christopher A Hargunani
- Oregon Hearing Research Center, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon 97201-3998, USA
| | | | | | | |
Collapse
|
47
|
|
48
|
Ye Q, Tillein J, Hartmann R, Gstoettner W, Kiefer J. Application of a corticosteroid (Triamcinolon) protects inner ear function after surgical intervention. Ear Hear 2007; 28:361-9. [PMID: 17485985 DOI: 10.1097/01.aud.0000261655.30652.62] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Opening of the inner ear during stapes surgery or cochlear implantation may result in trauma to inner ear structures and possible hearing loss. The dual aim of the present study was to evaluate the effectiveness of locally applied Triamcinolon* to protect the inner ear against surgically induced trauma and to exclude possible ototoxic effects. METHODS In an animal model (guinea pig), a corticosteroid (Triamcinolon) was topically applied to the inner ear, either by extracochlear application and diffusion through the round window membrane or by direct intracochlear application via a cochleostomy. Physiological effects of the steroid were investigated by monitoring the hearing of steroid treated animals in comparison to control animals treated with Ringer solution instead of Triamcinolon. Thresholds as well as input/output functions (I/O function) of compound action potentials (CAPs) in response to auditory stimuli were determined before the cochleostomy and at specific intervals up to 4 weeks after application of Triamcinolon. RESULTS Extracochlear application of Triamcinolon induced only minor shifts of mean CAP thresholds but significantly increased mean maximal amplitudes of I/O function 14 d after application. No detrimental effects on cochlear function were noted; thus, indicating absence of ototoxicity for extracochlear application in the concentrations used. After the surgical trauma of cochleostomy, CAP thresholds increased by 12.5 dB directly after surgery and by 15.8 dB at day 3. Amplitudes of CAPs diminished. Intracochlear application of Triamcinolon resulted in significantly enhanced recovery of CAP thresholds and amplitudes of I/O function from initial loss over a period of 4 weeks. CONCLUSIONS From these results, we conclude that extracochlear topical application of Triamcinolon has no ototoxic effect in the concentrations that were used and that intracochlear application supports an increased recovery of cochlear functions after surgical trauma. Furthermore, the results indicate a protective effect of corticosteroids, partially preventing progressive loss of hearing after cochleostomy over a period of 4 weeks. Intracochlear application of Triamcinolon may be useful to prevent hearing loss after surgical intervention on the inner ear; however, clinical safety and efficacy remain to be proven in clinical studies.
Collapse
Affiliation(s)
- Qing Ye
- Clinic for Otorhinolaryngology, Head and Neck Surgery, Department of Sensory Physiology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | | | | | | | | |
Collapse
|
49
|
Trune DR, Kempton JB, Harrison AR, Wobig JL. Glucocorticoid impact on cochlear function and systemic side effects in autoimmune C3.MRL-Faslpr and normal C3H/HeJ mice. Hear Res 2007; 226:209-17. [PMID: 17098384 DOI: 10.1016/j.heares.2006.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 09/01/2006] [Accepted: 09/27/2006] [Indexed: 12/20/2022]
Abstract
Glucocorticoids are effective in reversing hearing loss, but their severe side effects limit long term management of many ear disorders. A clearer understanding of these side effects is critical for prolonged therapeutic control of hearing and vestibular dysfunction. Therefore, this study characterized the impact of the glucocorticoid prednisolone on cochlear dysfunction and systemic organ systems in C3.MRL-Fas(lpr) autoimmune mice and their normal C3H/HeJ parent strain. Following 3 months of treatment, autoimmune mice had better auditory thresholds and improved hematocrits, anti-nuclear antibodies, and immune complexes. Steroid treatment also lowered body and spleen weights, both of which rise with systemic autoimmune disease. Steroid treatment of the normal C3H/HeJ mice significantly elevated their blood hematocrits and lowered their body and spleen weights to abnormal levels. Thus, systemic autoimmune disease and its related hearing loss in C3.MRL-Fas(lpr) mice are steroid-responsive, but normal hemopoiesis and organ functions can be significantly compromised. This mouse model may be useful for studies of the detrimental side effects of steroid treatments for hearing loss.
Collapse
Affiliation(s)
- Dennis R Trune
- Oregon Hearing Research Center, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
| | | | | | | |
Collapse
|
50
|
Finger RP, Gostian AO. Idiopathic sudden hearing loss: contradictory clinical evidence, placebo effects and high spontaneous recovery rate--where do we stand in assessing treatment outcomes? Acta Otolaryngol 2006; 126:1124-7. [PMID: 17043035 DOI: 10.1080/00016480600702084] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Idiopathic sudden hearing loss (ISHL) has an estimated incidence of 10-20/100,000 per year, impairing not only patients' hearing but also their ability to interact socially and their quality of life. Confronted with patients who demand successful treatment, physicians need to judge potential treatment options with regard to their reported efficiency, as well as their suitability for the individual patient. The dilemma of assessing treatment outcomes and options in ISHL will be discussed regarding a lack of knowledge of the disease's etiology, contradictory clinical evidence, high spontaneous recovery rate, and possible placebo effects. In conclusion, there is a dearth of structured research adhering to a common protocol, which makes comparison of trials and assessment of potential treatment outcomes difficult. Further research is warranted, taking some key recommendations into consideration.
Collapse
Affiliation(s)
- Robert P Finger
- Department of Otorhinolaryngology, Head and Neck Surgery, Neuss City Hospital, Neuss, Germany.
| | | |
Collapse
|