[Intratympanic injection therapy for therapy refractory acute hearing loss: A safe option for secondary treatment]

[Blast and explosion traumas-effects on the middle and inner ear based on the example of Bundeswehr foreign missions]

Despite all protective measures, blast and explosion traumas are a frequent pattern of injury in Bundeswehr missions abroad. Due to body protection measures, head injuries, particularly of the ears, are higher in number compared to injuries in other regions of the body. Perforations of the tympanic membrane are the most frequent lesions of the middle ear, acute sensorineural hearing loss is the most frequent lesion of the inner ear, often accompanied by tinnitus and dizziness. With a high spontaneous recovery rate, prompt specialist care for these injuries is provided according to medical standards comparable to those in the home country.

[Tolerance and acceptance of intratympanic injections]

Hintergrund

Die intratympanale Gabe von Steroiden ist Bestandteil der Therapie von akuten Hörverlusten. Bislang existieren nur wenig Daten zur Akzeptanz und Toleranz aus Sicht der Patient*innen.

Material und Methoden

Zu den gesundheitlichen Voraussetzungen und den Umstäden ihrer intratympanalen Therapie wurden 84 Patient*innen befragt.

Ergebnisse

Es stellten sich 38 Frauen und 46 Männer im Alter von durchschnittlich 57,2 Jahren meist auf Empfehlung ihres HNO-Arztes zur Zweitlinientherapie vor und empfanden die Injektionen zu 3,6 % als schmerzhaft, 22,6 % unangenehm, 67,9 % erträglich und zu 41,7 % als schmerzfrei (Mehrfachnennungen möglich). Eine Weiterempfehlung gaben 77,4 %, eine fehlende Empfehlung resultierte aus mangelnder Wirkung und unangenehmer Empfindung.

Schlussfolgerung

Der weit überwiegende Anteil der Behandelten beurteilt die intratympanale Therapie als erträglich und gibt eine Weiterempfehlung. Die enge Patientenführung ist ein entscheidender Therapiebaustein.

Diagnostics and therapy of sudden hearing loss

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.