Early Intratympanic Methylprednisolone in Sudden SNHL: A Frequency-wise Analysis

Intra-Tympanic Dexamethasone Therapy via Grommet Insertion for Improved Auditory Outcome in Sudden Sensorineural Hearing Loss

Idiopathic sudden-sensorineural hearing loss (ISSHL) is an emergent otological condition needing prompt treatment for better recovery. In our study we aimed to determine the efficacy of intra-tympanic dexamethasone therapy after inserting a grommet in postero-inferior quadrant of the tympanic membrane for dexamethasone instillation. This is a prospective cohort study of 31 patients of ISSHL, in whom grommet was inserted and dexamethasone drops were instilled for 5 days. Several factors such as time of initiation of therapy, age of patient was considered, and inferences were drawn. Auditory outcomes were divided into low, mid and high frequency and the results were tabulated. Paired t tested was applied for all frequencies for both pre-test and post-test. P-value was (< 0.05) in all the three ranges of frequencies. Also, statistical significance was found between early treatment from onset of disease and auditory outcome. The earlier the therapy was initiated, better were the results.

[The value of quantitative measurement of key structures of inner ear by HRCT in hearing evaluation of patients with congenital severe sensorineural deafness]

Objective:Study on the value of quantitative measurement of key structures of inner ear by high resolution computer tomography（HRCT） in hearing evaluation of patients with congenital severe sensorineural hearing loss（SNHL）. Methods:A total of 90 children with extremely severe SNHL diagnosed and treated in Beilun District People's Hospital from January 2018 to February 2021 were collected as the experimental group. In the same period, 90 children（180 ears） with normal inner ear structure and hearing were scanned because of head trauma and suspected temporal bone fracture. Logistic univariate and multivariate regression analysis were used to analyze the factors affecting the occurrence of extremely severe SNHL. Based on the results of multivariate analysis, a Nomogram prediction model was established. The model before and after internal correction was evaluated by the receiver working characteristic curve. Results:Inner ear malformation, SSCC bone island width, LSCC bone island width and cochlear height were independent risk factors for extremely severe SNHL. The results of Nomogram predictive model showed that cochlear height 34 points, LSCC bone island width 19 points, SSCC bone island width 22 points, inner ear malformation 37 points, the total score（112 points） corresponding to the incidence of extremely severe SNHL（0.3%）. The actual C-index value of Nomogram prediction model is 0.858, the C-index of internal verification is 0.851, and the C-index of external verification is 0.847. The coincidence of the model is good. It is suggested that the model can effectively predict the risk factors of congenital extremely severe SNHL and has high prediction accuracy. Conclusion:The standardized measurement of SSCC bone island width, LSCC bone island width and cochlear height by HRCT is of great value in the diagnosis of microinner ear malformation in children with extremely severe SNHL.

The Outcome of Prompt Concomitant Single-Dose High-Concentration Intratympanic and Tapered Low-Dose Oral Systemic Corticosteroid Treatment for Sudden Deafness

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.