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Ke Y, Ma X, Jing Y, Diao T, Yu L. The Breakdown of Blood-Labyrinth Barrier Makes it Easier for Drugs to Enter the Inner Ear. Laryngoscope 2024; 134:2377-2386. [PMID: 37987231 DOI: 10.1002/lary.31194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE This study aimed to investigate dynamic change of permeability of blood-labyrinth barrier (BLB) after noise exposure and its effect on the drug delivery efficiency of systemic administration. METHODS Gadopentetate dimeglumine (Gd-DTPA) and dexamethasone (DEX) were used as tracers, and magnetic resonance imaging (MRI) and immunofluorescence were used to observe the change of the BLB after strong noise exposure in guinea pigs. High-performance liquid chromatography-mass spectrometry (LC-MS) was used to observe the effect of the breakdown of BLB after noise exposure on the drug delivery efficiency of intravenous DEX. The guinea pigs were divided into 6 groups: normal group (N), 1, 3, 5, 8, and 12 days after noise exposure groups (P1, P3, P5, P8, P12), with 5 animals in each group. RESULTS The BLB changes dynamically after noise exposure. Increased permeability of the blood-endolymph barrier, the endolymph-perilymph barrier, and the blood-nerve barrier was observed at days 1-3, 1-5, and 1-8, respectively, after noise exposure in guinea pigs. Higher drug concentration in the cochlear tissue was obtained by intravenous administration of DEX in guinea pigs during the time window of increased permeability of the BLB. CONCLUSION After noise exposure, the increased BLB permeability makes it easier for drugs to enter the inner ear from blood. In guinea pigs, 1-8 days after strong noise exposure, the drug delivery efficiency of systemic administration increased. After 8 days, the efficiency gradually returned to normal level. 1-8 days after noise exposure may be the best intervention time for systemic administration. LEVEL OF EVIDENCE NA Laryngoscope, 134:2377-2386, 2024.
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Affiliation(s)
- Yujie Ke
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Tongxiang Diao
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
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Jin X, Wang Y, Zhang L, Zheng H, Ma X, Duan M, Yu L. Uptake of gadolinium and dexamethasone in rat inner ear and facial nerve using different administrations. Acta Otolaryngol 2024; 144:168-174. [PMID: 38753897 DOI: 10.1080/00016489.2024.2344807] [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] [Received: 03/16/2024] [Accepted: 04/13/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The pathway by which drugs are injected subcutaneously behind the ear to act on the inner ear has not been fully elucidated. OBJECTIVES To compare the uptake of gadopentetate dimeglumine (Gd-DTPA) and dexamethasone (Dex) in the cochlea and facial nerve of rats following different administrations. MATERIALS AND METHODS Magnetic resonance imaging was applied to observe the distribution of Gd-DTPA in the facial nerve and inner ear. We observed the uptake of Dex after it was injected with different methods. RESULTS Images of the intravenous (IV) and intramuscular (IM) groups showed that the bilateral cochlea of the rat was visualized almost simultaneously. While in the left post-auricular (PA) injection group, it was asynchronous. The maximum accumulation (Cmax) of the Gd in the left facial nerve of the PA group (35.406 ± 5.32) was substantially higher than that of the IV group (16.765 ± 3.7542) (p < .01). CONCLUSIONS Compared with systemic administration, PA has the advantages of long Gd and Dex action time and high accumulation concentration to treat facial nerve diseases. SIGNIFICANCE The distribution of Gd and Dex in the inner ear and facial nerve of rats following PA injection might be unique.
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Affiliation(s)
- Xing Jin
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, PR China
| | - Yixu Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, PR China
| | - Liyuan Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, PR China
| | - Hongwei Zheng
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, PR China
| | - Xin Ma
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, PR China
| | - Maoli Duan
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Department of Otolaryngology Head and Neck Surgery & Audiology and Neurotology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Lisheng Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, PR China
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Lin CY, Chang CH, Chang CJ, Ko JY, Wu SY, Kuo PH. Salvage therapy for refractory sudden sensorineural hearing loss (RSSNHL): a systematic review and network meta-analysis. Int J Audiol 2024:1-10. [PMID: 38251843 DOI: 10.1080/14992027.2024.2303037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Approximately 30-50% of sudden sensorineural hearing loss (SSNHL) patients show poor response to systemic steroid therapy. Additionally, the most appropriate treatment for patients with refractory sudden sensorineural hearing loss (RSSNHL) is unknown. This study aimed to explore the best treatment for RSSNHL. DESIGN Using a frequentist contrast-based model and PRISMA guidelines, this study compared five salvage regimes: intratympanic injection of steroids (ITS), hyperbaric oxygen (HBO) therapy, post auricle steroid injection (PSI), ITS combined with HBO therapy, and continued systemic steroids. STUDY SAMPLE We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases for randomised controlled trials and cohort studies comparing treatment regimens for RSSNHL. RESULTS Compared with the control group (no additional treatment), PSI and ITS demonstrated significant improvements. The mean hearing gain was greater after PSI (11.1 dB [95% CI, 4.4-17.9]) than after ITS (7.7 dB [95% CI, 4.8-10.7]). When a restricted definition of RSSNHL was used, the ITS + HBO therapy showed the largest difference in improvement for pure tone average compared with the control group (14.5 dB [95% CI, 4.2-25.0]). CONCLUSIONS The administration of either PSI or ITS leads to the greatest therapeutic effect in patients with RSSNHL. However, a consensus on the definition of RSSNHL is needed.
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Affiliation(s)
- Chuan-Yi Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Otorhinolaryngology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Chia-Hao Chang
- Department of Otorhinolaryngology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Chen-Jung Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otorhinolaryngology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health and Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Derdzakyan NA, Lava CX, Hakimi AA, Johns JD, Kim HJ, Hoa M. Variability in Perioperative Steroid Therapy Regimen for Cochlear Implantation as It Relates to Hearing Preservation. Otol Neurotol 2024; 45:e28-e35. [PMID: 38085763 DOI: 10.1097/mao.0000000000004058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
HYPOTHESIS We aimed to identify practice trends and association between physician training and administration of perioperative steroids for cochlear implantation (CI) as it relates to hearing preservation. BACKGROUND Perioperative steroid therapy regimens are postulated to protect residual hearing and improve hearing preservation outcomes in CI. METHODS A 27-question online survey was developed by the senior authors using the Qualtrics Survey Tool, then distributed via email from September to November 2022 to otolaryngologists specializing in otology or neurotology and who practice in the United States or Canada. RESULTS The survey was sent to 463 physicians, 162 (35.0%) of whom completed the survey. One hundred forty-four (31.1%) responses underwent analysis. All physicians administering preoperative steroids (n = 31) prefer preoperative oral prednisone. Of 143 physicians administering intraoperative steroids, 54.5% prefer intraoperative intravenous dexamethasone. More than half (77.6%) of 85 physicians administering postoperative steroids prefer postoperative oral prednisone. Postoperative steroid administration (p < 0.006) and taper utilization (p < 0.041) were greater among physicians who complete greater than 40 CIs annually (n = 47 [71.2%]; n = 30 [49.2%]) than physicians who complete up to 40 CIs annually (n = 37 [48.7%]; n = 20 [31.3%]), respectively. Physicians practicing for 5 to 20 years after residency are more prevalent in using postoperative steroid tapers than physicians practicing for fewer than 5 years after and more than 20 years after residency (n = 37 [51.4%] versus n = 14 [25.5%], p < 0.001). CONCLUSION Consensus is needed about the optimal steroid treatment for CI patients. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | | | - Amir A Hakimi
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
| | - J Dixon Johns
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
| | - H Jeffrey Kim
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
| | - Michael Hoa
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
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Qi R, Zhang J, Diao T, Yu L. The auditory function in migraine model rats induced by postauricular nitroglycerin injection. Front Neurol 2023; 14:1259982. [PMID: 38020638 PMCID: PMC10630915 DOI: 10.3389/fneur.2023.1259982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The mechanism by which migraines produce inner ear-related symptoms is not well understood. Previous studies have found that the latency of auditory brainstem response (ABR) in animal models of migraine has changed, but the threshold has not changed significantly. Therefore, it is necessary to establish a better animal model with both migraine and hearing loss to explore the relationship between migraine and auditory function deeply. Methods In this study, the rat model of migraine was induced by postauricular injection of nitroglycerin (NTG), and the effect on the auditory function of the inner ear was explored by comparing with intraperitoneal injection of nitroglycerin. The rats were given the drug repeatedly on alternate days, a total of 5 dosing, with the body weight monitored during the drug administration. The tactile threshold of the rats' forepaw was measured using von-Frey filaments and auditory function was assessed by ABR. Results The results showed that the baseline tactile threshold of rats gradually decreased during the modeling process, and hyperalgesia appeared. Postauricular injection of NTG did not affect the weight gain of rats, while intraperitoneal injection of NTG showed slow or even negative weight gain. The ABR threshold of Click, 4 and 8 kHz of postauricular NTG injection rats increased, the latency was prolonged, and the ABR threshold in the right ear was higher than that in the left ear. Conclusions We demonstrated that postauricular injection of nitroglycerin may be safer and more effective than intraperitoneal injection of nitroglycerin in the process of creating rat migraine model without affecting the weight gain. Postauricular injection of nitroglycerin has more damage to the auditory function of rats. Therefore, the migraine model rat induced by postauricular injection of nitroglycerin may be a new model of cochlear migraine.
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Jaffredo M, Duchamp O, Touya N, Bouleau Y, Dulon D, Devillard R, Bonnard D. Proof of concept of intracochlear drug administration by laser-assisted bioprinting in mice. Hear Res 2023; 438:108880. [PMID: 37666034 DOI: 10.1016/j.heares.2023.108880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/13/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
Transtympanic administration is used clinically for the injection of gentamicin and/or corticosteroids. This atraumatic route is based on passive diffusion through the round window membrane (RWM). The main limitation of this method is related to the clearance through the Eustachian tube, making the concentration of the therapeutic agent at the intracochlear level uncertain and limited. Moreover, this technique remains unsuitable for molecules of high molecular weight or in the case of gene therapies. The purpose was to study a new technique of intracochlear administration in an atraumatic, direct and controlled manner by laser-assisted bioprinting (LAB). LAB was used to deliver dexamethasone phosphate with thermosensitive hydrogel on the mouse RWM. After validation of the regularity and homogeneity of the pattern, the diffusion in vivo of the dexamethasone into the perilymph after LAB has been confirmed by ELISA. Auditory function measurements showed no hearing impairment suggesting that bioprinting does not induce significant cochlear damage. Hence, the present proof of concept study introduces a promising approach for inner ear drug delivery.
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Affiliation(s)
- Manon Jaffredo
- SATT Aquitaine, Aquitaine Science Transfert, Talence, France; INSERM UA06, Univ. Bordeaux, Bordeaux, France
| | | | - Nicolas Touya
- INSERM U1026 BIOTIS, Univ. Bordeaux, Bordeaux, France
| | | | - Didier Dulon
- INSERM UA06, Univ. Bordeaux, Bordeaux, France; Institut de l'Audition, Centre Institut Pasteur/Inserm, Paris, France
| | - Raphael Devillard
- CHU de Bordeaux, Bordeaux, France; INSERM U1026 BIOTIS, Univ. Bordeaux, Bordeaux, France
| | - Damien Bonnard
- CHU de Bordeaux, Bordeaux, France; INSERM UA06, Univ. Bordeaux, Bordeaux, France.
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Johns JD, Adadey SM, Hoa M. The role of the stria vascularis in neglected otologic disease. Hear Res 2023; 428:108682. [PMID: 36584545 PMCID: PMC9840708 DOI: 10.1016/j.heares.2022.108682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
The stria vascularis (SV) has been shown to play a critical role in the pathogenesis of many diseases associated with sensorineural hearing loss (SNHL), including age-related hearing loss (ARHL), noise-induced hearing loss (NIHL), hereditary hearing loss (HHL), and drug-induced hearing loss (DIHL), among others. There are a number of other disorders of hearing loss that may be relatively neglected due to being underrecognized, poorly understood, lacking robust diagnostic criteria or effective treatments. A few examples of these diseases include autoimmune inner ear disease (AIED) and/or autoinflammatory inner ear disease (AID), Meniere's disease (MD), sudden sensorineural hearing loss (SSNHL), and cytomegalovirus (CMV)-related hearing loss (CRHL). Although these diseases may often differ in etiology, there have been recent studies that support the involvement of the SV in the pathogenesis of many of these disorders. We strive to highlight a few prominent examples of these frequently neglected otologic diseases and illustrate the relevance of understanding SV composition, structure and function with regards to these disease processes. In this study, we review the physiology of the SV, lay out the importance of these neglected otologic diseases, highlight the current literature regarding the role of the SV in these disorders, and discuss the current strategies, both approved and investigational, for management of these disorders.
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Affiliation(s)
- J Dixon Johns
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University School of Medicine, Washington, DC, USA.
| | - Samuel M Adadey
- Auditory Development and Restoration Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA.
| | - Michael Hoa
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University School of Medicine, Washington, DC, USA; Auditory Development and Restoration Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA.
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Chen N, Karpeta N, Ma X, Ning X, Liu X, Song J, Jiang Z, Ma X, Liu X, Zhong S, Sun Q, Liu J, Chen G, Duan M, Yu L. Diagnosis, differential diagnosis, and treatment for sudden sensorineural hearing loss: Current otolaryngology practices in China. Front Neurol 2023; 14:1121324. [PMID: 36908605 PMCID: PMC9995834 DOI: 10.3389/fneur.2023.1121324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Although sudden sensorineural hearing loss (SSNHL) has been attempted to be understood for 70 years, diagnosis and treatment strategies still have strong heterogeneity worldwide, which are reflected in the guidelines issued by countries and the clinical practice of otolaryngologists. Methods Questionnaires were sent to registered otolaryngologists nationwide via an online questionnaire system. We investigated the current views and clinical practices of otolaryngologists in mainland China about the diagnosis, examination, and treatment strategies of SSNHL. Results Most otolaryngologists supported diagnostic classification via audiograms. Regional economic situation and hospital grade affected application strategies for differential diagnosis. Regarding corticosteroid therapy, 54.9% of respondents opted to discontinue the drug 5 days after systemic administration. Both intratympanic therapy and post-auricular injections were selected by more than half of the respondents as initial and salvage treatments. Discussion Chinese otolaryngologists exhibit heterogeneity in clinical practices for SSNHL, including distinct approaches to combination therapy and local application of steroids. This study pointed out Chinese doctors' similarities, differences, and unique strategies in diagnosing and treating SSNHL and analyzed the possible reasons to help the world understand the current otolaryngology practices in China.
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Affiliation(s)
- Nishan Chen
- Department of Otolaryngology, Head, and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Niki Karpeta
- Department of Otolaryngology, Head, and Neck Surgery, Karolinska University, Solna, Sweden
| | - Xin Ma
- Department of Otolaryngology, Head, and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Xianhui Ning
- Department of Otolaryngology, Head, and Neck Surgery, Zhongshan Hospital, Shanghai, China
| | - Xiaoling Liu
- Department of Otolaryngology, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia, China
| | - Jijun Song
- Department of Otolaryngology, Zhoukou Central Hospital, Zhoukou, China
| | - Zigang Jiang
- Department of Otolaryngology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiulan Ma
- Department of Otolaryngology, Head, and Neck Surgery, Sheng Jing Hospital, Shenyang, China
| | - Xiuli Liu
- Department of Otolaryngology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shixun Zhong
- Department of Otolaryngology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Sun
- Department of Otolaryngology, Head, and Neck Surgery, Third Medical Center of PLA General Hospital, Beijing, China
| | - Jun Liu
- Department of Otolaryngology, Head, and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Ganggang Chen
- Department of Otolaryngology, Head, and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Maoli Duan
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Lisheng Yu
- Department of Otolaryngology, Head, and Neck Surgery, Peking University People's Hospital, Beijing, China
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Xie W, Karpeta N, Liu J, Peng H, Li C, Zhang Z, Liu Y, Duan M. Efficacy of intratympanic or postauricular subperiosteal corticosteroid injection combined with systemic corticosteroid in the treatment of sudden sensorineural hearing loss: A prospective randomized study. Front Neurol 2023; 14:1138354. [PMID: 37090982 PMCID: PMC10118004 DOI: 10.3389/fneur.2023.1138354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023] Open
Abstract
Objectives This study aimed to investigate the efficacy and safety of intratympanic or postauricular subperiosteal glucocorticoid injection combined with systemic glucocorticoid in the treatment of sudden sensorineural hearing loss (SSNHL). Methods This study is a prospective randomized controlled study. This study included unilateral SSNHL patients who were hospitalized in our department between January 2020 and June 2021. Patients were randomly divided into three groups (groups A, B, and C). Patients in group A were treated with an intratympanic corticosteroid injection combined with systemic corticosteroid treatment, and patients in group B received a postauricular corticosteroid injection combined with systemic corticosteroid treatment. Patients in group C (control group) were treated with systemic corticosteroid alone. The case number of groups A, B, and C was 311, 375, and 369, respectively. Results There was no significant difference in gender distribution, the proportion of left and right affected ears, and the average interval from onset to treatment among the three groups (P > 0.05). However, there were significant differences in their average age, distribution of audiogram type, and hearing loss levels among them (P < 0.01). Our study shows that there was no significant difference in average hearing threshold improvement before and after treatment in the three groups (P > 0.05). Regarding the complications, in group A, 33 patients (10.6%) had a transient vertigo attack during tympanic injection, which lasted for ~1-3 min. In group B, 20 patients (6.43%) complained of pain at the injection site, which disappeared after 1-3 days. No other complications occurred in all the other patients. Conclusion The addition of intratympanic or postauricular corticosteroid to systemic steroids did not result in a significant effect on hearing recovery in SSNHL. No obvious complications occur in SSNHL patients treated with intratympanic injection or postauricular injection of corticosteroid. Clinical trial registration [chictr.org.cn], registration number: ChiCTR2100048762.
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Affiliation(s)
- Wen Xie
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Niki Karpeta
- Division of Ear, Nose and Throat Section, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Otolaryngology Head and Neck & Audiology and Neurotology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jiali Liu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haisen Peng
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chunhua Li
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhiling Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuehui Liu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Yuehui Liu
| | - Maoli Duan
- Division of Ear, Nose and Throat Section, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Otolaryngology Head and Neck & Audiology and Neurotology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Maoli Duan
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Tan J, Li Y, Gao D, Sun L, Song Q, Yang J. A liquid chromatography-mass spectroscopy-based untargeted metabolomic study of the rat cochlear nucleus at various stages of maturity. Hear Res 2022; 426:108645. [DOI: 10.1016/j.heares.2022.108645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022]
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Liu J, Xie X, Qin K, Xu L, Peng J, Li X, Li X, Liu Z. Dexamethasone and potassium canrenoate alleviate hyperalgesia by competitively regulating IL-6/JAK2/STAT3 signaling pathway during inflammatory pain in vivo and in vitro. Immun Inflamm Dis 2022; 10:e721. [PMID: 36301041 PMCID: PMC9597488 DOI: 10.1002/iid3.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
Background Dexamethasone (Dexa) and potassium canrenoate (Cane) modulate nociceptive behavior via glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) by two mechanisms (genomic and nongenomic pathways). This study was designed to investigate the Dexa‐ or Cane‐mediated nongenomic and genomic effects on mechanical nociception and inflammation‐induced changes in interleukin‐6 (IL‐6) mediated signaling pathway in rats. Methods Freund's complete adjuvant (FCA) was used to trigger an inflammation of the right hind paw in male Sprague–Dawley rats. First, the mechanical nociceptive behavioral changes were examined following intraplantar administration of GR agonist Dexa and/or MR antagonist Cane in vivo. Subsequently, the protein levels of IL‐6, IL‐6Rα, JAK2, pJAK2, STAT3, pSTAT3Ser727, migration inhibitory factor, and cyclooxygenase‐2 were assessed by Western blot following intraplantar injection of Dexa or Cane or the combination. Moreover, the molecular docking studies determined the interaction between Dexa, Cane, and IL‐6. The competition binding assay was carried out using enzyme‐linked immunosorbent assays (ELISA). Results Administration of Dexa and Cane dose‐dependently attenuated FCA‐induced inflammatory pain. The sub‐additive effect of Dexa/Cane combination was elucidated by isobologram analysis, accompanied by decrease in the spinal levels of IL‐6, pJAK2, and pSTAT3Ser727. The molecular docking study demonstrated that both Dexa and Cane displayed a firm interaction with THR138 binding site of IL‐6 via a strong hydrogen bond. ELISA revealed that Dexa has a higher affinity to IL‐6 than Cane. Conclusions There was no additive or negative effect of Dexa and Cane, and they modulate the IL‐6/JAK2/STAT3 signaling pathway through competitive binding with IL‐6 and relieves hypersensitivity during inflammatory pain.
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Affiliation(s)
- Jie Liu
- Department of AnesthesiologyThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouGuangdongChina
| | - Xiaolan Xie
- Department of AnesthesiologyThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouGuangdongChina
| | - Kai Qin
- Department of AnesthesiologyThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouGuangdongChina
| | - Le Xu
- Department of AnesthesiologyThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouGuangdongChina
| | - Juxiang Peng
- Department of AnesthesiologyThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouGuangdongChina
| | - Xiangyu Li
- Department of AnesthesiologyThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouGuangdongChina
| | - Xiongjuan Li
- Department of Anesthesiology, Shenzhen Second People's HospitalThe First Affiliated Hospital of Shenzhen University, Health Science CenterShenzhenGuangdongChina
| | - Zhiheng Liu
- Department of Anesthesiology, Shenzhen Second People's HospitalThe First Affiliated Hospital of Shenzhen University, Health Science CenterShenzhenGuangdongChina
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12
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Leong S, Aksit A, Feng SJ, Kysar JW, Lalwani AK. Inner Ear Diagnostics and Drug Delivery via Microneedles. J Clin Med 2022; 11:jcm11185474. [PMID: 36143121 PMCID: PMC9500619 DOI: 10.3390/jcm11185474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Precision medicine for inner ear disorders has seen significant advances in recent years. However, unreliable access to the inner ear has impeded diagnostics and therapeutic delivery. The purpose of this review is to describe the development, production, and utility of novel microneedles for intracochlear access. Methods: We summarize the current work on microneedles developed using two-photon polymerization (2PP) lithography for perforation of the round window membrane (RWM). We contextualize our findings with the existing literature in intracochlear diagnostics and delivery. Results: Two-photon polymerization lithography produces microneedles capable of perforating human and guinea pig RWMs without structural or functional damage. Solid microneedles may be used to perforate guinea pig RWMs in vivo with full reconstitution of the membrane in 48–72 h, and hollow microneedles may be used to aspirate perilymph or inject therapeutics into the inner ear. Microneedles produced with two-photon templated electrodeposition (2PTE) have greater strength and biocompatibility and may be used to perforate human RWMs. Conclusions: Microneedles produced with 2PP lithography and 2PTE can safely and reliably perforate the RWM for intracochlear access. This technology is groundbreaking and enabling in the field of inner ear precision medicine.
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Affiliation(s)
- Stephen Leong
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Aykut Aksit
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
| | - Sharon J. Feng
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jeffrey W. Kysar
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
- Department of Otolaryngology—Head & Neck Surgery, New-York Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Anil K. Lalwani
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
- Department of Otolaryngology—Head & Neck Surgery, New-York Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
- Correspondence: ; Tel.: +1-212-305-3319
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13
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Dash S, Zuo J, Steyger PS. Local Delivery of Therapeutics to the Cochlea Using Nanoparticles and Other Biomaterials. Pharmaceuticals (Basel) 2022; 15:ph15091115. [PMID: 36145336 PMCID: PMC9504900 DOI: 10.3390/ph15091115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
Hearing loss negatively impacts the well-being of millions of people worldwide. Systemic delivery of ototherapeutics has limited efficacy due to severe systemic side effects and the presence of the blood–labyrinth barrier that selectively limits or enables transfer of molecules between plasma and inner ear tissues and fluids. Local drug delivery into the middle and inner ear would be preferable for many newly emerging classes of drugs. Although the cochlea is a challenging target for drug delivery, recent technologies could provide a safe and efficacious delivery of ototherapeutics. Local drug delivery routes include topical delivery via the external auditory meatus, retroauricular, transtympanic, and intracochlear delivery. Many new drug delivery systems specifically for the inner ear are under development or undergoing clinical studies. Future studies into these systems may provide a means for extended delivery of drugs to preserve or restore hearing in patients with hearing disorders. This review outlines the anatomy of the (inner) ear, describes the various local delivery systems and routes, and various quantification methodologies to determine the pharmacokinetics of the drugs in the inner ear.
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14
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Qiu K, Mao M, Deng D, Jiang C, Li L, Zheng Y, Ren J, Zhao Y. Is postauricular injection a systemic or a topical route for inner ear drug delivery? Hear Res 2022; 422:108570. [PMID: 35863163 DOI: 10.1016/j.heares.2022.108570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 06/28/2022] [Accepted: 07/12/2022] [Indexed: 02/05/2023]
Abstract
The challenges associated with the blood-labyrinth barrier and unwanted systemic adverse effects severely impede the development of systemic drug administration for inner ear therapy. Previous studies have demonstrated that postauricular injection might be an alternative route for the systemic administration for inner ear therapy because it is minimally invasive and can achieve a high drug concentration in the inner ear. However, the in vivo effects remain unclear. This study aimed to compare differences in cisplatin-induced ototoxicity and systemic adverse effects between postauricular and systemic administration. Here, we compared the differences in hair cell loss, body weight change, and renal dysfunction (indicated by serum levels of blood urea nitrogen and creatinine) between these two routes of administration. The results showed that although postauricular injection of cisplatin might induce greater hair cell damage in the ipsilateral cochleae than that after intraperitoneal injection, significant hair cell damage in the contralateral cochleae as well as systemic adverse effects were also observed. Our results indicated that: (1) topical administration effects might occur in the ipsilateral inner ear following postauricular injection, and (2) systemic circulation might also be an underestimated route of drug delivery to the inner ear following postauricular injection. Overall, postauricular injection is a hybrid administration route, which simultaneously shares the features of topical and systemic administration for inner ear drug delivery.
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Affiliation(s)
- Ke Qiu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Minzi Mao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Di Deng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Chuanhuan Jiang
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China; Research Core Facility of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Li
- Institute of Clinical Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yongbo Zheng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Jianjun Ren
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.
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15
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Chen BC, Lin LJ, Lin YC, Lee CF, Hsu WC. Optimal N-acetylcysteine concentration for intratympanic injection to prevent cisplatin-induced ototoxicity in guinea pigs. Acta Otolaryngol 2022; 142:127-131. [PMID: 35287541 DOI: 10.1080/00016489.2022.2038796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Cisplatin is a chemotherapy drug that can induce sensorineural hearing loss. At present, no otoprotective agent is approved for use. OBJECTIVES This study investigated the optimal concentration of intratympanic N-acetylcysteine (NAC) to prevent cisplatin-induced ototoxicity in a guinea pig model. MATERIALS AND METHODS Guinea pigs (n = 64) were treated with a single intratympanic injection containing different NAC concentrations or saline (control) 3 days prior to intraperitoneal injection with cisplatin. The threshold change in the auditory brainstem response was assessed. RESULTS Four weeks after intraperitoneal cisplatin injection, only the group that received 2% NAC exhibited significant otoprotection (p < .05) compared with the control. Otoprotection was observed at all the frequencies tested (1k, 2k, 4k, and 8k Hz). The 2% NAC group also exhibited significant otoprotection (p < .05) compared with the other NAC groups (at 1k, 2k, 4k, and 8k Hz). The 4% NAC group exhibited significantly reduced hearing capacity (p < .05) in the fourth week compared with controls. CONCLUSIONS AND SIGNIFICANCE Intratympanic NAC administration is an efficient and safe means of preventing cisplatin-induced ototoxicity. In our animal model, the optimal intratympanic NAC concentration was 2%; concentrations of 4% loss of otoprotection.
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Affiliation(s)
- Bo-Cheng Chen
- Department of Otolaryngology, Hualien Tzu Chi Hospital, Medical Foundation, Hualien, Taiwan
| | - Lian-Jie Lin
- Department of Otolaryngology, Hualien Tzu Chi Hospital, Medical Foundation, Hualien, Taiwan
| | - Yi-Chen Lin
- Department of Otolaryngology, Hualien Tzu Chi Hospital, Medical Foundation, Hualien, Taiwan
| | - Chia-Fone Lee
- Department of Otolaryngology, Hualien Tzu Chi Hospital, Medical Foundation, Hualien, Taiwan
- Department of otolaryngology Head and Neck Surgery, School of Medicine, Chi University, Hualien, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, Head and Neck Surgery, National Taiwan, University Hospital, Taipei, Taiwan
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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16
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Wang Y, Gao G, Wang L, Ma X, Yu L, Ye F. Association Between the Number of Intratympanic Steroid Injections and Hearing Recovery in Sudden Sensorineural Hearing Loss. Front Neurol 2022; 12:798569. [PMID: 34970216 PMCID: PMC8712747 DOI: 10.3389/fneur.2021.798569] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
The frequency of intratympanic (IT) steroid injection varies from once daily to once weekly or less among studies and does not reach a uniform standard. This study investigated the potential association between the number of IT steroid injections and hearing recovery to determine the optimal number in sudden sensorineural hearing loss (SSNHL) patients. A retrospective study involving 233 SSNHL patients receiving IT steroids plus batroxobin within 7 days of onset was performed. Patients were followed up for 3 months. More than 15 dB of HL improvement in the pretreatment pure tone average (PTA) was defined as effective. The effective group had a higher IT injection numbers than the ineffective group (≥ 6 times: 84.6 vs. 61.1, p < 0.001). Regardless of the unadjusted model or adjusted model, patients who received more frequent IT steroid injections seemed more likely to recover hearing (unadjusted model, OR, 95% CI: 1.25, 1.06-1.48; p = 0.007; adjusted model, OR, 95% CI: 1.21, 1.01-1.45; p = 0.044). Six IT injections had the highest rate of hearing recovery (79.1%). In conclusion, IT injection number was an independent factor that was positively associated with hearing recovery, and the optimal number of IT steroid injections was 6. Batroxobin plus higher number of IT steroid injections showed more effective for treating SSNHL.
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Affiliation(s)
- Yixu Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Ge Gao
- Department of Radiology, First Hospital, Peking University, Beijing, China
| | - Le Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Xin Ma
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Fanglei Ye
- Department of Otorhinolaryngology, Head and Neck Surgery, First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
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17
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Garov EV, E Garova E, Pryakhina MA. [Corticosteroids for acute sensorineural hearing loss treatment. The contemporary state of problem. Literature review. Part 1]. Vestn Otorinolaringol 2022; 87:51-56. [PMID: 35818946 DOI: 10.17116/otorino20228703151] [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] [Indexed: 06/15/2023]
Abstract
The article presents modern literary data relating to the expediency of the purpose of glucocorticosteroids in sudden sensorineural hearing loss (SSHL) of various genes. In detail, the radar molecular mechanisms and the anatomo-physiological features of the exposure to the inner ear, side effects, the introduction methods, their comparative efficacy and modern schemes of the SSHL.
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Affiliation(s)
- E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E E Garova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Pryakhina
- Pirogov Russian National Research Medical University, Moscow, Russia
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18
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Szeto B, Valentini C, Aksit A, Werth EG, Goeta S, Brown LM, Olson ES, Kysar JW, Lalwani AK. Impact of Systemic versus Intratympanic Dexamethasone Administration on the Perilymph Proteome. J Proteome Res 2021; 20:4001-4009. [PMID: 34291951 DOI: 10.1021/acs.jproteome.1c00322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Glucocorticoids are the first-line treatment for sensorineural hearing loss, but little is known about the mechanism of their protective effect or the impact of route of administration. The recent development of hollow microneedles enables safe and reliable sampling of perilymph for proteomic analysis. Using these microneedles, we investigate the effect of intratympanic (IT) versus intraperitoneal (IP) dexamethasone administration on guinea pig perilymph proteome. Guinea pigs were treated with IT dexamethasone (n = 6), IP dexamethasone (n = 8), or untreated for control (n = 8) 6 h prior to aspiration. The round window membrane (RWM) was accessed via a postauricular approach, and hollow microneedles were used to perforate the RWM and aspirate 1 μL of perilymph. Perilymph samples were analyzed by liquid chromatography-mass spectrometry-based label-free quantitative proteomics. Mass spectrometry raw data files have been deposited in an international public repository (MassIVE proteomics repository at https://massive.ucsd.edu/) under data set # MSV000086887. In the 22 samples of perilymph analyzed, 632 proteins were detected, including the inner ear protein cochlin, a perilymph marker. Of these, 14 proteins were modulated by IP, and three proteins were modulated by IT dexamethasone. In both IP and IT dexamethasone groups, VGF nerve growth factor inducible was significantly upregulated compared to control. The remaining adjusted proteins modulate neurons, inflammation, or protein synthesis. Proteome analysis facilitated by the use of hollow microneedles shows that route of dexamethasone administration impacts changes seen in perilymph proteome. Compared to IT administration, the IP route was associated with greater changes in protein expression, including proteins involved in neuroprotection, inflammatory pathway, and protein synthesis. Our findings show that microneedles can mediate safe and effective intracochlear sampling and hold promise for inner ear diagnostics.
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Affiliation(s)
- Betsy Szeto
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032, United States
| | - Chris Valentini
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032, United States
| | - Aykut Aksit
- Department of Mechanical Engineering, Columbia University, New York, New York 10027, United States
| | - Emily G Werth
- Quantitative Proteomics and Metabolomics Center, Department of Biological Sciences, Columbia University, New York, New York 10027, United States
| | - Shahar Goeta
- Quantitative Proteomics and Metabolomics Center, Department of Biological Sciences, Columbia University, New York, New York 10027, United States
| | - Lewis M Brown
- Quantitative Proteomics and Metabolomics Center, Department of Biological Sciences, Columbia University, New York, New York 10027, United States
| | - Elizabeth S Olson
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032, United States.,Department of Biomedical Engineering, Columbia University, New York, New York 10027, United States
| | - Jeffrey W Kysar
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032, United States.,Department of Mechanical Engineering, Columbia University, New York, New York 10027, United States
| | - Anil K Lalwani
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032, United States.,Department of Mechanical Engineering, Columbia University, New York, New York 10027, United States
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19
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Hwang YJ, Park M, Park MK, Lee JH, Oh SH, Suh MW. High-Molecular-Weight Hyaluronic Acid Vehicle Can Deliver Gadolinium Into the Cochlea at a Higher Concentration for a Longer Duration: A 9.4-T Magnetic Resonance Imaging Study. Front Neurol 2021; 12:650884. [PMID: 34248816 PMCID: PMC8263933 DOI: 10.3389/fneur.2021.650884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022] Open
Abstract
Intratympanic (IT) gadolinium (Gd) injection is one method of delivering Gd into the inner ear to evaluate the amount of endolymphatic hydrops (EH) using magnetic resonance imaging (MRI). As Gd is usually prepared in a fluid form mixed with saline, Gd injected into the middle ear drains easily through the Eustachian tube within several hours. High-molecular-weight (hMW) hyaluronic acid (HA) is an ideal vehicle for IT Gd due to its viscous and adhesive properties. The present study was performed to elucidate whether novel hMW HA is superior to conventional HA in delivering Gd into the inner ear in the short term. The second aim was to verify the long-term Gd delivery efficiency of hMW HA compared to the standard-of-care vehicle (saline). IT Gd injection and 3D T1-weighted MRI were performed in 13 rats. For the short-term study (imaging after 1, 2, and 3 h), the left ear was treated with hMW HA+Gd and the right ear with conventional HA+Gd. For the long-term study (imaging after 1, 2, 3, and 4 h, 1 – 3 days, and 7 – 10 days), the left ear was treated with hMW HA+Gd and the right ear with saline+Gd. Signal intensities (SIs) in the scala tympani (ST) and scala vestibuli (SV) were quantified. Compared to conventional HA, signal enhancement was 2.3 – 2.4 times greater in the apical and middle turns after hMW HA+Gd injection (SV at 1 h). In comparison to the standard-of-care procedure, the SI was not only greater in the short term but the higher SI also lasted for a longer duration. On days 7 – 10 after IT Gd delivery, the SI in the basal turn was 1.9 – 2.1 times greater in hMW HA+Gd-treated ears than in saline IT Gd-treated ears. Overall, hMW HA may be a useful vehicle for more efficient IT Gd delivery. Gd enhancement in the cochlea improved approximately two-fold when hMW HA was used. In addition, this greater enhancement lasted for up to 7 – 10 days. Repeated MRI of EH may be possible for several days with a single IT hMW HA+Gd delivery.
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Affiliation(s)
- Yu-Jung Hwang
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea.,Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University, Seoul, South Korea
| | - Mina Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Medical Center, Seoul, South Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea.,Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University, Seoul, South Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
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20
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Sawamura S, Ogata G, Asai K, Razvina O, Ota T, Zhang Q, Madhurantakam S, Akiyama K, Ino D, Kanzaki S, Saiki T, Matsumoto Y, Moriyama M, Saijo Y, Horii A, Einaga Y, Hibino H. Analysis of Pharmacokinetics in the Cochlea of the Inner Ear. Front Pharmacol 2021; 12:633505. [PMID: 34012393 PMCID: PMC8128070 DOI: 10.3389/fphar.2021.633505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/16/2021] [Indexed: 11/14/2022] Open
Abstract
Hearing loss affects >5% of the global population and therefore, has a great social and clinical impact. Sensorineural hearing loss, which can be caused by different factors, such as acoustic trauma, aging, and administration of certain classes of drugs, stems primarily from a dysfunction of the cochlea in the inner ear. Few therapeutic strategies against sensorineural hearing loss are available. To develop effective treatments for this disease, it is crucial to precisely determine the behavior of ototoxic and therapeutic agents in the microenvironment of the cochlea in live animals. Since the 1980s, a number of studies have addressed this issue by different methodologies. However, there is much less information on pharmacokinetics in the cochlea than that in other organs; the delay in ontological pharmacology is likely due to technical difficulties with accessing the cochlea, a tiny organ that is encased with a bony wall and has a fine and complicated internal structure. In this review, we not only summarize the observations and insights obtained in classic and recent studies on pharmacokinetics in the cochlea but also describe relevant analytical techniques, with their strengths, limitations, and prospects.
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Affiliation(s)
- Seishiro Sawamura
- Division of Glocal Pharmacology, Department of Pharmacology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Genki Ogata
- Division of Glocal Pharmacology, Department of Pharmacology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kai Asai
- Department of Chemistry, Keio University, Yokohama, Japan
| | - Olga Razvina
- Department of Molecular Physiology, Niigata University School of Medicine, Niigata, Japan.,G-MedEx Office, Niigata University School of Medicine, Niigata, Japan
| | - Takeru Ota
- Division of Glocal Pharmacology, Department of Pharmacology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Qi Zhang
- Division of Glocal Pharmacology, Department of Pharmacology, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Molecular Physiology, Niigata University School of Medicine, Niigata, Japan.,Department of Otolaryngology, Head and Neck Surgery Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sasya Madhurantakam
- Division of Glocal Pharmacology, Department of Pharmacology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koei Akiyama
- Department of Molecular Physiology, Niigata University School of Medicine, Niigata, Japan
| | - Daisuke Ino
- Division of Glocal Pharmacology, Department of Pharmacology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sho Kanzaki
- Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan
| | - Takuro Saiki
- Department of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshifumi Matsumoto
- Department of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masato Moriyama
- Department of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yasuo Saijo
- Department of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Arata Horii
- Department of Otolaryngology, Head and Neck Surgery Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yasuaki Einaga
- Department of Chemistry, Keio University, Yokohama, Japan
| | - Hiroshi Hibino
- Division of Glocal Pharmacology, Department of Pharmacology, Graduate School of Medicine, Osaka University, Osaka, Japan.,AMED-CREST, AMED, Osaka, Japan
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21
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Ren G, Xu J, Lan L, Ma B, Zhang Q. Postauricular injection of methylprednisolone sodium succinate as a salvage treatment for refractory sudden sensorineural hearing loss. Ir J Med Sci 2021; 190:1165-1172. [PMID: 33866519 DOI: 10.1007/s11845-021-02610-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postauricular steroid administration has been popular for treating sudden sensorineural hearing loss. However, there are few reports on its use in patients with refractory sudden sensorineural hearing loss (RSSNHL). AIMS The objective of this study was to investigate the therapeutic efficacy of postauricular steroid injection as a salvage treatment for RSSNHL patients. METHODS This retrospective study enrolled 63 RSSNHL patients between January 2016 and January 2019. Thirty-three patients of them who have been divided into the treatment group received postauricular methylprednisolone sodium succinate injection. The remaining 30 patients who formed the control group did not receive any steroid as a salvage therapy. Improvements in hearing were evaluated between pre-salvage therapy and 3 months follow-up after salvage therapy. RESULTS The median hearing gain in PTA was 9.88 dB HL (quartile range 7.58, 18.65) in the treatment group and 0.90 dB HL (quartile range 0.00, 4.90) in the control group (P<0.01). According to the criteria of Furuhashi, the total percentage for effective prognosis was 48.48% (16/33) in the treatment group and 10.00% (3/30) in the control group (P<0.01). The time interval from onset to study entry was significantly and independently associated with the prognosis for RSSNHL patients (P< 0.01). CONCLUSIONS The present findings suggest that postauricular corticosteroid administration as a salvage treatment demonstrated better results than no treatment for RSSNHL patients. The time interval from onset to study entry was mainly the prognostic factor for RSSNHL patients. It is therefore considered that postauricular corticosteroid administration may be used as a salvage therapy for RSSNHL patients.
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Affiliation(s)
- Gang Ren
- Department of Otolaryngology, the First Affiliated Hospital of Huzhou University, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, China
| | - Jue Xu
- Department of Otolaryngology, the First Affiliated Hospital of Huzhou University, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, China
| | - Longjiang Lan
- Department of Otolaryngology, the First Affiliated Hospital of Huzhou University, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, China
| | - Bingliang Ma
- Department of Otolaryngology, the First Affiliated Hospital of Huzhou University, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, China
| | - Qi Zhang
- Department of Otolaryngology, the First Affiliated Hospital of Huzhou University, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, China.
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22
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Abstract
: Local glucocorticosteroid ("steroid") therapy is widely used to treat the inner ears of patients with Menière's disease, idiopathic sudden sensorineural hearing loss and in combination with cochlear implants. Applied steroids have included dexamethasone, methylprednisolone, and triamcinolone. In reality, however, this is often not true and the steroid forms commonly applied are dexamethasone-phosphate, methylprednisolone-hemisuccinate, or triamcinolone-acetonide. In each case, the additional component is not a counter-ion but is covalently bound to the molecule to increase aqueous solubility or potency. These drug forms are approved for intravenous or intramuscular delivery and are used "off-label" in the ear. When given systemically, the molecular form of the drug is of minor importance as the drugs are rapidly metabolized. In contrast, when administered intratympanically, the exact form of the drug has a major influence on entry into perilymph and elimination from perilymph, which in turn influences distribution along the cochlear scalae. Dexamethasone-phosphate has completely different molecular properties to dexamethasone and has different pharmacokinetic properties entering and leaving perilymph. Molecular properties and perilymph pharmacokinetics also differ markedly for triamcinolone and triamcinolone-acetonide. Methylprednisolone-hemisuccinate has completely different molecular properties to methylprednisolone. In the ear, different steroid forms cannot therefore be regarded as equivalent in terms of pharmacokinetics or efficacy. This presents a terminology problem, where in many cases the drug stated in publications may not be the form actually administered. The lack of precision in nomenclature is a serious problem for the inner ear drug delivery field and needs to be recognized.
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Wang Z, Han L, Yu L. Effects of surgery and topical medication on eosinophilic granulomatosis with polyangiitis with otitis media and sinusitis: a case report. J Int Med Res 2021; 48:300060520920049. [PMID: 32345078 PMCID: PMC7218976 DOI: 10.1177/0300060520920049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is eosinophil-rich, necrotizing granulomatous inflammation often involving the respiratory tract. Furthermore, EGPA is necrotizing vasculitis that predominantly affects small to medium vessels and is associated with asthma and eosinophilia. Most patients with EGPA have sinusitis and some complain of hearing loss and refractory otitis media with effusion. Systemic use of immunosuppressants and glucocorticoids is currently recommended, despite the inevitable associated side effects. However, systemic treatment is not always effective for nasal and ear symptoms. We report a case of EGPA with refractory otitis media and chronic sinusitis, which were resistant to systemic high-dose steroids and immunosuppressants. However, these symptoms responded well to functional endoscopic sinus surgery and myringotomy and grommet insertion. We also administered budesonide nasal irrigation and glucocorticoid injection by intratympanic and postaural methods in this patient. The therapeutic effect was satisfactory.
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Affiliation(s)
- Zijing Wang
- Department of Otolaryngology, Peking University People's Hospital, Beijing, China
| | - Lin Han
- Department of Otolaryngology, Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otolaryngology, Peking University People's Hospital, Beijing, China
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24
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Varela-Nieto I, Murillo-Cuesta S, Calvino M, Cediel R, Lassaletta L. Drug development for noise-induced hearing loss. Expert Opin Drug Discov 2020; 15:1457-1471. [PMID: 32838572 DOI: 10.1080/17460441.2020.1806232] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Excessive exposure to noise is a common occurrence that contributes to approximately 50% of the non-genetic hearing loss cases. Researchers need to develop standardized preclinical models and identify molecular targets to effectively develop prevention and curative therapies. AREAS COVERED In this review, the authors discuss the many facets of human noise-induced pathology, and the primary experimental models for studying the basic mechanisms of noise-induced damage, making connections and inferences among basic science studies, preclinical proofs of concept and clinical trials. EXPERT OPINION Whilst experimental research in animal models has helped to unravel the mechanisms of noise-induced hearing loss, there are often methodological variations and conflicting results between animal and human studies which make it difficult to integrate data and translate basic outcomes to clinical practice. Standardization of exposure paradigms and application of -omic technologies will contribute to improving the effectiveness of transferring newly gained knowledge to clinical practice.
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Affiliation(s)
- Isabel Varela-Nieto
- Neurobiology of Hearing Research Group, Endocrine and Nervous System Pathophysiology Department, Institute for Biomedical Research "Alberto Sols" CSIC-UAM , Madrid, Spain.,Institute for Biomedical Research "Alberto Sols" CSIC-UAM , Madrid, Spain.,Oto-Neurosurgery Research Group, Cancer and Human Molecular Genetics Department, IdiPAZ Research Institute , Madrid, Spain
| | - Silvia Murillo-Cuesta
- Neurobiology of Hearing Research Group, Endocrine and Nervous System Pathophysiology Department, Institute for Biomedical Research "Alberto Sols" CSIC-UAM , Madrid, Spain.,Institute for Biomedical Research "Alberto Sols" CSIC-UAM , Madrid, Spain.,Oto-Neurosurgery Research Group, Cancer and Human Molecular Genetics Department, IdiPAZ Research Institute , Madrid, Spain
| | - Miryam Calvino
- Institute for Biomedical Research "Alberto Sols" CSIC-UAM , Madrid, Spain.,Oto-Neurosurgery Research Group, Cancer and Human Molecular Genetics Department, IdiPAZ Research Institute , Madrid, Spain.,Department of Otorhinolaryngology, La Paz University Hospital , Madrid, Spain
| | - Rafael Cediel
- Neurobiology of Hearing Research Group, Endocrine and Nervous System Pathophysiology Department, Institute for Biomedical Research "Alberto Sols" CSIC-UAM , Madrid, Spain.,Institute for Biomedical Research "Alberto Sols" CSIC-UAM , Madrid, Spain.,Oto-Neurosurgery Research Group, Cancer and Human Molecular Genetics Department, IdiPAZ Research Institute , Madrid, Spain.,Department of Animal Medicine and Surgery, Complutense University of Madrid , Madrid, Spain
| | - Luis Lassaletta
- Institute for Biomedical Research "Alberto Sols" CSIC-UAM , Madrid, Spain.,Oto-Neurosurgery Research Group, Cancer and Human Molecular Genetics Department, IdiPAZ Research Institute , Madrid, Spain.,Department of Otorhinolaryngology, La Paz University Hospital , Madrid, Spain
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25
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Yu D, Gu J, Chen Y, Kang W, Wang X, Wu H. Current Strategies to Combat Cisplatin-Induced Ototoxicity. Front Pharmacol 2020; 11:999. [PMID: 32719605 PMCID: PMC7350523 DOI: 10.3389/fphar.2020.00999] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Cisplatin is widely used for the treatment of a number of solid malignant tumors. However, ototoxicity induced by cisplatin is an obstacle to effective treatment of tumors. The basis for this toxicity has not been fully elucidated. It is generally accepted that hearing loss is due to excessive production of reactive oxygen species by cells of the cochlea. In addition, recent data suggest that inflammation may trigger inner ear cell death through endoplasmic reticulum stress, autophagy, and necroptosis, which induce apoptosis. Strategies have been extensively explored by which to prevent, alleviate, and treat cisplatin-induced ototoxicity, which minimize interference with antitumor activity. Of these strategies, none have been approved by the Federal Drug Administration, although several preclinical studies have been promising. This review highlights recent strategies that reduce cisplatin-induced ototoxicity. The focus of this review is to identify candidate agents as novel molecular targets, drug administration routes, delivery systems, and dosage schedules. Animal models of cisplatin ototoxicity are described that have been used to evaluate drug efficacy and side effect prevention. Finally, clinical reports of otoprotection in patients treated with cisplatin are highlighted. For the future, high-quality studies are required to provide reliable data regarding the safety and effectiveness of pharmacological interventions that reduce cisplatin-induced ototoxicity.
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Affiliation(s)
- Dehong Yu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Jiayi Gu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Yuming Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Wen Kang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Xueling Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Hao Wu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
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Chen Y, Pei T, Sun Y, Jiang J, Zhang H. [New progress of IGF-1 and allosteroid injection in the treatment of sudden deafness complicated with type 2 diabetes]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:569-572. [PMID: 32842194 PMCID: PMC10128332 DOI: 10.13201/j.issn.2096-7993.2020.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Indexed: 06/11/2023]
Abstract
Glucocorticoids are a recognized treatment for sudden deafness, and there has always been a contradiction between the control of blood glucose levels and the use of glucocorticoids. The systemic use of hormones may lead to a series of adverse events, which are dose-dependent. High doses can induce an increase in blood sugar, especially for patients with type 2 diabetes, which can aggravate their condition or cause complications. The systemic application of glucocorticoids has been largely replaced by local glucocorticoids treatment. Topical insulin-like growth factor (IGF-1) is used without increasing blood sugar, thus avoiding the possible complications. The author intends to compare the local IGF-1 treatment and local glucocorticoid treatment to systemic therapy. The efficacy of local IGF-1 therapy in treating corticosteroid-refractory sudden sensorineural hearing loss combined with type 2 diabetes is reviewed.
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Roßberg W, Goetz F, Timm ME, Lenarz T, Helmstaedter V. Intratympanic application of triamcinolone in sudden hearing loss-radiologic anatomy in cone beam CT and its' correlation to clinical outcome. Eur Arch Otorhinolaryngol 2020; 277:1931-1937. [PMID: 32206871 PMCID: PMC7286852 DOI: 10.1007/s00405-020-05920-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/12/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate temporal bone cone-beam CT in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) being treated with primary and secondary intratympanic (IT) triamcinolone and to possibly correlate these results to the clinical outcome. METHODS Retrospective analysis of patients treated with IT triamcinolone for ISSNHL at our department in 2018. Pre- and post-therapeutic audiologic examinations included four-tone average (FTA) at 0.5, 1, 2 and 3 kHz. Using a clinical questionnaire, pre-therapeutic CBCT scans were re-evaluated looking at items, which might interfere with adequate drug diffusion into the inner ear (e.g. bony overhangs or secondary membranes at the round or oval window). RESULTS Thirty-one patients were included. Twenty-four (77%; group A) had experienced ineffective systemic steroid therapy before and seven (23%; group B) received primary IT injections. Four group A-patients (21%) and two group B-patients (33%) showed a post-therapeutic FTA improvement of more than 15 dB HL. Bony overhangs at the round window niche (RWN) were present in seven cases (26%), a secondary membrane at the RWN in four (15%) and soft tissue in eight (30%) cases, respectively. CONCLUSION Most patients present radiological findings in CBCT imaging, which might interfere with drug diffusion through the RW membrane. Interestingly, soft or bony tissue obstructing the RWN or the OWN was found in 50% of patients, who showed improvement of hearing. We conclude that radiologic 'tiny' findings are either clinically irrelevant or improvement in hearing is independent from intratympanic drug delivery.
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Affiliation(s)
- Willi Roßberg
- Department of Otorhinolaryngology, Hannover Medical University, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Friedrich Goetz
- Department of Neuroradiology, Hannover Medical University, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Max Eike Timm
- Department of Otorhinolaryngology, Hannover Medical University, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical University, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Victor Helmstaedter
- Department of Otorhinolaryngology, Hannover Medical University, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Kalinec GM, Cohn W, Whitelegge JP, Faull KF, Kalinec F. Preliminary Characterization of Extracellular Vesicles From Auditory HEI-OC1 Cells. Ann Otol Rhinol Laryngol 2019; 128:52S-60S. [DOI: 10.1177/0003489419836226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: Isolate, purify, and characterize extracellular vesicles (EVs) obtained from auditory HEI-OC1 cells, and evaluate their suitability for intracochlear transport and delivery of pharmacological drugs and/or pro-resolution mediators of acute inflammatory processes. Methods: HEI-OC1 EVs were isolated and purified using the exoEasy Maxi Kit, and their size was evaluated by nanoparticle tracking techniques. Bottom-up proteomics of the EVs, either freshly obtained or stored for up to 4 months at −20°C, was performed by LC-ESI-MS/MS. LC-ESI-MS/MS-MRM was used to measure the loading of dexamethasone inside EVs following co-incubation at room temperature for 1 hour with and without 5 minutes sonication. Results: Routinely, we were able to obtain purified fractions of >2 × 109 EVs/mL, with diameters varying between 50 and 800 nm. Bottom-up proteomics showed that among the most abundant EVs proteins, 19.2% were cytoplasmic, 17.2% were membrane localized, 12.3% were cytosolic, and 14.6% were nucleolar. No significant differences between fresh and stored EVs were detected. Importantly, co-incubation of HEI-OC1 EVs (1 × 108 EVs/mL) with dexamethasone (10 mM) resulted in the incorporation of 10.1 ± 1.9 nM dexamethasone per milliliter of EVs suspension. Conclusions: Altogether, the results suggest that EVs from HEI-OC1 cells could be advantageously used as biological nanocarriers for the delivery of specific molecules and pharmacological drugs into the inner ear.
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Affiliation(s)
- Gilda M. Kalinec
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Whitaker Cohn
- Pasarow Mass Spectrometry Laboratory, Jane and Terry Semel Institute for Neuroscience and Human Behavior and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julian P. Whitelegge
- Pasarow Mass Spectrometry Laboratory, Jane and Terry Semel Institute for Neuroscience and Human Behavior and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kym F. Faull
- Pasarow Mass Spectrometry Laboratory, Jane and Terry Semel Institute for Neuroscience and Human Behavior and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Federico Kalinec
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Trune DR, Shives KD, Hausman F, Kempton JB, MacArthur CJ, Choi D. Intratympanically Delivered Steroids Impact Thousands More Inner Ear Genes Than Systemic Delivery. Ann Otol Rhinol Laryngol 2019; 128:134S-138S. [DOI: 10.1177/0003489419837562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Glucocorticoids are given for sensorineural hearing loss, but little is known of their molecular impact on the inner ear. Furthermore, in spite of claims of improved hearing recovery with intratympanic delivery of steroids, no studies have actually documented the inner ear molecular functions that are enhanced with this delivery method. Methods: To assess steroid-driven processes in the inner ear, gene chip analyses were conducted on mice treated systemically with the glucocorticoids prednisolone or dexamethasone or the mineralocorticoid aldosterone. Other mice were given the same steroids intratympanically. Inner ears were harvested at 6 hours and processed on the Affymetrix 430 2.0 Gene Chip for expression of its 34 000 genes. Results were statistically analyzed for up or down expression of each gene against control (untreated) mice. Results: Analyses showed approximately 17 500 genes are normally expressed in the inner ear and steroids alter expression of 55% to 82% of these. Dexamethasone changed expression of 9424 (53.9%) inner ear genes following systemic injection but 14 899 ear genes (85%) if given intratympanically. A similar pattern was seen with prednisolone, as 7560 genes were impacted by oral delivery and 11 164 genes (63.8%) when given intratympanically. The mineralocorticoid aldosterone changed expression of only 268 inner ear genes if given orally, but this increased to 10 124 genes (57.9%) if injected intratympanically. Furthermore, the glucocorticoids given actually impacted more inner ear genes via the mineralocorticoid receptor than the glucocorticoid receptor. Conclusions: Thousands of inner ear genes were affected by steroids, and this number increased significantly if steroids were delivered intratympanically. Also, the impact of glucocorticoids on inner ear mineralocorticoid functions is more substantial than previously known. Thus, the application of therapeutic steroids for hearing loss needs to be reassessed in light of their more comprehensive impact on inner ear genes. Furthermore, simply ascribing the efficacy of steroids to immunosuppression no longer appears to be warranted.
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Affiliation(s)
- Dennis R. Trune
- Oregon Hearing Research Center, Department of Otolaryngology-Head & Neck Surgery, OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Katherine D. Shives
- Oregon Hearing Research Center, Department of Otolaryngology-Head & Neck Surgery, OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
- Sartorius-Stedim North America, Arvada, CO, USA
| | - Fran Hausman
- Oregon Hearing Research Center, Department of Otolaryngology-Head & Neck Surgery, OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - J. Beth Kempton
- Oregon Hearing Research Center, Department of Otolaryngology-Head & Neck Surgery, OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Carol J. MacArthur
- Oregon Hearing Research Center, Department of Otolaryngology-Head & Neck Surgery, OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Dongseok Choi
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
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