Impacts of different methylprednisolone administration routes in patients with sudden hearing loss or Meniere’s disease

Background:Evidence suggests that glucocorticoids are important in the treatment of sudden hearing loss(SHL)and Meniere’s disease(MD).However,different glucocorticoid administration methods may have a significant impact on treatment outcomes.Objective:This study aimed to investigate effects of different glucocorticoid administration methods on sudden hearing loss and Meniere’s disease.Methods:In this study,glucocorticoids were administered orally in 18 patients,by retroauricular injection in 15 patients and by intratympanic injection in 15 patients.White blood cell(WBC)count,serum Kt,fasting plasma glucose(FPG),body temperature,heart rate and blood pressure were used to evaluate effects of glucocorticoids on patients with hearing loss.Visual analog scale(VAS)of pain and sleep disorders were also surveyed,and pure tone audiometry(PTA)results were compared among groups to evaluate efficacy of different glucocorticoids administration methods.Result:WBC count,heart rate and blood pressure were higher in patients taking oral glucocorticoids,while body temperature,serum Kt and FPG levels did not change in all three groups.However,patients who received intratympanic injection of glucocorticoids experienced more pain,while those taking oral glucocorticoids reported more sleep impairment.Treatment efficacy on hearing loss was not significantly different among the three groups.Conclusion:These findings suggest that systemic glucocorticoid administration can result in greater whole body responses than local administration,but with similar hearing treatment efficacy.

Role of Intratympanic Steroids in the Management of Meniere’s Disease—A Review of 151 Cases

Objective: To assess the outcomes of hearing and vertigo in patients with Meniere’s disease who were treated with intratympanic methylprednisolone. Study Design: Retrospective study. Setting: Tertiary referral hospital. Methods: In our study with 151 patients [191 ears] were diagnosed as Menieres as per 1995 AAO-HNS guidelines. As an office based procedure these patients were treated with intratympanic methyl prednisolone. Results: There was a 98.6% improvement in the vertigo control rate, a 73.82% improvement in hearing and 29.31% had a definitive improvement in tinnitus. Conclusion: We conclude from our study that intratympanic steroid injection significantly controls vertigo, tinnitus and improves hearing in Meniere’s disease with minimal complications. Hence, it can be tried as a first line treatment for patients with Meniere’s disease.

Identification of early-stage Meniere’s disease as a cause of unilateral tinnitus

Introduction:Meniere’s disease(MD)is characterized by episodic symptoms,including vertigo,hearing loss,and tinnitus.Objectives:in this study,cases of unilateral tinnitus were investigated for MD.Method:Twenty-two patients who presented with chronic unilateral tinnitus on puretone audiograms showing an average threshold better than 25 dB HL and thresholds in the lower frequencies worse than those in the higher frequencies by more than 10 dB were suspected to have early-stage MD and underwent electrocochleography(ECochG).Patients showing ECochG findings conclusive for MD were compared to a control group of patients presenting with chronic unilateral tinnitus on pure-tone audiograms showing an average threshold better than 25 dB and thresholds in the higher frequencies worse than those in the lower frequencies by more than 10 dB.Results:Eighteen of the 22 patients included in this study showed elevated summating potential amplitude to action potential amplitude ratios in ECochG(suggestive of endolymphatic hydrops due to MD)and were followed up for 2 months;14 of them experienced at least two attacks of vertigo or unsteadiness.In contrast,only one patient in the control group reported two or more attacks of vertigo or unsteadiness in the 2 month observation period.The incidence of this finding in the two groups was significantly different.Conclusion:Patients with early-stage MD can present with only unilateral tinnitus.Thus,the addition of“pure-tone audiograms showing lower-frequency thresholds worse than higher-frequency thresholds”to the probable MD category in the globally.

Cochlear implantation in patients with Meniere’s disease:A systematic review

Background:Meniere’s disease(MD)is an idiopathic disorder of the inner ear,which manifests as cochleo-vestibular dysfunction.Hearing loss will progress to a profound levelin a subset of patients with MD,and vestibular interventions can independently cause loss of hearing.The aim of this study was to systematically review the published literature describing the safety and efficacy of CI in patients with MD.Materials and methods:A systematic literature review was conducted in accordance PRISMA guidelines to identify articles that assessed at least one functional outcome in patients with MD who underwent CI.Demographic information,disease history,MD symptoms,outcomes measures,and complications related to CI were extracted from included studies.Results:In total,17 studies were included,and 182 patients with MD underwent CI.The weighted-mean age was 61.9 years(range 27-85).Study objective and methodology varied,and there was significant heterogeneity in CI outcome measures reported.In total,179(98.3%)of 182 patients reported objective improvements in at least one hearing metric after CI.A total of 69 patients(37.9%)reported vertigo or severe dizziness prior to CI,compared to 22 patients(15.4%)postoperatively.Two studies reported significant reductions in postoperative Tinnitus Handicap Inventory score(THI).Quality of life assessments varied between studies.Complications rates were low with only nine patients(4.9%)reporting a serious CI-related complication.Conclusions:This systematic review evaluated 17 studies describing the safety and efficacy of CI in patients with MD and encountered many challenges due to small sample sizes,and heterogeneity in study design and outcomes measured.Despite these limitations,this study of 182 patients is to the best of our knowledge the largest systematic review evaluating the safety and efficacy of CI in MD.The results of this study support the need for a standardized approach to evaluating outcomes of CI in patients with MD in future studies.

Contralateral delayed endolymphatic hydrops: Clinical features and long term outcome

Background:Contralateral delayed endolymphatic hydrops(CDEH)is a clinical entity characterized by fluctuating low frequency hearing loss and/or vertigo,mimicking Meniere’s disease(MD),that manifests after the appearance of severe non-hydropic hearing loss(NHHL)at the other ear.Objectives:to describe the clinical features and the course of 57 patients affected by CDEH.Method:this is a retrospective study;57 patients affected by CDEH,out of 1065 patients seen in the same period and affected by MD,were subjected to otoscopy,PTA threshold evaluation,impedance testing,ABR,research of positioning nystagmus,vestibular function evaluated by means of bithermal caloric test under video-oculographic,and MRI with gadolinium.Results:the CDEH was definite in 24 cases(42%),probable in 2(4%)and possible in 31(54%).The mean PTA threshold at the hydropic ear was 41 dB.At the last follow-up,40 patients(70%)did not report vertigo or fluctuating hearing loss.Among the 17 patients who still reported symptomatology,11(64%)were affected by fluctuating hearing loss alone,4(23%)reported a subjective worsening of hearing loss and 2(12%)an acute vertigo crisis.Conclusions:contralateral delayed endolymphatic hydrops is a relatively rare form of Meniere disease that manifests more frequently as a definite form or with fluctuating low-frequency hearing loss.The prognosis at a long term follow-up is relatively good in terms of vertigo resolution.Contralateral delayed endolymphatic hydrops rarely determines a severe hearing loss in the better ear.

Integrating cupping therapy in the management of tinnitus and dizziness:a pilot study

Background:Cupping therapy is one of integrative medicine modalities which is used by several nations.Its mechanism of action is not well known but there are several theories explained how it can play a rule in the treatment of diseases.In recent years,huge advances have taken place in understanding of inner ear pathophysiology causing sensorineural hearing loss,tinnitus,and vertigo.Research articles providing evidence of acupuncture treating dizziness and vertigo but no studies of cupping therapy.The aim of this pilot study was to evaluate the safety and efficacy of integrating wet cupping therapy in the management of tinnitus and dizziness associated with ear pathologies.Methods:This is a prospective interventional pilot study in which pre and post intervention outcomes(tinnitus handicap inventory and dizziness handicap inventory)were assessed and compared.27 patients diagnosed with Ménière's disease and idiopathic tinnitus or tinnitus secondary to inner ear pathology were included in this study and received usual medical treatment and wet cupping therapy.Results:There was a significant improvement after 6 sessions of cupping in tinnitus handicap inventory and dizziness handicap inventory but not in patient’s hearing.No adverse events were reported in this study.Conclusion:Wet cupping therapy demonstrates a promising effectiveness in reducing discomforts of both dizziness and tinnitus.A large scale randomized controlled trial is recommended.

Comparison of Transtympanic and Extratympanic Electrocochleography

Electrocochleography (ECoG) has been an important tool in the diagnosis of Meniere’s disease or endolymphatic hydrops. There are two methods employed, transtympanic and extratympanic. Many have regarded the results of these methods as being equally reliable. The purpose of this study is to determine any differences in sensitivity between the two methods. In this study patients with known endolymphatic hydrops or Meniere’s disease underwent ECoG testing with both the extratympanic method and the transtympanic method on the same day in the same ear. The results show a significant difference between the two methods, with the transtympanic wave values being smaller and therefore more sensitive than the extratympanic method. In addition, transtympanic ECoG resulted in better waveform morphology and better correlation with the audiometric findings in endolymphatic hydrops and Meniere’s disease. The results emphasize the superior role of transtympanic ECoG over extratympanic ECoG as a valuable component in the confirmation of Meniere’s disease or endolymphatic hydrops along with history and audiometric findings characteristic of the disease. Implications of the study promote the use of transtympanic ECoG rather than extratympanic ECoG in patients with symptoms suggestive of Meniere’s disease or endolymphatic hydrops.

鼓室注射庆大霉素治疗顽固性梅尼埃病

目前利用庆大霉素的耳毒性治疗梅尼埃病眩晕，得到越来越多耳科医师的关注。我科自2005年来对23例反复发作的顽固性梅尼埃病眩晕患者采用鼓室注射庆大霉素治疗，现报道如下。

美尼埃病的非手术治疗

为了提高临床对Meniere's病诊断、治疗的认识,提高对此类患者的治疗效果,查阅并总结了近年来国内外治疗Meniere's病患者的各种方法及经验。

梅尼埃病的综合治疗

梅尼埃病是一种特发性的内耳疾病，典型的临床症状包括反复发作的眩晕、波动性听力卞降、耳鸣及耳胀满感等，其基本病理改变为膜迷路积水。梅尼埃病的综合治疗包括调整生活方式、口服药物、压力治疗、鼓室内给药、手术治疗以及前庭康复。

梅尼埃病研究新动态

梅尼埃病（Meniere disease，MD）是一种特发的内耳病，主要病理特征是膜迷路积水。关于其发病因素有很多学说。本文就激素水平变化、自身免疫、遗传因素方面的最新研究做一综述。

经鼓室钆注射内耳造影技术原理及应用

经鼓室钆注射内耳造影技术为近年来耳科学新发展的影像技术。由于成像上的优势，经鼓室钆注射内耳造影技术可以清晰区分迷路中内、外淋巴液，被广泛应用于内耳疾病的影像学诊断、治疗评估以及发病机制的研究。本文针对这一新兴发展的技术原理及临床、科研上的应用进行综述。

梅尼埃病病因学研究进展

梅尼埃病的病因至今尚无定论,近年来人们在梅尼埃病的病因学方面有了更深入的研究。本文就影像学、病理生理、病毒感染、免疫等方面的最新研究进展进行了综述。

梅尼埃病诊断研究进展

梅尼埃病是一种原因不明的 ,以膜迷路积水为基本病理特征的内耳疾病 ,膜迷路积水如何产生原因不明。梅尼埃病缺少病因诊断给医生和患者带来很大的困惑。为了正确地诊断梅尼埃病 ,必须综合应用电生理、影像学和免疫学检查 。

梅尼埃病听觉和前庭功能损伤的评价方法

梅尼埃病的诊断主要是根据典型的临床表现和听力学检测结果，但缺乏系统的听觉和前庭功能的评价和分析，无法为鉴别诊断、临床分期、治疗选择及疗效观察等方面提供客观依据。随着梅尼埃病的听觉和前庭功能评价方法研究报道的增多，出现了一些客观性强、灵敏度和特异度较高的诊断方法，但由于入组标准和所定的指标不同，各种评价方法的参考价值也不统一。本文就梅尼埃病的听觉一前庭功能的评价方法和意义做一综述。

Meniett低压脉冲发生器梅尼埃病微创治疗的新方法

梅尼埃病(Meniere’s disease,MD)的基本病理改变为膜迷路积水。由于其病因迄今不明、病程发展多变,给患者带来了严重的功能障碍,同时也影响了临床治疗的疗效评价。目前梅尼埃病的治疗主要集中在对眩晕发作和听力损失的控制上,本文对梅尼埃病微创治疗的新方法Meniett低压脉冲发生器及其相关问题进行综述。