Role of Intratympanic Steroids in the Management of Idiopathic Sudden Sensori Neural Hearing Loss— Our Experience of 67 Cases

Objective: To assess the outcomes of intratympanic steroids in the management of idiopathic sudden sensorineural hearing loss. Study Design: Retrospective study. Setting: Academic tertiary care medical centre. Materials and Methods: A total of 67 patients with idiopathic sudden sensorineural hearing loss were included in our study. Pre- and post-injection audiograms were taken to assess the outcomes in improvement in hearing. Hearing outcomes were assessed with respect to duration of onset of treatment and age of the patient. Improvement in the speech discrimination score was also assessed. Results: A total of 67 patients were included in our study of which unilateral cases were 59 and bilateral cases were 8. Subjectively 35 patients reported improvement in hearing after the therapy while objectively we found 44 ears [41 patients] had improvement. The mean PTA pre ITS was 62.7 and after ITS it was 56.3. Maximum improvement was noted at 2000 Hz and 1000 Hz. Conclusion: Intratympanic steroids can be offered as a first line therapy for idiopathic sudden sensorineural hearing loss as it is minimally invasive, and can be performed as an office based procedure with no systemic side effects. No major complications have been reported in our study and results have been satisfactory.

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.

Clinical characteristics of radiation-induced optic neuropathy:A single-center retrospective study

Purpose:To observe the clinical and imaging characteristics of radiation-induced optic neuropathy(RION).Methods:We retrospectively reviewed the clinical data of 43 patients(69 eyes)who were diagnosed with RION at the Chinese PLA General Hospital from 2010 to 2021.Results:The latency from radiotherapy to onset of visual loss ranged from 1 to 132(36.33±30.48)months.Optic disc pallor and optic disc edema were found in 27.0%(10/37)and 8.1%(3/37)of the eyes,respectively,within 2 months.After treatment,the best corrected visual acuity(BCVA)was restored in 24.6%(17/69)of the eyes and the final BCVA improved in 13.0%(9/69)of the eyes.An 82.5%(33/40)of the eyes with magnetic resonance imaging(MRI)showed enhancement of the affected optic nerve,mostly(69.7%)in the intracranial segment,and 36.4%(12/33)of the eyes with expansion and T2-high signals also showed enhancement of the affected optic nerve.The superior retinal nerve fiber layer(RNFL)and the outer circle superior quadrant(OS)of the inner limiting membrane to retinal pigment epithelium(ILM-RPE)layer thinned significantly during the first month.The center of the ILM-RPE layer thickened significantly during the first two months and the inner circle temporal quadrant(IT)of the ILM-RPE layer thickened significantly from the third to sixth month.The RNFL thinned significantly after 6 months except for the temporal quadrant,and the average inner circle superior quadrant(IS)and outer circle of the ILM-RPE layer thinned significantly after 6 months.There was no significant difference between hyperbaric oxygen therapy(HBOT)and high-dose intravenous methylprednisolone(IVMP)therapy in improving BCVA recovery or final BCVA(P>0.05).Conclusions:The structural damage of the RNFL and ILM-RPE layer occurred during the first month,the RNFL showed progressive thinning during the follow-up period,while the ILM-RPE layer showed thinning during the first month,thickening from the third to sixth month,and thinning after 6 months.There was a discrete region of enhancement of the optic nerve,often with expansion and high-T2 signals on MRI.HBOT and high-dose IVMP therapy were hardly effective for treating RION in the non-acute stage.