Modified intratympanic steroid therapy for sudden sensorineural hearing loss via tympanic tube and gelfoam as a salvage treatment

Background: Sudden sensorineural hearing loss(SSNHL) is a prevalent emergency in ear, nose, and throat practice. Previous studies have demonstrated that intratympanic steroid therapy(IST) can serve as a salvage treatment for SSNHL after the failure of systemic steroid therapy(SST).Objective: This study aimed to analyze the efficacy of modified IST involving the insertion of a tympanic tube and gelfoam as a salvage treatment for patients with SSNHL, and to explore its associated factors.Methods: Totally, 74 patients who were aged 22–81 years with SSNHL were enrolled and allocated to either the control group(n = 25) or the treatment group(n = 49) based on their treatment modalities. All patients received SST lasting for at least 7 days. Subsequently, patients in the treatment group, after SST failure, underwent IST twice a week for 2–6 weeks, while the control group did not. Efficacy was assessed by the improvement in pure tone average at the affected frequency at the beginning and end of IST.Results: Hearing improvement in all patients after IST in the treatment group was 9.71 ± 14.84 dB, with significant improvement at affected frequencies(250-8000 Hz) compared with the control group(P < 0.05). The findings indicated the duration from the onset of SSNHL to the beginning of IST as an independent factor for pure tone average improvement after treatment(P = 0.002), whereas age, duration of SST, and time of IST were not(P > 0.05).Conclusion: The modified IST was demonstrated to be a safe and effective method as a salvage treatment for SSNHL. This study explored the efficacy of a modified IST approach, incorporating the utilization of tympanic tubes and gelfoam as key components. The findings underscore the advantages of gelfoam as a strategic drug carrier placed in the round window niche. By minimizing drug loss, extending action time, and increasing perilymph concentration, gelfoam enhances the therapeutic impact of IST, contributing to improved hearing outcomes in patients with SSNHL.

Hyperbaric Oxygen Treatment Improves Hearing Level via Attenuating TLR4/NF-κB Mediated Inflammation in Sudden Sensorineural Hearing Loss Patients

Objective Hyperbaric oxygen treatment(HBOT)has demonstrated efficacy in improving hearing levels of patients with idiopathic sudden sensorineural hearing loss(ISSHL);however,the underlying mechanisms are not well understood.HBOT alleviates the inflammatory response,which is mediated by Toll-like receptor(TLR)4 and nuclear factor(NF)-κB.In this study we investigated whether HBOT attenuates inflammation in ISHHL patients via alteration of TLR4 and NF-κB expression.Methods ISHHL patients(n=120)and healthy control subjects(n=20)were enrolled in this study.Patients were randomly divided into medicine group treated with medicine only(n=60)and HBO group receiving both HBOT and medicine(n=60).Audiometric testing was performed pre-and posttreatment.TLR4,NF-кB,and TNF-αexpression in peripheral blood of ISSHL patients and healthy control subjects was assessed by ELISA before and after treatment.Results TLR4,NF-κB,and TNF-αlevels were upregulated in ISSHL patients relative to healthy control subjects;the levels were decreased following treatment and were lower in the HBO group than that in the medicine group post-treatment(P<0.05 and P<0.01).Conclusion HBOT alleviates hearing loss in ISSHL patients by suppressing the inflammatory response induced by TLR4 and NF-κB signaling.

Intratympanic dexamethasone injection for sudden sensorineural hearing loss in pregnancy

BACKGROUND As sudden sensorineural hearing loss(SSNHL)rarely occurs in pregnant women,there is a lack of knowledge and relevant research on its management.AIM To investigate the effect of intratympanic dexamethasone injection in the treatment of pregnant patients with SSNHL.METHODS A retrospective chart review was made for the period between June 2017 and August 2019 at our Department of Otorhinolaryngology-Head and Neck Surgery.Pregnant women who met the criteria for SSNHL were included and grouped based on the therapeutic modalities.The treatment group received intratympanic dexamethasone(2.5 mg)q.o.d.for a total of four times,while the control group received no medication other than bed rest and medical observations.All the patients were under close care of obstetricians.Pure-tone audiograms were performed before and after treatment.RESULTS Eleven patients who met the inclusion criteria were assigned to the treatment group(n=7)and the control group(n=4).The mean age of patients was 31.2±3.8 years;the right ear was affected in seven(63.64%)cases.Two patients(18.2%)suffered from vertigo,10(90.9%)suffered from tinnitus and 6(54.5%)suffered from aural fullness.The time from onset to clinic visit was relatively short,with a mean time of 1.3±0.9 d.All the women were within the second or third trimester;the average gestation period was 26.0±6.2 wk.The pure-tone averages at onset between the two groups were similar.After one wk of therapy,the treatment group had a curative rate of 57.1%and a significantly better hearing threshold and greater improvement compared to the control group(all P<0.05).Some patients experienced transient discomfort from intratympanic injections that disappeared after getting rest,while none had permanent complications.All patients delivered healthy full-term neonates with an average Apgar score of 9.7±0.5.CONCLUSION Intratympanic dexamethasone injections can be used as a first-line therapy in pregnant women with SSNHL.

Idiopathic sudden sensorineural hearing loss:Effectiveness of salvage treatment with low-dose intratympanic dexamethasone

Objectives:To evaluate hearing outcome of salvage treatment with intratympanic steroids(ITS)in idiopathic sudden sensorineural hearing loss(ISSNHL)refractory to initial systemic steroid(SS)therapy.Material and methods:A retrospective medical chart review was conducted on 54 consecutive patients with ISSNHL refractory to SS.Salvage treatment with a low dose intratympanic dexamethasone(4 mg/ml)was offered after one week of primary treatment.Patients were divided into two groups:25 patients accepted ITS(treatment group)and 29 patients did not undergo additional treatment(control group).A pure tone average(PTA)gain of at least 10 dB was considered hearing improvement.Results:Hearing improvement rate was higher in ITS group compared to control group(40%vs.13.8%,p=0.035).A mean PTA improvement of 8.6±9.8 dB was observed in the ITS group and,whereas the control group had an average hearing gain of 0.7±2 dB(p<0.001).Audiometric analysis revealed a significant hearing gain in ITS group at all tested frequencies compared to control group(p<0.05).Analysis of the selected variables,identified intratympanic steroid treatment as the only independent prognostic factor for hearing improvement(OR=4.2,95%CI:1.1e15.7;p=0.04).Conclusion:Intratympanic low dose dexamethasone is effective in patients with incomplete hearing recovery after primary systemic steroid treatment.

The Role of Endolymphatic Hydrops in Patients with Pantonal Idiopathic Sudden Sensorineural Hearing Loss:A Cause or Secondary Reaction

The purpose of this study was to investigate the presence of endolymphatic hydrops(EH)in both affected and unaffected ears of patients with pantonal unilateral idiopathic sudden sensorineural hearing loss(ISSNHL)using three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging(3D-FLAIR MRI)and further evaluate the significance of EH in this disorder.Twenty-seven ISSHL patients were enrolled in this study.3D-FLAIR MRI was performed 24 h after intratympanic injection of gadolinium-diethylenetriaminepentaacetic acid(Gd-DPTA).The incidences of EH in the affected ears and contralateral unaffected ears were compared and the correlations of EH with vertigo or prognosis were analyzed using the Chi-square test.The results showed that the incidence of EH was 68.0%(17/25)in the affected ears and 34.8%(8/23)in the unaffected ears.There was a statistically significant difference between affected ears and unaffected ears in regard to the incidence of EH(P<0.05).There were no significant correlations of EH with vertigo(P=1.000)or with prognosis(P=0.359)in the affected ears.In conclusion,there is EH in the inner ear of patients with pantonal ISSNHL;EH is not related to vertigo,a concomitant symptom of ISSNHL,and the prognosis of this condition.The presence of EH may be a secondary reaction following the impairment of the inner ears with pantonal ISSNHL.

Association between routine hematological parameters and sudden sensorineural hearing loss:A meta-analysis

Objective:Recent studies have shown that chronic inflammation contributes to the development of sudden sensorineural hearing loss(SSNHL).Some hematologic parameters have also been linked to the prognosis of SSNHL.However,the prognostic value of such hematological factors is not conclusive.This study explored the association of routine hematological parameters with SSNHL.Methods:A systematic literature search was conducted in PubMed,Cochrane Library,Web of Science and Embase to identify eligible studies.Standardized mean deviation(SMD)and the 95%confidence interval(CI)were retried from relevant studies for analysis.Heterogeneity,subgroup,and publication bias analyses were performed.Results:A total of 18 studies involving 1505 SSNHL patients and 1466 healthy persons were enrolled in the final analysis.The study population included 699 responders and 458 non-responders to treatment.Pooled results revealed that the neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)value in the SSNHL patient group were higher than in the healthy group(SMD=1.05,95%CI:0.86,1.24,p<0.001,SMD=0.52,95%CI:0.26,0.78,p<0.001,respectively).However,there was no significant difference in the mean platelet volumes(MPV)between the groups(SMD=0.03,95%CI:0.44,0.49,p=0.91).Notably,NLR and PLR values were evidently higher in the unrecovered group than in the recovered group(SMD=0.63,95%CI:1.02,0.23,p=0.002,SMD=0.4,95%CI:0.76,0.03,p=0.03,respectively).However,the MPV value was similar in both groups(SMD=0.35,95%CI:1.14,0.44,p=0.38).Conclusions:Our results show that NLR and PLR values can predict the onset and prognosis of SSNHL.

Sudden Sensorineural Hearing Loss after Pituitary Adenoma Resection-A Case Series with Literature Review

Objective Complications after transsphenoidal surgery for pituitary adenoma have been well documented in the literatures,but the occurrence of delved sudden sensorineural hearing loss(SNHL)after pituitary adenoma resection is extremely rare.In this study three cases who developed sudden SNHL 3 to 7 days after pituitary adenoma surgery without experiencing cerebrospinal fluid leak or meningitis were presented,and the possible causes of SNHL were discussed.Methods Three cases with sudden hearing loss after transsphenoidal surgery for pituitary adenoma were reviewed.The past medical history,onset of sudden hearing loss,accompanying symptoms such as headache,tinnitus,dizziness and aural fullness,and the post-operative MRI images,therapy and hearing results were reported.Results Three cases developed profound sudden SNHL on the 3rd to 7th post-operative day,all accompanied by prior headache,tinnitus and dizziness.One patient developed episodic vertigo,ear fullness accompanying with fluctuating hearing loss in the first post-operative month.Two patients had past medical history of arteriosclerosis and coronary heart disease or cerebral infarction.Two of three demonstrated obstructive hydrocephalus on MRI on the first post-operative day.Under treatment with prednisone orally,dexamethasone intratympanic mjection,neurotrophic and vasodilatation drugs for 3 to 8 months,hearing of all three improved partially.Obstructive hydrocephalus and ischemia might be responsible for the hearing loss.Conclusion Post-operative obstructive hydrocephalus and ischemia of labyrinthine arteries might lead to the delayed SNHL after transsphenoidal surgery for pituitary adenoma.

Otoacoustic emissions value in patients with idiopathic sudden sensorineural hearing loss

Objectives:This study aimed to determine the prognostic value of otoacoustic emissions(OAEs)in idiopathic sudden sensorineural hearing loss patients.Methods:The study included 30 subjects with unilateral idiopathic sudden sensorineural hearing loss(ISSNHL).Each patient was evaluated four times:at baseline and after one week,one month,and three months of treatment.During each visit,each patient was subjected to full audiological history,otoscopic examination,basic audiological evaluations,and transiently evoked and distortion product otoacoustic emission(TEOAEs&DEOAEs).Results:The hearing thresholds(frequency range 250e8000 Hz)and word recognition scores of patients with detectable TEOAEs and DPOAEs improved significantly,whereas no significant improvements were observed in those with no response.Conclusion:Hearing improvement is better in patients with detectable TEOAEs and DPOAEs.As a result,TEOAEs and DPOAEs are recommended as routine tests in all SSNHL patients to predict outcomes and monitor treatment as TEOAEs and DPOAEs reflect the cochlear OHCs activity.

Relationship between Sudden Sensorineural Hearing Loss and Vascular Risk Factors

Objective To explore the relationship between sudden sensorineural hearing loss(SSNHL) and vascular risk factors(including serum lipids and uric acid).Method This is a retrospective analysis of 100 cases of SSNHL seen at the Drum Tower Hospital,Nanjing Medical University,between Jan.2007 and Apr.2008。 Patient history,blood test results and imaging scans were analyzed.Levels of triglyceride(TG),cholesterols(CHO),high density lipoprotein-cholesterol(HDL-CH),low density lipoprotein-cholesterol(LDL-CH),apolipoprotein AI(ApoAI),apolipoprotein B(ApoB) and uric acid(UA) from these patients were compared with a control group of 56 patients treated for vocal cord polyps or nasal septum deviation during the same period.Patients with hypertension,diabetes,heart,brain,liver or kidney disorders are excluded from the present investigation.Results HDLCH level was higher and UA level lower in the study group than the control group(P < 0.05).HDL-CH and UA showed no significant differences among different age-groups(P > 0.05).There were no significant differences in the levels of TG,CHO,LDL-CH,ApoAI and ApoB(P > 0.05).Conclusion These data indicate that metabolic disturbances of serum lipids and/or uric acid may be potential risk factors for

Sudden sensorineural hearing loss treated with intratympanic dexamethasone injection

Objective To evaluate the effect of different protocols of intratympanic dexamethasone injection in patients with unilateral sudden sensorineural hearing loss (SSNHL) who have failed to respond to typical medical treatment (including systemic steroid treatment). Methods From January 2005 to January 2008, 71 patients who were diagnosed with unilateral SSNHL and failed typical medical treatment received intratympanic dexamethasone injection. Four injection protocols were employed: injection of 0.3 ml dexamethasone(5 mg / ml) three times a week for 3 weeks for a total dose of 13.5 mg (Group I, n=16); injection of 0.6 ml (5 mg / ml) dexamethasone three times a week for 3 weeks for a total dose of 27 mg (Group II, n=18); injection at 0.3 ml(5 mg/ml) week for 6 weeks for a total dose of 9 mg (Group III, n=18); injection at 0.3 ml (5 mg / ml) / 2 days for a total dose of 4.5 mg (Group IV n=19). Hearing recovery was assessed by pure tone audiogram. Results The total effective rate was 37.5%, 38.89%, 33.33% and 36.84% for each treatment protocol, respectively, with no statistical difference between them (P > 0.05). The results suggest that a total dose of 4.5 mg (injected once a week for 3 weeks) is the most adequate protocol, and increasing dose or injection frequency yields no additional benefits. Conclusion Intratympanic dexamethasone significantly improves the prognosis of SSNHL. Small dose at low injection frequency is sufficient. Further multicenter studies are needed to determine the standard treatment protocol.

Genetic Susceptibility Study of Chinese Sudden Sensorineural Hearing Loss Patients with Vertigo

Objective To investigate the genetic causes of sudden sensorineural hearing loss(SSNHL)patients in China.This study focused on analyzing variations of coding sequence of common genes related to deafness,revealing the molecular pathogenesis of sudden deafness from a genomics perspective,discovering molecular markers associated with the onset of deafness,and then supplying prevention to high-risk populations,classifying disease according to accurate etiology,and choosing a much more precision therapy.Methods We retrospectively analyzed the clinical characteristics of 51 patients diagnosed as SSNHL with vertigo treated in the Chinese PLA General Hospital.In this study,mutation screening of 307 nuclear genes and mitochondrial genome responsible for human or mouse deafness was performed on the 51 cases of unilateral sudden deafness patients with vertigo.Results We identified 51 cases of unilateral sudden deafness,including 2 cases of low-mid frequency hearing impairment,18 cases of mid-high frequency hearing loss,11 cases of flat-type hearing loss,and 20 cases of all frequency hearing loss.Among the 51 cases,8(15.69%)cases of GJB2 heterozygous variations,1(1.96%)case of GJB3 heterozygous variations,5(9.8%)cases of SLC26A4 heterozygous variations,2(3.92%)cases of COCH heterozygous variations,14(27.45%)cases of CDH23 heterozygous variations,14(27.45%)cases of OTOF heterozygous variations,1(1.96%)case of SLC17A8 heterozygous variations and 2(3.92%)cases of KCNE1 heterozygous variations.No mtDNA gene variations were identified.Conclusion SSNHL has some relationship with hereditary in Chinese population,but its complex genetic pathogenic mechanisms need further study.

Analysis of thyroid dysfunction in patients with sudden sensorineural hearing loss

Background:Sudden sensorineural hearing loss(SSHL)refers to the sudden occurrence of unexplained sensorineural hearing loss.The present study showed that different systemic diseases had different influence on the occurrence and hearing outcome of SSHL.Thyroid hormone is one of the important factors for the development of fetal ear and auditory function.However,the distribution of thyroid dysfunction in SSHL patients and the effect of thyroid dysfunction on the occurrence and hearing outcome of SSHL has not been studied.Methods:In this study,a retrospective analysis had been done in 676 patients with SSHL.We had described the distribution of thyroid function in patients with SSHL in detail,and by the statistical method,analyzed the relationship between the hearing outcome and thyroid dysfunction,respectively.Results:In all patients,24.41%(165/676)had abnormal thyroid function testing results.The onset age of SSHL in FT3 abnormal group(including low and high group)was younger than that in normal FT3 group.Recovery group had more patients with lower-than-normal T3 level as compared to non-recovery patients.Significant associations between T3 levels and hearing outcome were observed in the subgroup with longer time elapse between symptom onset and treatment(≥14 d).Conclusion:The incidence of thyroid dysfunction in SSHL is significantly higher than in the general population.There was obvious relationship between T3 and FT3 item of thyroid dysfunction and the onset time and hearing outcome of SSHL,which indicated that T3 or FT3 indicator may be one of the affecting factors for the SSHL.Early screening and diagnosis of thyroid dysfunction,especial T3 level,may help to evaluate the prognosis in SSHL patients.

Vestibular function of pediatric patients with sudden sensorineural hearing loss:based on vertigo symptom and vestibular function testing

Background This study aimed to evaluate the relationship between vestibular and auditory functions in pediatric patients with sudden sensorineural hearing loss(SSHL).Methods A total of 30 pediatric patients experiencing unilateral SSHL between 5.9 and 13.0 years of age were enrolled in this study.Pure tone audiometry was evaluated prior to treatment initiation and again after one month of treatment.Prior to treatment initiation,vertigo symptoms were noted;then several vestibular function tests were conducted including caloric testing,ocular vestibular evoked myogenic potentials(o-VEMPs)and cervical vestibular evoked myogenic potentials(c-VEMPs).Associations between pre and post-treatment vestibular function and hearing threshold levels were analyzed.Results Initial hearing thresholds of children with vertigo were higher than thresholds of children without vertigo(92 dB vs 79 dB,F=0.033),while initial hearing thresholds of children with abnormal caloric test findings were higher than thresholds of children with normal caloric test findings(93 dB vs 67 dB.P=0.014).Cutoff values of hearing thresholds for those with vertigo symptoms and abnormal vestibular test results were 86.000-and 89.583-dB HL.respectively.Regarding prognosis,children with vertigo exhibited lower recovery rates than children without vertigo(33%vs 75%,P=0.025);recovery rates of children with abnormal caloric test results were lower than the overall recovery rate(25%vs 73%,respectively,P=0.039).Conclusion Assessments of vertigo symptoms and vestibular function are useful tools in predicting pediatric SwSHL patient disease severity and prognosis.

Intratympanic vs systemic use of steroids as first-line treatment for sudden hearing loss:A meta-analysis of randomized,controlled trials

Background Sudden sensorineural hearing loss(SSNHL)is a common disease in otology,and steroids play an important role in its treatment.Steroids can be administered systemically or locally,and the efficacies of different administration routes remain controversial.Methods We searched the Cochrane,EMBASE,PubMed,Web of Science,CNKI,Wanfang and Weipu databases for randomized controlled trials(RCTs)on glucocorticoid treatments for SSNHL to compare the efficacy of topical and systemic steroid administration.The Review Manager 5.4 software was used for synthesis of data:the rate of reported hearing improvement and change in pure-tone audiometry(PTA).Results In all the included studies,when intratympanic administration was compared to systemic therapies,the risk difference(RD)using reported hearing improvement as an outcome measure was 0.08(95%CI:0.01–0.14,I2=45%).Using PTA changes as an outcome measure in 4 studies,the mean difference(MD)was 10.43 dB(95%CI:3.68–17.18,I2=81%).Hearing improvement RD was also compared among different types of steroid,recovery criteria,follow-up times and diagnostic criteria,and showed no significant differences exception for recovery criteria(>10 dB)(RD-0.06,95%CI:0.14-0.2,I2=0%).Conclusion As the initial treatment for SSNHL,topical steroids seem to be superior to systemic steroid administration,especially in patients with contraindications to systemic steroids usage.However,further verification based on high-quality research is needed.

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.

Controlled release of dexamethasone from fibrin sealant for intratympanic administration in inner ear therapy

The aim of the present work was to show the sustainability of fibrin sealant in releasing dexamethasone and adjust the protocol for clinical application of the novel method in the treatment of Meniere’s disease (MD) and sudden sensorineural hearing loss (SSHL).Gelation occurred shortly after mixing dexamethasone-containing fibrinogen with thrombin.Dexamethasone was constantly released for at least 16 d at a stable level after 7d in protocol 1 (low-dose),while it was robustly released within 4 d and slowed afterward until 10 d in protocol 2(high-dose).There were significant differences among the time points in Protocol 2 (p<0.01,ANOVA),and the exponential model with the formula y=15.299*e~(-0.483*t) fits the association.The estimated concentration of dexamethasone released on 7 d in protocol 2 was slightly lower than that observed in protocol 1.The fibrin sealant is capable of constantly releasing dexamethasone with adjustable dynamics.Targeted and minimally invasive administration of the material can be achieved in the clinic by sequential injections of the fluids using a soft-tipped catheter.

Mechanism of aseptic inflammation upon the inner ear injury

Many factors can cause inner ear injury,such as noise exposure,chemicals,viral infection,and radiation.The main pathological manifestations of inner ear injury are local hypoxia-ischemia,micro-trauma,and an increased level of reactive oxygen species and inflammatory mediators.The contribution of the inflammatory response to the mediation of cochlear and vestibular pathologies has received increasing attention in recent years.Aseptic inflammation can devastate audition and balance,which can lead to many typical clinical inner ear diseases.In this review,we will discuss the most pertinent and recent research on inflammatory mechanisms in inner ear injury.We will also discuss the pathophysiology of some common and significant ear diseases,such as sudden sensorineural hearing loss,age-related hearing loss,noise-induced hearing loss,and Meniere’s disease.