Sains Malaysiana 47(11)(2018): 2777–2782

http://dx.doi.org/10.17576/jsm-2018-4711-20

 

Intratympanic Methylprednisolone Injection in Idiopathic Sudden Sensorineural Hearing Loss after Failure of Systemic Corticosteroid Therapy

(Suntikan Metilprednisolon Intratimpanum dalam Idiopati Kurang Pendengaran Sensorineuron Mengejut selepas Kegagalan Terapi Kortikosteroid Sistemik)

 

HO HON LIAN1,3, RUSZYMAH BINTI IDRUS2, LOKMAN BIN SAIM1 & AMINUDDIN BIN SAIM1,3*

 

1KPJ Healthcare University College, Lot PT 17010, Persiaran Seriemas, Kota Seriemas, 71800 Nilai, Negeri Sembilan Darul Khusus, Malaysia

 

2Department of Physiology, UKM Medical Faculty, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Federal Territory, Malaysia

 

3Department of Otorhinolaryngology Head and Neck Surgery, KPJ Ampang Puteri Specialist Hospital, Jalan Mamanda 9, Taman Ahmad Razali, Ampang Jaya, 68000 Ampang, Selangor Darul Ehsan, Malaysia

 

Received: 28 March 2018/Accepted: 30 July 2018

 

ABSTRACT

Idiopathic sudden sensorineural hearing loss (ISSNHL) is considered to be an otological emergency. The intratympanic (IT) steroid injection technique is introduced to decrease the side effects of systemic steroids and assumed to deliver a higher concentration of corticosteroids into the affected cochlea. The objective of the current study was to evaluate the hearing outcomes of high dose IT methylprednisolone among ISSNHL patients after failure of systemic corticosteroid therapy (SCT). Hearing outcomes of SCT were evaluated over a 15 months period. Upon failure of SCT, the treatment was continued with higher dose IT steroid (methylprednisolone 62.5 mg/mL). Pre-treatment and post-treatment audiometric evaluations were analysed using pure tone audiogram (PTA). There were 36 patients diagnosed with ISSNHL included in the study. After two weeks of SCT, eighteen (56.3%) patients had hearing improvement of more than 10 dB. Another fourteen (43.7%) patients had no hearing improvement (less than 10 dB). Following that, twelve patients were recruited for weekly IT methylprednisolone for three weeks. During the one month follow up after completion of IT therapy, six patients (50%) showed more than 10 dB improvement in the PTA with a mean of 19.37 dB (p<0.05). Out of the six, two patients had more than 20 dB hearing improvement. Almost all patients in this study had an improvement in their symptoms of tinnitus and vertigo. High dose IT methylprednisolone after failure of SCT resulted in significant improvement in the patients’ hearing outcome during one month follow up. The IT therapy not only improved the patients’ hearing but in addition reduced the symptoms of tinnitus and vertigo.

 

Keywords: Intratympanic; methylprednisolone; sudden hearing loss

 

ABSTRAK

Kehilangan pendengaran sensorineuron mengejut idiopati (ISSNHL) dianggap sebagai kecemasan otologi. Teknik suntikan steroid intratimpanum (IT) diperkenalkan untuk mengurangkan kesan sampingan steroid sistemik dan diandaikan memberi tumpuan yang lebih tinggi daripada kortikosteroid ke koklea yang terjejas. Objektif kajian adalah untuk menilai hasil pendengaran dos yang tinggi metilprednisolon IT dalam kalangan pesakit ISSNHL selepas kegagalan terapi sistemik kortikosteroid (SCT). Laporan hasil SCT telah dinilai dalam tempoh 15 bulan. Atas kegagalan SCT, rawatan diteruskan dengan dos IT steroid yang tinggi (metilprednisolon 62.5 mg/mL). Penilaian pra dan pasca rawatan audiometrik dianalisis menggunakan audiogram bernada tulen (PTA). Terdapat 36 pesakit yang didiagnosis dengan ISSNHL terlibat dalam kajian ini. Selepas dua minggu SCT, lapan belas (56.3%) pesakit mempunyai peningkatan pendengaran melebihi 10 dB. Empat belas (43.7%) pesakit lain tidak mempunyai sebarang kemajuan pendengaran (kurang daripada 10 dB). Berikutan itu, dua belas pesakit telah diambil bekerja untuk mingguan IT metilprednisolon selama tiga minggu. Pada bulan pertama susulan selepas selesai terapi IT, enam pesakit (50%) menunjukkan lebih daripada 10 dB peningkatan dalam PTA dengan min 19.37 dB (p<0.05). Daripada enam, dua pesakit mempunyai lebih daripada 20 dB penambahbaikan pendengaran. Hampir semua pesakit dalam kajian ini menunjukkan penambahbaikan dalam mereka gejala tinitus dan vertigo mereka. Dos tinggi IT metilprednisolon selepas kegagalan SCT telah mengakibatkan peningkatan yang ketara dalam keputusan pendengaran pesakit sepanjang sebulan susulan. Terapi IT bukan sahaja memperbaiki pendengaran pesakit tetapi mengurangkan gejala tinitus dan vertigo.

 

Kata kunci: Intratimpanum; metilprednisolon; kehilangan pendengaran mengejut

REFERENCES

Abdullah, A., Hazim, M.Y., Almyzan, A., Jamilah, A.G., Roslin, S., Ann, M.T., Borhan, L., Sani, A., Lokman, S. & Boo, N.Y. 2006. Newborn haring screening: Experience in a Malaysia hospital. Singapore Medical Journal 47(1): 60-64.

Alexander, T.H., Harris, J.P., Nguyen, Q.T. & Vorasubin, N. 2015. Dose effect of intratympanic dexamethasone for idiopathic sudden sensorineural hearing loss: 24 mg/mlL is superior to 10 mg/mL. Otology & Neurotology 36: 1321-1327.

Arastou, S., Tajedini, A. & Borghei, P. 2013. Combined intratympanic and systemic steroid therapy for poor-prognosis sudden sensorineural hearing loss. Iranian Journal of Otorhinolaryngology 1(25): 23-28.

Arslan, N., Oğuz, H., Demirci, M., Şafak, M.A., İslam, A., Kaytez, S.K. & Samim, E. 2011. Combined intratympanic and systemic use of steroids for idiopathic sudden sensorineural hearing loss. Otology & Neurotology 32: 393-397.

Battaglia, A., Burchette, R. & Cueva, R. 2008. Combination therapy (intratympanic dexamethasone + high-dose prednisolone taper) for the treatment of idiopathic sudden sensorineural hearing loss. Otology & Neurotology 28: 453-460.

Bennet, M., Kertesz, T. & Yeung, P. 2005. Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss and tinnitus: A systematic review of randomized controlled trials. Journal of Laryngology & Otology 119: 791-798.

Chandrasekhar, S.S. 2003. Updates on methods to treat sudden hearing loss. Operative Techniques in Otolaryngology-Head and Neck Surgery 14: 288-292.

Chau, J.K., Lin, J.R., Atashband, S., Irvine, R.A. & Westerberg, B.D. 2010. Systematic review of the evidence for the etiology of adult sudden sensorineural hearing loss. Laryngoscope 120: 1011-1021.

Choi, S.J., Lee, J.B., Lim, H.J., In, S.M., Kim, J.Y., Bae, K.H. & Choung, Y.H. 2013. Intratympanic dexamethasone injection for refractory tinnitus: Prospective placebo-controlled study. Laryngoscope 123: 2817-2822.

Cinamon, U., Bendet, E. & Kronenberg, J. 2001. Steroids, carbogen or placebo for sudden hearing loss: A prospective double-blind study. European Archives of Otorhinolaryngology 258: 477-480.

Deenadayal, D.S., Vidyasagar, D., Bommakanti, V., Goel, K. & Naeem, N. 2016a. Role of intratympanic steroids in the management of Meniere’s disease-A review of 151 cases. International Journal of Otolaryngology and Head & Neck Surgery 5: 108-113.

Deenadayal, D.S., Vidyasagar, D., Vyshanavi, B., Madisetty, N.K., Nakirikanti, R.K. & Ramesh, C. 2016b. Role of intratympanic steroids in the management of idiopathic sudden sensori neural hearing loss - our experience of 67 cases. International Journal of Otolaryngology and Head & Neck Surgery 5: 174-180.

Ferri, E., Frisina, A., Fasson, A.C., Armato, E., Spinato, G. & Amadori, M. 2012. Intratympanic steroid treatment for idiopathic sudden sensorineural hearing loss after failure of intravenous therapy. ISRN Otolaryngology 2012: 647271.

Gundogan, O., Pinar, E., Imre, A., Ozturkcan, S., Cokmez, O. & Yigiter, A.C. 2013. Therapeutic efficacy of the combination of intratympanic methylprednisolone and oral steroid for idiopathic sudden deafness. Otolaryngology Head & Neck Surgery 149: 753-758.

Ho, H.G., Lin, H.C., Shu, M.T., Yang, C.C. & Tsai, H.T. 2004. Effectiveness of intratympanic dexamethasone injection in sudden-deafness patients as salvage treatment. Laryngoscope 114: 1184-1189.

Hyun, J.S. 2016. Intratympanic steroid injection in tinnitus management. Hanyang Medical Review 36: 125-130.

Jong, D.L., Moo, K.P., Chi, K.L., Kye, H.P. & Byung, D.L. 2010. Intratympanic steroids in severe to profound sudden sensorineural hearing loss as salvage treatment. Clinical and Experimental Otorhinolaryngology 3: 122-125.

Kong, M.H., Goh, B.S., Hamidah, A. & Zarina, A. 2014. The prevelance of sensorineural hearing loss in B-thalassemia patient treated with Desferrioxime. Medical Journal Malaysia 69(1): 9-12.

Kuhn, M., Heman-Ackah, S.E., Shaikh, J.A. & Roehm, P.C. 2011. Sudden sensorineural hearing loss: A review of diagnosis, treatment, and prognosis. Trends in Amplification 15: 91-105.

Mazita, A., Abdullah, A., Awang, M.A., Liyab, B. & Lokman, S. 2008. Relation of distortion product optoacoustic emission with tinnitus. Laryngocope 118(4): 712-717.

Moon, I.S., Lee, J.D., Kim, J., Hong, S.J. & Lee, W.S. 2011. Intratympanic dexamethasone is an effective method as a salvage treatment in refractory sudden hearing loss. Otology & Neurotology 32: 1432-1436.

Mühlmeier, G., Baguley, D., Cox, T., Suckfüll, M. & Meyer, T. 2016. Characteristics and spontaneous recovery of tinnitus related to idiopathic sudden sensorineural hearing loss. Otology & Neurotology 37: 634-641.

Noell, C. & Meyerhoff, W. 2003. Tinnitus. Diagnosis and treatment of this elusive symptom. Geriatrics 58: 28-34.

Parnes, L.S., Sun, A.H. & Freeman, D.J. 1999. Corticosteroid pharmacokinetics in the inner ear fluids: An animal study followed by clinical application. Laryngoscope 109: 1-17.

Rausch, S.D., Halpin, C.F., Antonelli, P.J., Babu, S., Carey, J.P., Gantz, B.J., Goebel, J.A., Hammerschlag, P.E., Harris, J.P., Isaacson, B., Lee, D., Linstrom, C.J., Parnes, L.S., Shi, H., Slattery, W.H., Telian, S.A., Vrabec, J.T. & Reda, D.J. 2011. Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: A randomized trial. Journal of the American Medical Association 305: 2071-2079.

Raymundo, I.T., Bahmad, F.J., Barros Filho, J., Piaheiro Pinheiro, T.G. & Oliveira, C.A. 2010. Intratympanic methylprednisolone as rescue therapy in sudden sensorineural hearing loss. Brazilian Journal of Otorhinolaryngology 76(4): 499-509.

Ruszymah, B., Farah, W., Zakinah, Y., Zahari, Z., Norazlinda, Lokman, S. & Aminuddin, B.S. 2005. Congenital deafness: High prevalence of a V371 mutation in the GJB2 gene among deaf school children in Alor Setar. Medical Journal Malaysia 60(3): 269-271.

She, W., Dai, Y., Du, X., Chen, F., Ding, X. & Cui, X. 2009. Treatment of subjective tinnitus: A comparative clinical study of intratympanic steroid injection vs. oral carbamazepine. Medical Science Monitor 15: 135-139.

Spear, S.A. & Schwartz, S.R. 2011. Intratympanic steroids for sudden sensorineural hearing loss: A systematic review. Otolaryngology Head and Neck Surgery 145: 534-543.

Trowbridge, B.C. 1949. Tympanosympathetic anesthesia for tinnitus aurium and secondary otalgia. Archives of Otolaryngology 50: 200-215.

Tucci, D.L., Farmer, J.C., Kitch, R.D. & Witsell, D.L. 2002. Treatment of sudden sensorineural hearing loss with systemic steroids and valacyclovir. Otology & Neurotology 23: 301- 308.

Wan, S.I., Fei, Z., Deepak, R. & Mohammed, A. 2013. Measurement of subtle auditory deficit in tinnitus patients with normal audiometric thresholds using evoked optoacoustic emissions and threshold equalizing noise test. International Tinnitus Journal 18(1): 35-44.

Wang, M., Han, Y., Fan, Z., Zhang, D. & Wang, H. 2016. Therapeutic effect on idiopathic sudden sensorineural hearing loss with duration of onset more than 3 months. Indian Journal of Otolaryngology and Head & Neck Surgery 65: 61-65.

 

*Corresponding author; email: aminuddin_saim@yahoo.com

 

 

 

 

 

 

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