Combined Treatment of Intratympanic and Systemic Corticosteroids in Patients with Sudden Sensorineural Hearing Loss

Research Article

Austin J Otolaryngol. 2016; 3(1): 1068.

Combined Treatment of Intratympanic and Systemic Corticosteroids in Patients with Sudden Sensorineural Hearing Loss

Senna CG, Lacerda NSO, Silva VAR, Castilho AM and Guimarães AC*

Department of Otorhinolaryngology, Head & Neck Surgery, Hospital of the Faculty of Medical Sciences, State University of Campinas, São Paulo, Brazilss

*Corresponding author: Alexandre Caixeta Guimarães, Department of Otolaryngology Head and Neck, Faculty of Medical Sciences, Hospital of the Clinics, University of Campinas, Campinas, Brazil

Received: December 22, 2015; Accepted: February 05, 2016; Published: February 06, 2016

Abstract

Introduction: Sudden sensor neural hearing loss is an emergency of low incidence. Its treatment also presents controversial points and has been widely studied; the most recent evidence shows superiority in treatment with systemic and Intratympanic corticosteroids.

Objectives: To expose the experience of the Otolaryngology Service of Unicamp Hospital in cases of sudden sensorineural hearing loss and evaluate the therapeutic response of patients undergoing treatment with intratympanic corticosteroids and / or systemic.

Methods: A retrospective, descriptive study that evaluated all patients with sudden deafness treated at the clinic in a tertiary care hospital in the period from 2013 to 2015. Epidemiological, clinical and pre and post therapy audiometric were analyzed.

Results: The medical records of 11 patients were evaluated, most were idiopathic (n=8). 54% of patients were female and 46% male, aged between 16-54 years, mean 39 years. Of the 11 cases submitted to the application of intratympanic corticosteroids, 1 had improved pure tonal average (PTA) and SRT, 2 patients had improvement of the PTA alone and 2 only of the SRT. The remaining patients had no change in audiometric parameters and 3 showed progression of hearing loss.

Discussion: Several studies have demonstrated the benefit of corticosteroid therapy in the recovery of hearing loss in patients with sudden deafness, but adding intratympanic therapy for systemic therapy still has no proven benefits in the recovery of hearing.

Conclusion: There was improvement of the hearing in 45% of patients with sudden deafness treated with combination steroids, improvement of 20 dB PTA and 20% in SRT.

Keywords: Sudden hearing loss; Sudden deafness; Intratympanic steroid treatment; Steroids treatment

Introduction

Sudden sensorineural hearing loss (SNHL) is an ENT emergency, with a low incidence, about 4,000 new cases per year in the United States with a prevalence of 5 to 20 per 100,000 inhabitants. Early diagnosis and treatment should be established to improve the recovery of hearing of patients and quality of life [1].

SNHL is defined as a rapid onset hearing loss, which occurs within 72 hours, as described by the patient as a subjective sense of hearing loss in one or both ears. Hearing loss is sensorineural hearing with decreased =30 decibels (dB), affecting at least three consecutive frequencies, if no prior audiometry is present the opposite ear thresholds may be considered as normal standard [1].

There are various etiologies of sudden hearing loss, among which the most important are infectious (herpes zoster, meningitis, syphilis, CMV infection), diseases of the inner ear (Meniere, otosclerosis, ototoxicity, autoimmune diseases), trauma, cardiovascular disease, cancer and multiple sclerosis. However, only 10-15% of cases have an identifiable cause, and most causes turns out to be idiopathic. It is believed that these idiopathic cases there is a viral factor or vascular involved [1,2].

Several treatment strategies have been proposed for these patients, including the use of vasodilators, thrombolytic agents, antioxidants, antiviral agents, hyperbaric therapy, among others. The most widely accepted is the use of steroids administered systemically and / or intratympanic [3].

Steroids showed a superior effect compared to other substances due to their ability to prevent the reduction of cochlear blood flow, reduce the area of the groove vascular degeneration and its antioxidant effect [4]. The use of intratympanic corticosteroids generates a higher concentration in the inner ear to any another route of administration, leading to better outcomes for being an organ-specific therapy [1-9].

Therapy with steroids, either systemic or intratympanic, combined or isolated is being widely studied. Many of the studies comparing groups submitted to corticosteroid therapy versus placebo have shown better results with the combined treatment. Furthermore, it was found that the audiometric responses are related to the length of treatment and the dose [5-8].

Aim

To expose the experience of university hospital in cases of sudden sensorineural hearing loss and evaluate the therapeutic response of patients undergoing treatment with intratympanic corticosteroids and / or systemic.

Methods

This is a retrospective descriptive study, which evaluated all patients with sudden sensorineural hearing loss treated at the otolaryngology service of a tertiary hospital, from 2013 to 2015.

It was performed analysis of epidemiological data, and clinical response to treatment with systemic corticosteroids and / or intratympanic through a chart review. The following variables were analyzed: gender, age, presence of comorbidities, cause of SNHL, associated symptoms, type of therapy used, time between onset of deafness and the beginning of treatment, number of intratympanic applications and range of applications.

Patients underwent audiometry and vocal pre and post treatment. Pure tone average (500Hz, 1000Hz and 2000Hz), speech discrimination score (SDS) and speech reception threshold (SRT) were evaluated.

The medications administered during the study period were systemic prednisone with a dose of 0.5mg / kg / day to 1mg / kg / day and via intratympanic dexamethasone, at a dose ranging from 2 to 4mg. Those patients who had clinical contraindication to the use of systemic corticosteroids, received exclusively via intratympanic therapy.

Criteria for improvement: Adequate clinical response was considered for the patient with improvement of 20 dB in the frequencies of 0.5, 1 and 2 KHz or 20% improvement in discrimination, to consider the therapeutic intervention successful.

Results

Eleven cases of sudden sensorineural hearing loss were diagnosed in the period surveyed, was 54% of the patients with SNHL were female and 46% were males, the age ranged from 16-54 years, mean 39 years. The etiology, the majority was caused by the idiopathic sudden sensorineural hearing loss (n=8), the other etiologies were: autoimmune (n=1), barotrauma (n=1) and meningioma (n=1). Most of the patients had tinnitus (n=8) and dizziness (n=5) at the beginning of the frame, and right ear the most affected (n=7). Regarding comorbidities, the most frequent were: hypertension (n=3), diabetes mellitus (n=2) and Hepatitis C (n=2). As Table 1.