Intratympanic steroid delivery by an indwelling catheter in refractory severe sudden sensorineural hearing loss

Diego Zanetti, Federica Di Berardino, Nader Nassif, Luca Oscar Redaelli De Zinis

Research output: Contribution to journalArticle

Abstract

Objective: Many studies over the last decade showed favorable outcomes with intratympanic (IT) steroid treatment, alone as salvage treatment or in combination with conventional systemic therapy (ST). However, in severe to profound sensorineural hearing loss resistant to ST, the optimal infusion mode, the type and concentration of the solution, the preferable drug, its total amount, and the duration and fractionation of the treatment are still debated. Aim of the study was to investigate the feasibility and the outcomes of a direct and constant IT delivery of dexamethasone (DEX) by means of a new indwelling catheter. Methods: A prospective case-control study in a tertiary referral university hospital. Ninety-nine subjects treated with ST only and 28 with additional IT DEX have been included in the study. A 4 Fr catheter inserted in a sub-annular fashion with a minimal postero-inferior tympanotomy through and endocanalar approach under local anesthesia. DEX 4. mg/ml delivered daily, up to 7 days. Daily bone and air-conducted pure tone and speech audiometry were performed with a follow-up at 1, 3, 6 months after treatment. Results: Twenty-one out of 28 patients (75%) refractory to ST gained on average 24.0. dB. ±. 20.5. dB HL after IT-DEX, compared to 35.4% (average 6.7. dB. ±. 16.6. dB HL) of those receiving only medical ST (p. <. 0.001). No significant side effects were noted. Conclusion: In severe to profound sudden deafness refractory to conventional ST, the daily perfusion of 4. mg/ml DEX through an intratympanic catheter is an easy, well accepted procedure that enables patients to receive a drug in the middle ear in a repeatable or sustained form, with minimal discomfort and a partial rescue (67.86%) and a speech recognition gain of 39%.

Original languageEnglish
Pages (from-to)227-233
JournalAuris Nasus Larynx
Volume45
Issue number2
DOIs
Publication statusPublished - 2018

Fingerprint

Sudden Hearing Loss
Indwelling Catheters
Sensorineural Hearing Loss
Steroids
Dexamethasone
Therapeutics
Catheters
Speech Audiometry
Pure-Tone Audiometry
Salvage Therapy
Middle Ear
Local Anesthesia
Tertiary Care Centers
Pharmaceutical Preparations
Case-Control Studies
Perfusion
Air
Bone and Bones

Keywords

  • Catheter
  • Dexamethasone
  • Intratympanic
  • Salvage treatment
  • Sudden sensorineural hearing loss
  • Sustained perfusion

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Intratympanic steroid delivery by an indwelling catheter in refractory severe sudden sensorineural hearing loss. / Zanetti, Diego; Di Berardino, Federica; Nassif, Nader; Redaelli De Zinis, Luca Oscar.

In: Auris Nasus Larynx, Vol. 45, No. 2, 2018, p. 227-233.

Research output: Contribution to journalArticle

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abstract = "Objective: Many studies over the last decade showed favorable outcomes with intratympanic (IT) steroid treatment, alone as salvage treatment or in combination with conventional systemic therapy (ST). However, in severe to profound sensorineural hearing loss resistant to ST, the optimal infusion mode, the type and concentration of the solution, the preferable drug, its total amount, and the duration and fractionation of the treatment are still debated. Aim of the study was to investigate the feasibility and the outcomes of a direct and constant IT delivery of dexamethasone (DEX) by means of a new indwelling catheter. Methods: A prospective case-control study in a tertiary referral university hospital. Ninety-nine subjects treated with ST only and 28 with additional IT DEX have been included in the study. A 4 Fr catheter inserted in a sub-annular fashion with a minimal postero-inferior tympanotomy through and endocanalar approach under local anesthesia. DEX 4. mg/ml delivered daily, up to 7 days. Daily bone and air-conducted pure tone and speech audiometry were performed with a follow-up at 1, 3, 6 months after treatment. Results: Twenty-one out of 28 patients (75{\%}) refractory to ST gained on average 24.0. dB. ±. 20.5. dB HL after IT-DEX, compared to 35.4{\%} (average 6.7. dB. ±. 16.6. dB HL) of those receiving only medical ST (p. <. 0.001). No significant side effects were noted. Conclusion: In severe to profound sudden deafness refractory to conventional ST, the daily perfusion of 4. mg/ml DEX through an intratympanic catheter is an easy, well accepted procedure that enables patients to receive a drug in the middle ear in a repeatable or sustained form, with minimal discomfort and a partial rescue (67.86{\%}) and a speech recognition gain of 39{\%}.",
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