Hipoacusia: Hipoacusia súbita, tratamiento intratimpanico con corticoides

Sudden Sensorineural Hearing Loss: Results of intratympanic steroids as salvage treatment  

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Authors

• Francesco Dispenza, MD, PhD^{a, ,} ,
• Alessandro De Stefano, MD, PhD, FAINOT^b,
• Claudio Costantino, MD^c,
• Donatella Marchese, MD^d,
• Francesco Riggio, MD, PhD^d

• ^a U.O. Otorinolaringoiatria, Azienda Sanitaria Provinciale 1 Agrigento, Ospedale “S. Giovanni di Dio”, Italia
• ^b Dipartimento di Scienze Orali e Nano-Biotecnologiche-U.O. Otorinolaringoiatria, Università degli Studi “G. d'Annunzio” Chieti-Pescara, Italia
• ^c Istituto Igiene, Università degli Studi di Palermo, Italia
• ^d Dipartimento Biomedicina e Neuroscienze Cliniche-U.O. Otorinolaringoiatria, Università degli Studi di Palermo, Italia

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Abstract

Objective

The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone to treat sudden sensorineural hearing loss as salvage therapy.

Materials and methods

A prospective study was conducted on patients affected by idiopathic sudden hearing loss who were treated before with some systemic therapy, but without recovery of the hearing 

The patients able to undergo the study, but who refused salvage treatment were considered as control group. A solution of Dexamethasone 4 mg/ml was then injected through the posterior–inferior quadrant filling completely the middle ear. 

The follow-up in the following 6 months included an audiogram every month.

Results

The number of patients treated with salvage therapy was 36. The patients who refused treatment were further 10. The salvage treatment was done with a mean delay of 24.3 days from the onset of symptoms. Mean hearing threshold after the onset of sudden hearing loss at PTA was 66.5 dB.

After the failed treatment the mean PTA was 59.6 dB. 

The mean PTA after the intratympanic steroid administration was 46.8 dB, with a mean improvement of 12.8 dB. No hearing change was noted in the 10 patients who refused salvage therapy.

The patients that assumed systemic steroid as first therapy showed a better PTA threshold after the salvage intratympanic treatment (p < 0.01). A significant difference (p < 0.05) of hearing recovery was evidenced between non-smoker patients and those with smoking habit.

Conclusions

Our data showed that a salvage treatment with intratympanic dexamethasone should be suggested to all patients who failed the first systemic treatment. The systemic steroid therapy done before the salvage treatment seems to exert a protective role for the inner ear, as shown by our series. On the contrary the smoke habit is a negative prognostic factor in the hearing recovery.

Fuente:  American Journal of Otolaryngology: