Intratympanic Dexamethasone for the Treatment of Sudden Sensorineural Hearing Loss among Adult Patients: An Institutional Study
Authors/Creators
- 1. Professor, ENT Department, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India.
- 2. Audiologist & Speech Therapist, ENT Department, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
- 3. Second Year Resident, ENT Department, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
- 4. First Year Resident, ENT Department, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
- 5. Second Year Resident, ENT Department, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India.
- 6. Incharge of Pharmacovigilance, Wipro Technologies Ltd., Hinjawadi, Pune, Maharashtra, India.
Description
Background: Sudden sensorienural hearing loss (SSNHL) is an otological emergency. Steroids, in various forms still the treatment of choice. Intratympanic steroids avoid systemic side effects. Higher concentration of drug is achieved in the end organ. Topical application of steroids in low dose is therefore, preferred. Methods: Prospective study of 36 months. Total 59 patients were included in the study. Intratympanic dexamethasone were given twice a week for 4 weeks, weekly for 3 months and once in 2 weeks up to 6 months. Pure tone audiograms (PTA) were taken on the day of first presentation (pre-treatment) and 1 month, 3 month and 6 month post treatment. They were compared to know the effect of local treatment. Results: Complete recovery noticed in 36 (61%) patients, partial recovery in 15(25.4%) patients and no improvement shown by 8 (13.6%) patients. Early initiation of treatment is the key to success. No serious side effects were noticed in our study. Conclusion: Intratympanic dexamethasone is cost effective, widely available. Intratympanic dexamethasone therapy can lower the total amount of steroid administration. It reduces the systemic toxicity, duration of treatment. This is one among the best option for treatment of SSNHL patients. The dosage and duration of this medication is individual to each patient. Nanocarrier – based therapy can diffuse into inner ear allowing direct drug delivery. Targeted delivery of certain type of nanoparticles is the latest therapy of SSNHL. Direction towards less toxic nanoparticles might be the future research with respect to therapy of SSNHL.
Abstract (English)
Background: Sudden sensorienural hearing loss (SSNHL) is an otological emergency. Steroids, in various forms still the treatment of choice. Intratympanic steroids avoid systemic side effects. Higher concentration of drug is achieved in the end organ. Topical application of steroids in low dose is therefore, preferred. Methods: Prospective study of 36 months. Total 59 patients were included in the study. Intratympanic dexamethasone were given twice a week for 4 weeks, weekly for 3 months and once in 2 weeks up to 6 months. Pure tone audiograms (PTA) were taken on the day of first presentation (pre-treatment) and 1 month, 3 month and 6 month post treatment. They were compared to know the effect of local treatment. Results: Complete recovery noticed in 36 (61%) patients, partial recovery in 15(25.4%) patients and no improvement shown by 8 (13.6%) patients. Early initiation of treatment is the key to success. No serious side effects were noticed in our study. Conclusion: Intratympanic dexamethasone is cost effective, widely available. Intratympanic dexamethasone therapy can lower the total amount of steroid administration. It reduces the systemic toxicity, duration of treatment. This is one among the best option for treatment of SSNHL patients. The dosage and duration of this medication is individual to each patient. Nanocarrier – based therapy can diffuse into inner ear allowing direct drug delivery. Targeted delivery of certain type of nanoparticles is the latest therapy of SSNHL. Direction towards less toxic nanoparticles might be the future research with respect to therapy of SSNHL.
Files
IJPCR,Vol15,Issue12,Article223.pdf
Files
(357.1 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:60f0aab42e27cf83d7eef628864c15ce
|
357.1 kB | Preview Download |
Additional details
Dates
- Accepted
-
2023-11-18
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue12,Article223.pdf
- Development Status
- Active
References
- 1. Alexander Arts. H, Sensorineural Hearing Loss in Adults: Paul W. Flist, Brucelt Haughey, Valerie T Lund, John K., Viparko et al. Cummings otolaryngology Head and Neck Surgery, 6th edition, Volume 3, Saunders Elsevier, 2015; Canada. 2331-35. 2. Chen Z, Duan M, Lee H, Ruan R, Ulfendahl M. Pharmacokinetics of caroverine in the inner ear and its effects on cochlear function after systemic and local administration in Guinea pigs. Audiol Neurootol 2003; 8:49-56. 3. Chandrasekhar SS. Intratympanic dexamethasone for sudden sensorineural hearing loss: clinical and laboratory evaluation. Otol Neurotol 2001; 22: 18-23. 4. Jobe AH, Milad MA, Peppard T, Jusko WJ. Pharmacokinetics and Pharmocodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India. Clinical and Translation Science. March 2020; 13(2): 391-99. 5. Zhao H, Zhang TY, Jing JH, Fu YY, Luo JN. Prognostic factors for patients with the idiopathic sudden sensorineural hearing loss. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008; 43:660-4. 6. Gao Z, Chi FL. The clinical value of threedimensional fluid-attenuated inversion recovery magnetic resonance imaging in patients with idiopathic sudden sensorineural hearing loss: a meta-analysis. Otol Neurotol 2014; 35:1730-1735. 7. Salt AN, Plontke SK. Local inner-ear drug delivery and pharmacokinetics. Drug Discov Today 2005;10:1299-306. 8. Dogra P, Vijayshankar NP (14 September 2020). Dexamethasone Suppression Test. StatPearls (14 September 2020). 9. Drugs FDA: Dexamethasone. U.S. Food and Drug Administration (FDA). from the original on 30 November 2017. Retrieved 27 March 2022. 10. "Dexamethasone". The American Society of Health-System Pharmacists. from the original on 31 August 2017. Retrieved 29 July 2015. 11. Wilkinson IB (13 July 2017). Oxford Handbook of Clinical Medicine. OUP Oxford. p. 176. 12. Cole TJ. Glucocorticoid action and the development of selective glucocorticoid receptor ligands". Biotechnol Annu Rev. Biotechnology Annual Review. 2006; 12: 269-300. 13. Dexamethasone for Accelerating Lung Maturation in Preterm Babies". from the original on 22 December 2015. Retrieved 29 July 2015. 14. Tripathi. K. D. Corticosteroids. In: Essentials of Medical Pharmocology. 8th edition, Jaypee Brothers Medical Publishers, New Delhi. 2019; 314-15. 15. Kakehata S, Sasaki A, Oji K, Futai K, Ota S, Makinae K, et al. Comparison of intratympanic and intravenous dexamethasone treatment of sudden sensorineural hearing loss with diabetes. Otol Neurotol 2006; 27 (5): 604-8. 16. Peng Y, Xiong S, Cheng y, Qi YF, Yang Y. Clinical investigation of different routes of administration of dexamethasone on sudden deafness. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008; 22(10): 442-5. 17. D. Buckiova, S. Ranjan, T. A. Newman et al., Minimally invasive drug delivery to the cochlea through application of nanoparticles to the round window membrane, Nanomedicine, 2012; 7(9): 1339-1354, 2012. 18. I. Pyykko, J. Zou, A. Schrott-Fisher, R. Glueckert, and P. Kinnunen, An overview of nanoparticle based delivery for treatment of inner ear disorders, Sokolowski B. (eds) Auditory and Vestibular Research. Methods in Molecular Biology, Human Press, New York, NY, 2016. 19. C. Jaudoin, F. Agnely, Y. Nguyen, E. Ferrary, and A. Bochot, Nanocarriers for drug delivery to the inner ear: physicochemical key parameters, biodistribution, safety and efficacy, International Journal of Pharmaceutics, article 120038, 2021. 20. X. An and D. Zha, Development of nanoparticle drug-delivery systems for the inner ear, Nanomedicine, 2020; 15: 1981-1993. 21. K. Mader, E. Lehner, A. Liebau, and S. K. Plontke, Controlled drug release to the inner ear: concepts, materials, mechanisms, and performance, Hearing Research, 2018; 368: 49- 66. 22. J. Zou, H. Feng, M. Mannerstrom, T. Heinonen, and I. Pyykko, Toxicity of silver nanoparticle in rat ear and BALB/c 3T3 cell line,Journal of nanobiotechnology, 2014; 12(1): 1- 10. 23. J. S. Kim, T. Yoon, K. N. Yu et al., Toxicity and tissue distribution of magnetic nanoparticles in mice, Toxicological Sciences, 2006; 89 (1): 338-347. 24. S. Murugadoss, I. V. Vrcek, B. Pem et al., A strategy towards the generation of testable adverse outcome pathways for nanomaterails, ALTEX-Alternatives to animal experimentation, 2021; 38(4): 580-594.