Intratympanic injection of dexamethasone after failure of intravenous prednisolone in simultaneous bilateral sudden sensorineural hearing loss☆
Introduction
Sudden sensorineural hearing loss (SSNHL) is common, with an estimated incidence of 5–20 per 100,000 each year in the USA [1]. It is usually unilateral, with idiopathic etiology in most cases [2]. 32%–65% cases with unilateral SSNHL can achieve spontaneous recovery [3,4]. Systemic steroid is the main treatment modality for SSNHL, which significantly increases the recovery rate [3]. In contrast, bilateral SSNHL is rather rare, accounting for 0.4–4.9% of all SSNHL cases [[5], [6], [7], [8]]. The prognosis of bilateral SSNHL is poor, especially simultaneous bilateral SSNHL. Xenellis J et al. [9] compared outcomes of simultaneous bilateral SSNHL and sequential bilateral SSNHL as well as unilateral SSNHL treated by intravenous prednisolone, and it was found that meaningful improvement of hearing was observed in only 27.2% cases with simultaneous bilateral SSNHL, which was significantly lower compared to 74.1% of cases with unilateral SSNHL and 71.4% of cases with sequential bilateral SSNHL. It was indicated that outcomes of simultaneous bilateral SSNHL treated by intravenous prednisolone were much poorer compared to sequential bilateral SSNHL and unilateral SSNHL.
Intratympanic steroid therapy is increasingly employed to treat idiopathic SSNHL. A higher level of intracochlear dexamethasone was noted for intratympanic infusion compared to intravenous administration [10]. Moreover, lower plasma levels were also found in intratympanic infusion group, indicating smaller possibility of systemic side effects. Intratympanic injection has been recommended for salvage after failure of systemic steroid therapy [11]. However, to our knowledge, application of intratympanic injection in simultaneous bilateral SSNHL has not been reported. In order to maximize the outcomes of simultaneous bilateral SSNHL, we employed intratympanic infiltration of dexamethasone after failure of intravenous steroid therapy to treat simultaneous bilateral SSNHL, and analyzed the outcomes.
Section snippets
Subjects
From March 2007 to March 2018, the cases of simultaneous bilateral SSNHL treated in our hospital were enrolled in the study and retrospectively analyzed. Inclusion criteria: 1. SSNHL >30 dB in 3 consecutive frequencies in standard pure tone hearing thresholds (0.5, 1, 2 and 4 kHz) within 72 h; 2. bilateral concurrent onset of hearing loss (the second ear was affected within 3 days of the first ear). Exclusion criteria: 1. acoustic neuroma; 2. large vestibular aqueduct syndrome; 3. syphilis; 4.
Baseline information
A total of 42 cases (84 ears) with simultaneous bilateral SSNHL were enrolled in the study. There were 20 cases (40 ears) in group A, and 22 cases (44 ears) in group B. The detailed information is listed in Table 1. In group A, there were 8 males and 12 females, with an average age of 52.1 ± 12.3 years. The mean interval between onset of hearing loss and treatment was 5.7 ± 3.4 days. Vertigo, aural fullness, and tinnitus were presented by 30%, 20%, and 55% cases, respectively. Regarding to
Discussion
Bilateral SSNHL is a rare entity, and its pathophysiology remains largely unknown. Bilateral SSNHL is considered as a group of symptoms associated with cochlear damage, rather than a single disease. Viral infection and cardiovascular diseases are most proposed causes of bilateral SSNHL. Yanagita and Murahashi [6] found high viral antibody titers in the patients in whom common cold and fever seemed to trigger the onset of bilateral sudden deafness, which were more commonly seen than the cases
Compliance with ethical standards
Conflict of interests: We declare that there is no conflict of interest.
Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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