Hyperbaric oxygen and steroid therapy for idiopathic sudden sensorineural hearing loss

In our controlled retrospective analysis of medical records in tertiary care academic medical center, we aimed to investigate the therapeutic effects of hyperbaric oxygen (HBO) therapy combined with steroid administration for idiopathic sudden sensorineural hearing loss (ISSNHL) in comparison with that of steroid administration alone. Our subjects were 130 consecutive inpatients with ISSNHL (hearing levels ≥40 dB; time from the onset of hearing loss to the start of treatment ≤30 days). Sixty-seven patients underwent HBO plus steroid therapy (HBO group), and 63 were given steroids alone (steroid group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to that in the unaffected contralateral ear. The cure rate and hearing improvement rate were not statistically different between the two groups; however, the recovery rate was significantly higher in the HBO group than in the steroid group (59.7% vs. 39.7%; P < 0.05). With regard to patients with initial hearing levels of ≥80 dB, the hearing improvement rate was significantly higher in the HBO group than in the steroid group (51.1 ± 7.0% vs. 27.1 ± 7.8%; P < 0.05), while in patients whose initial hearing levels were <80 dB, hearing outcomes were not statistically different between the two groups. In both the HBO and steroid groups, patients with initial hearing levels of <80 dB showed a better hearing improvement rate than those with initial hearing levels of ≥80 dB. In conclusion HBO therapy shows a significant additional effect in combination with steroid therapy for ISSNHL, particularly in patients with severe hearing loss.     

高压氧辅助治疗突发性聋的预后及相关因素分析

目的分析高压氧辅助治疗突发性聋的疗效,并探讨其相关预后因素。方法回顾性总结分析2012年1月~2017年1月在南华大学附属第一院诊断并住院治疗的167例突发性聋患者的一般临床资料,根据疗效将患者分为总体有效组（84例）及无效组（83例）,采用单因素及多因素分析的方法分析患者的性别、耳侧、年龄、初诊听阈、是否伴发耳鸣及眩晕、高血压、糖尿病、入院到高压氧治疗间隔、高压氧次数及听力曲线类型等对预后的影响。结果患者总体有效率为50.3%,其中痊愈率、显效率及有效率分别为15.6%、15.6%和19.2%。多因素分析结果显示,初诊听阈、伴发眩晕及入院到高压氧治疗间隔对疗效的影响具有统计学意义（P＜0.05）。结论高压氧辅助治疗突发性聋时,20次左右的高压氧可能足以实现其治疗效果;听力损失程度轻、不伴发眩晕、早期行高压氧治疗的突聋患者预后较好。     

Idiopathic sudden sensorineural hearing loss: Effectiveness of salvage treatment with low-dose intratympanic dexamethasone

Objectives:To evaluate hearing outcome of salvage treatment with intratympanic steroids(ITS)in idiopathic sudden sensorineural hearing loss(ISSNHL)refractory to initial systemic steroid(SS)therapy.Material and methods:A retrospective medical chart review was conducted on 54 consecutive patients with ISSNHL refractory to SS.Salvage treatment with a low dose intratympanic dexamethasone(4 mg/ml)was offered after one week of primary treatment.Patients were divided into two groups:25 patients accepted ITS(treatment group)and 29 patients did not undergo additional treatment(control group).A pure tone average(PTA)gain of at least 10 dB was considered hearing improvement.Results:Hearing improvement rate was higher in ITS group compared to control group(40%vs.13.8%,p=0.035).A mean PTA improvement of 8.6±9.8 dB was observed in the ITS group and,whereas the control group had an average hearing gain of 0.7±2 dB(p<0.001).Audiometric analysis revealed a significant hearing gain in ITS group at all tested frequencies compared to control group(p<0.05).Analysis of the selected variables,identified intratympanic steroid treatment as the only independent prognostic factor for hearing improvement(OR=4.2,95%CI:1.1e15.7;p=0.04).Conclusion:Intratympanic low dose dexamethasone is effective in patients with incomplete hearing recovery after primary systemic steroid treatment.     

Prostaglandin E1 versus steroid in combination with hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss

OBJECTIVE: We conducted a controlled retrospective analysis of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) in order to investigate the effect of prostaglandin E1 (PGE1) plus hyperbaric oxygen (HBO) therapy in comparison with that of steroid plus HBO therapy. METHODS: One hundred and ninety-six consecutive patients with ISSNHL (hearing levels > or ==40dB; time from the onset of hearing loss to the start of treatment < or ==30 days) were enrolled. Ninety-five patients underwent PGE1 plus HBO therapy (PG group) and 101 underwent steroid administration plus HBO therapy (steroid group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to the unaffected contralateral ear. RESULTS: The hearing levels after treatment were 52.2+/-3.0 and 47.5+/-2.8dB, the hearing gains were 31.3+/-2.2 and 27.2+/-2.3dB, the cure rates were 28.4% and 28.7%, the recovery rates were 54.7% and 53.5%, and the hearing improvement rates were 48.4+/-5.1% and 53.9+/-4.2% in the PG and steroid groups, respectively. There were no significant differences between the two groups. CONCLUSION: We concluded that PGE1 and a steroid are equally effective in the treatment of ISSNHL when used together with HBO therapy. PGE1 plus HBO therapy can be one of the potential alternative treatments for ISSNHL, particularly in steroid-intolerant patients such as those with severe diabetes mellitus, an active peptic ulcer, or viral hepatitis.     

Intratympanic steroids in severe to profound sudden sensorineural hearing loss as salvage treatment

Objectives

Intratympanic steroids are being increasingly used in the treatment of sudden sensorineural hearing loss (SSNHL) after the failure of systemic therapy. This study evaluated the efficacy of administering intratympanic dexamethasone (ITD) as a salvage treatment for severe to profound SSNHL.

Methods

We reviewed the medical records of patients who presented with severe to profound SSNHL between January 2007 and December 2009. ITD was given about 14 days after the initial systemic treatment. Successful recovery was defined as complete or partial recovery using Sigel''s criteria. We compared the results of treatment between the severe SSNHL (S-SSNHL) and profound SSNHL (P-SSNHL) groups.

Results

All the patients in the S-SSNHL group showed significant improvement, as compared to the P-SSNHL group (P=0.017). The recovery rate after the initial systemic treatment was 36% (9/25) in the S-SSNHL group and 18.1% (4/22) in the P-SSNHL group (P=0.207). In comparison, the recovery rate of ITD as a salvage treatment was 37.5% (6/16) in the S-SSNHL group and 5.5% (1/18) in the P-SSNHL group (P=0.03).

Conclusion

Our comparative study dose not support the efficacy of ITD as salvage treatment for patients with P-SSNHL as compared with that for S-SSNHL. We recommend that patients with P-SSNHL be informed about the low efficacy of ITD as a salvage treatment.     

经咽鼓管鼓室途径注射地塞米松治疗突发性聋

目的 观察经咽鼓管鼓室注入地塞米松（简称PTIDI）治疗突发性聋（突聋）的疗效。方法 对18例常规方法治疗无效的突聋患者采用经咽鼓管鼓室径路注入地塞米松，首次剂量为5mg，此后，每天重复注药1次，每次5mg，共7次，总剂量35mg，用药期间密切观察记录听力改变，耳鸣和眩晕等情况。结果 18例患者于治疗完成后两周复查纯音测听。痊愈1例；显效5例，0．25-4kHz听阈平均提高50．2dB；有效1例，平均提高19dB；无效11例；有效率为38．9％（7／18）。结论 PTIDI治疗突聋疗效好，操作方便，避免全身用药可能产生的不良反应，为常规方法治疗无效的突聋患者提供了再次治疗的机会。     

鼓室灌注地塞米松治疗难治性突发性感音神经性聋临床分析

目的观察和比较鼓膜穿刺、鼓膜置管和圆窗置管微泵灌注地塞米松3种方法治疗难治性突发性感音神经性聋的疗效。方法55例常规方法治疗无效的突聋患者作为研究对象,其中圆窗置管微泵灌注用药治疗21例(置管组),每次2.5mg/0.5ml,维持1小时,每天两次,连续给药7天,总剂量35mg;鼓膜穿刺注药23例(穿刺组),首次剂量为2.5mg,此后,每2天重复注药1次(每次2.5mg),共4次,总剂量10mg;鼓膜切开置管滴药11例(滴药组),首次剂量为0.5%地塞米松0.5ml,经通气管滴入鼓室,每天重复滴药2次(每次2.5mg),共7天,总剂量32.5mg。同期常规方法治疗无效的32例突聋患者,且拒绝鼓室用药者随访作为对照(对照组),比较各组听力恢复及并发症情况。4组治疗前听力无显著差异(P>0.05)。结果治疗完成后1月纯音测听检查:置管组、穿刺组和滴药组平均PTA分别提高9dB、8.6dB和1.7dB,前2组明显高于对照组1.4dB(P<0.05),置管组8例(38.1%)听力改善约15～56dB,无效13例;穿刺组8例(34.8%)听力改善约16～54dB,无效15例;滴药组1例(9.1%)听力改善约26dB,无效10例;对照组3例(9.4%)听力改善约15～36dB,无效29例。结论鼓室灌注地塞米松治疗难治性突聋方法安全有效,为用常规方法治疗无效的突聋患者,提供了再次治疗的机会。     

鼓室置管灌注甲泼尼龙治疗难治性突发性聋的听力疗效再分析

目的 探讨经耳道鼓室置管灌注甲泼尼龙治疗难治性突发性聋(sudden sensorineural hearing loss,SSNHL)的安全性和有效性.方法 对常规治疗至少一个疗程(10天)无效的SSNHL,根据病人的意愿分成灌注组和对照组分别继续治疗10天.灌注组给予鼓室置管灌注甲泼尼龙+常规治疗,对照组继续常规治疗,比较治疗结束后3个月时两组的听力改善结果.结果 灌注组26例和对照组23例,两组的有效率分别是50.0%和21.7%,继续治疗前后PTA改善分别是16.7 dB和9.2 dB,两组比较灌注组的有效率高于对照组(P=0.041); 若仅将发病至继续治疗的时间间隔≤60天的病例纳入分析,则灌注组为21例,对照组仍为23例,有效率分别是61.9%和21.7%,PTA改善分别为20.2 dB和9.2 dB,灌注组均优于对照组(P_(有效率)=0.007,P_(PTA 改善)=0.011);鼓室灌注前后低频区(0.25 kHz,0.5 kHz)、中频区(1 kHz、2 kHz)和高频区(4 kHz、8 kHz)的听阈分别改善19.8 dB、16.0 dB和13.4 dB,低频区听力改善大于高频区(P=0.046).结论 鼓室置管灌注甲泼尼龙联合常规治疗用于难治性SSNHL是安全的、有效的,疗效优于继续常规治疗,且低频区的听力改善优于高频区,发病后宜尽早采用.     

性别、年龄和听力损害程度与突发性聋患者耳鸣症状相关性分析

目的 分析突发性聋患者耳鸣症状与其性别、年龄和听力损害程度等因素的相关性.方法 采用列联表x^2检验和Logistic回归分析方法,对242例住院治疗的突发性聋病例进行统计分析,探讨影响耳鸣症状的相关因素.结果 不同性别间耳鸣发生率差异不明显.Logistic回归分析表明,不同年龄患者的耳鸣发生差异P=0.024,优势比^↑OR=0.956（95%置信区间为0.919-0.994）,上限、下限均小于1,而不同听力损害水平的耳鸣发生差异x^2=6.060,P=0.109.本组患者耳鸣发生率为93.80%.结论 突发性聋患者听力损害程度和性别对耳鸣的发生率无明显影响.随着年龄的增长,患者的耳鸣发生率下降.     

The effect of intratympanic steroid injection frequency in idiopathic sudden sensorineural hearing loss

Purpose

To evaluate the effect of intratympanic steroid injection frequency on hearing outcomes for patients with idiopathic sudden sensorineural hearing loss.

Sudden sensorineural hearing loss treated with intratympanic dexamethasone injection

Objective To evaluate the effect of different protocols of intratympanic dexamethasone injection in patients with unilateral sudden sensorineural hearing loss (SSNHL) who have failed to respond to typical medical treatment (including systemic steroid treatment). Methods From January 2005 to January 2008, 71 patients who were diagnosed with unilateral SSNHL and failed typical medical treatment received intratympanic dexamethasone injection. Four injection protocols were employed: injection of 0.3 ml dexamethasone(5 mg/ml) three times a week for 3 weeks for a total dose of 13.5 mg (Group Ⅰ, n=16); injection of 0.6 ml (5 mg/mi) dexamethasone three times a week for 3 weeks for a total dose of 27 mg (Group Ⅱ, n=18); injection at 0.3 ml(5 mg/ml) week for 6 weeks for a total dose of 9 mg (Group Ⅲ, n=18); injection at 0.3 ml (5 mg/ml)/2 days for a total dose of 4.5 mg (Group IV n=19). Hearing recovery was assessed by pure tone audiogram. Results The total effective rate was 37.5%,38.89%, 33.33% and 36.84% for each treatment protocol, respectively, with no statistical difference between them (P>0.05). The results suggest that a total dose of 4.5 mg (injected once a week for 3 weeks) is the most adequate protocol, and increasing dose or injection frequency yields no additional benefits. Conclusion Intratympanic dexamethasone significantly improves the prognosis of SSNHL. Small dose at low injection frequency is sufficient.Further malticenter studies are needed to determine the standard treatment protocol.     

Intratympanic dexamethasone as initial therapy for idiopathic sudden sensorineural hearing loss: Clinical evaluation and laboratory investigation

Objective

To evaluate the effect of intratympanic dexamethasone (ITD) as initial therapy for idiopathic sudden sensorineural hearing loss (ISSHL) as well as to determine the concentration-dependent time course distribution of dexamethasone in the inner ear.

Methods

Sixty-six patients with profound ISSHL were included. Twenty-two were treated with ITD and the rest as control. Audiograms were performed before the treatment and one month afterwards. In the animal study, dexamethasone of different concentrations (5, 10 and 20 mg/ml) was injected into the tympanums of three groups of SD rats (Groups A, B and C), their inner ears dissected free at various postinjection survival intervals. Immunofluorescence was applied to detect the locations of dexamethasone.

Results

The overall rate of good prognosis was 77.27% in ITD group, which was not significantly different from 81.82% in the control group. In the animal study, the higher local concentration and longer lasting period was found in Groups B and C.

Conclusions

ITD at 5 mg/ml did not add effect to systemic steroids in improving hearing outcomes in patients with ISSHL. An increase in dexamethasone concentration led to large variations in pharmacokinetics in animal study, showing potential value in optimizing the drug delivery protocols and improving the therapeutic results.     

Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss

Introduction

Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL.

Chikungunya virus induced sudden sensorineural hearing loss

The aim of this study is to demonstrate the association of Chikungunya virus and sudden sensorineural hearing loss. In the case report described we had a case which developed sudden unilateral sensorineural hearing loss following chikungunya fever. A 15-year-old female presented to us with the complains of unilateral sudden onset of hearing loss following an episode of fever, arthralgia and rashes 1 month ago. At the time of these symptoms there were many cases of chikungunya fever in the city, three being in her locality. Clinically Chikungunya fever was suspected and a positive serological test further confirmed our diagnosis. The hearing loss could thus be attributed to Chikungunya virus. Viruses have always been implicated in causing sudden sensorineural hearing loss but Chikungunya virus as a cause has not been documented earlier making this case report a unique one.     

Frequency-specific efficacy of intratympanic steroid on idiopathic sudden sensorineural hearing loss

Abstract

Background: Hearing recovery would be different in each sound frequency in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

Aims/objectives: To analyze frequency-specific efficacy of intratympanic steroid on ISSNHL.

Materials and methods: Of a total of 381 patients with ISSNHL (hearing threshold ≥40?dB; ≤30?days until treatment), 174 patients (174 ears) received systemic steroid plus hyperbaric oxygen therapy (HBO group), and 207 patients (208 ears) received systemic plus intratympanic steroid (IT group). Hearing thresholds at 125–8000?Hz were measured at every octave before and after treatment.

Results: % of patients with hearing gains ≥10?dB in the IT group was significantly higher for 500?Hz and the average of 5 mid-frequencies, tended to be higher for 1000?Hz, but was significantly lower for 8000?Hz, compared to the HBO group. Multiple regression analysis showed that hearing recovery was negatively correlated with patients’ age for 125/2000/4000/8000?Hz and with days from onset to treatment for all frequencies, and also revealed better hearing recovery at 500/1000?Hz in the IT group than in the HBO group.

Conclusions: Intratympanic steroid is more effective than hyperbaric oxygen to yield better hearing outcomes at mid-frequencies and would be advantageous to restore sound/speech perception.

Significance: Superiority of intratympanic steroid over hyperbaric oxygen for treating ISSNHL was verified.     

强的松龙联合鼓室注射地塞米松治疗双耳突发性感音神经性聋临床疗效

目的本研究旨在分析注射强的松龙同时鼓室内注射地塞米松治疗双侧突发性感音神经性聋(SSNHL)的临床疗效。方法回顾性分析2007年3月至2020年3月就诊于我院同期治疗的双侧SSNHL病例。早期(2007年3月至2012年2月),这些病例仅用静脉注射泼尼松龙治疗,并分为A组。晚期(2012年2月至2020年3月),采用静脉强的松龙治疗联合鼓室内注射地塞米松治疗双侧SSNHL,这些患者被纳入B组。比较了A组和B组两种治疗方式的有效率。结果A组痊愈3耳,有效4耳,有效率为17.5%(7/40耳)。相比之下,B组痊愈6只,有效10只,有效率为36.4%(16/44只)。两组有效率有显著性差异。结论静脉注射强的松龙同时鼓室内注射地塞米松治疗双侧SSNHL是较好选择。     

Efficacy of intratympanic corticosteroid,intravenous batroxobin and combined treatment for sudden sensorineural hearing loss with type-2 diabetes

Background: Intratympanic corticosteroid (IC), intravenous batroxobin (IB) as the treatment for sudden sensorineural hearing loss (SSNHL) has been reported. However, the data on combination therapy (CT) was scarce.

Objective: The aim of this retrospective study was to compare the efficacy of IC, IB, and CT in the treatment of SSNHL with diabetes.

Material and Methods: A total of 212 SSNHL patients with diabetes, who were initially treated within 14 days of onset of disease, were divided into three groups by treatment modality. The hearing recovery was evaluated by the results of pure-tone test after completion of treatment. The prognostic factors, including age, severity of initial hearing loss, duration to onset of treatment, and audiometric curve type, were further compared.

Results: There was a significant difference in hearing recovery by the treatment (p?<?.05). Recovery rates in the CT group were significantly higher in patients with early treatment than with delayed treatment (p?=?.021). However, duration and recovery rate was not significantly correlated in IC and IB group (p?>?.05). In patients recieving early treatment, the recovery rate in CT group was significantly higher than that in IC (p?=?.013) and IB group (p?=?.029). Regardless of treatment, the recovery rates were higher in patients with flat and ascending audiograms (p?<?.05).

Conclusions and Significance: Patients receiving combined therapy, especially in the early stage of SSNHL, could achieve significantly superior recovery in the treatment of SSNHL with diabetes, compared with those using IC or IB alone.     

巴曲酶治疗突发性聋的临床分析

目的评估巴曲酶治疗突发性聋的效果。方法180例病因不明的突发性聋患者分为3组,分别为丹参 激素组(对照组),丹参 激素 巴曲酶组,丹参 巴曲酶组(激素治疗禁忌)开展平行对照研究。在药物治疗的同时进行高压氧治疗。结果除去不良反应、治疗依从性差等病例,将剩下的164例进行最终统计,分别为巴曲酶 激素组 丹参58例,巴曲酶 丹参组53例,丹参 激素组53例。结果显示,初始听力表现为下坡型、平坦型、极重度型和全聋型的患者,治疗方式对前三种听力曲线患者预后的影响差异无显著性,而全聋组的病例巴曲酶治疗的两组与激素组之间疗效差异有显著性(巴曲酶 丹参 激素组、巴曲酶 丹参组显效率分别为75%、62.5%,丹参 激素组为28.6%,P<0.005);而巴曲酶治疗的两组之间疗效无显著性差异(P>0.05)。结论全聋型的突发性聋治疗中早期进行巴曲酶降纤治疗,可能会获得较为满意的疗效。