Intratympanic steroids for sudden sensorineural hearing loss a systematic review

People who experience a sudden hearing loss (SSNHL) are often treated with systemic steroids, which are taken orally. Studies however show that people with sudden sensorineural hearing loss (SSNHL) who do not respond to this treatment can benefit from intratympanic steroid injections. Studies carried out at universities in USA and Thailand show intratympanic steroid injections to be very effective and that the treatment does not have any side-effects.

Dr. David Haynes from Vanderbilt University Medical Center, Nashville, USA, carried out the study of 40 people who had experienced sudden sensorineural hearing loss (SSNHL). Overall, 40% showed some kind of improvement when treated with intratympanic steroid injections.

The injections are performed with the patient lying down and using the office microscope. The ear is first cleaned of wax. A small area of the eardrum is numbed with a drop of medication. A small needle and syringe are then used and the needle is passed through the eardrum at the site that is numbed so that the tip is in the ear, near the round window. This is a membrane where drugs are absorbed in to the cochlea. The fluid is injected in to the middle ear and the patient stays lying down for 20-30 minutes during which he does not swallow or sniff. The drug sits against the round window and is absorbed in to the inner ear. The patient then sits up slowly and leaves the office. Patients should not drive for a few hours after this procedure. Water is kept out of the ear until it is confirmed that the tiny hole has healed.

A total of 16 patients (%) had hearing loss greater than 90 dB with an improvement rate of %; a total of 29 patients (%) had hearing loss of 90 dB or less and greater than to 50 dB with improvement rate of %; a total of 10 patients (%) had hearing loss less than 50 dB and greater than 30 dB with an improvement rate of % (Figure 3 ). Patients with severe losses greater than 90 dB had a poorer recovery (%) compared with losses less than 90 dB (%) ( 𝑃 = 0 . 0 6 Fisher’s test).

In some instances, your specialist may recommend that you undergo an injection of gentamicin into the middle ear instead of a steroid. Gentamicin is an antibiotic which is known to have mildly toxic effects on both the balance and hearing parts of the ear, although its toxic effects on the vestibular system are very much more potent than on the hearing. Despite this, there is an increased chance of a hearing loss occurring with intratympanic gentamicin injections. For this reason, they are usually reserved for patients with a pre-existing severe hearing loss at the time the vertigo is diagnosed.

Intratympanic steroids for sudden sensorineural hearing loss a systematic review

intratympanic steroids for sudden sensorineural hearing loss a systematic review

In some instances, your specialist may recommend that you undergo an injection of gentamicin into the middle ear instead of a steroid. Gentamicin is an antibiotic which is known to have mildly toxic effects on both the balance and hearing parts of the ear, although its toxic effects on the vestibular system are very much more potent than on the hearing. Despite this, there is an increased chance of a hearing loss occurring with intratympanic gentamicin injections. For this reason, they are usually reserved for patients with a pre-existing severe hearing loss at the time the vertigo is diagnosed.

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