Skip to main content
Log in

Early Intratympanic Methylprednisolone in Sudden SNHL: A Frequency-wise Analysis

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Sudden sensorineural hearing loss is a dire medical emergency which must be treated at the earliest to get better long term hearing results. Our study aims to determine the efficacy of intratympanic steroid (Methylprednisolone) on auditory outcomes in patients of sudden sensorineural hearing loss and study the relation between time of onset of hearing loss to start of therapy and frequency-wise recovery of hearing loss. A prospective cohort clinical study with 33 patients with sudden hearing loss of 30 dB or more were treated with the intratympanic injection of methylprednisolone and the effect of the drug was observed. In this study, 33 patients with sudden onset (unilateral or bilateral) of hearing loss were treated with intratympanic methylprednisolone. The duration at which the drug was administered and the age of the participants was taken into consideration. Main outcome measures included audiometry results at low, medium and high hearing loss frequencies. The specific frequency at which the hearing improvement took place was tabulated. It was observed that hearing improved significantly if the steroid is injected within the first 4 days of onset (p < 0.05) at all the frequencies. A gain of 15 dB or more was achieved in more than 78% patients after injecting methylprednisolone intratympanically. A statistically significant association was found between recovery rate and frequency of hearing loss with patients showing greater improvement at low hearing loss frequency in comparison to mid and high frequencies (p < 0.05). The drug efficacy does not change with the age of the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Wilson WR, Byl FM, Laird N (1980) The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double-blind clinical study. Arch Otolaryngol 106(12):772–776

    Article  CAS  PubMed  Google Scholar 

  2. Jaffe B (1973) Clinical studies in sudden deafness. Adv Otorhinolaryngol 20:221–228

    CAS  PubMed  Google Scholar 

  3. WilsonVetriR L et al (1983) Viral and epidemiological studies of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg 91:650–653

    Google Scholar 

  4. Pearlman HB, Kimura R, Fernandez C (1959) Experiments on temporary obstruction of the internal auditory artery. Laryngoscope 69:591–613

    Google Scholar 

  5. Fisch UF (1983) Management of sudden deafness. Otolaryngol Head Neck Surg 91:3–8

    Article  CAS  PubMed  Google Scholar 

  6. Goodhill V, Harris I, Brockman S et al (1973) Sudden deafness and labyrinthine window ruptures. Ann Otol Rhinol Laryngol 82:2–12

    Article  CAS  PubMed  Google Scholar 

  7. Gussen R (1981) sudden hearing loss associated with cochlear membrane rupture: two human temporal bone reports. Arch Otolaryngol 107(598–600):2

    Google Scholar 

  8. Filipo R, Covelli E, Balsamo G, Attanasio G (2010) Intratympanic prednisolone therapy for sudden sensorineural hearing loss: a new protocol. Acta Otolaryngol 130(11):1209–1213. https://doi.org/10.3109/00016481003793766

    Article  CAS  PubMed  Google Scholar 

  9. HoHG LH, Shu MT, Yang CC, Tsai HT (2004) Effectiveness of intratympanic dexamethasone injection in sudden-deafness patients as salvage treatment. Laryngoscope 114:1184–1189

    Article  Google Scholar 

  10. Slattery WH, Fisher LM, Iqbal Z, Friedman RA, Liu N (2005) Intratympanic steroid injection for treatment of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg 133:251–259

    Article  PubMed  Google Scholar 

  11. Battista RA (2005) Intratympanic dexamethasone for profound idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 132:902–905

    Article  PubMed  Google Scholar 

  12. Choung YH, Park K, Shin YR, Cho MJ (2006) Intratympanic dexamethasone injection for refractory sudden sensorineural hearing loss. Laryngoscope 116:747–752

    Article  CAS  PubMed  Google Scholar 

  13. Dallan I, Bruschini L, Nacci A, Bruschini P, Traino C, Rognini F et al (2006) Trans tympanic steroids as a salvage therapy in sudden hearing loss: preliminary results. ORL J Otorhinolaryngol Relat Spec 68:247–252

    Article  CAS  PubMed  Google Scholar 

  14. Xenellis J, Papadimitriou N, Nikolopoulos T, Maragoudakis P, Segas J, Tzagaroulakis A et al (2006) Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: a control study. Otolaryngol Head Neck Surg 134:940–945

    Article  PubMed  Google Scholar 

  15. Haynes DS, O’ Malley M, Cohen S, Watford K, Labadie RF (2007) Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy. Laryngoscope 117:3–15

    Article  CAS  PubMed  Google Scholar 

  16. Roebuck J, Chang CY (2006) Efficacy of steroid injection on idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 135:276–279

    Article  PubMed  Google Scholar 

  17. Plaza G, Herráiz C (2007) Intratympanic steroids for treatment of sudden hearing loss after failure of intravenous therapy. Otolaryngol Head Neck Surg 137:74–78

    Article  PubMed  Google Scholar 

  18. Kiliç R, Safak MA, O˘guz H, Kargin S, Demirci M, Samim E et al (2007) Intratympanic methylprednisolone for sudden sensorineural hearing loss. Otol Neurotol 28:312–316

    Article  PubMed  Google Scholar 

  19. Ahn JH, Han MW, Kim JH, Chung JW, Yoon TH (2008) Therapeutic effectiveness over time of intratympanic dexamethasone as salvage treatment of sudden deafness. Acta Otolaryngol 128:128–131

    Article  CAS  PubMed  Google Scholar 

  20. Battaglia A, Burchette R, Cueva R (2008) Combination therapy (intratympanic dexamethasone + high-dose prednisone taper) for the treatment of idiopathic sudden sensorineural hearing loss. Otol Neurotol 29:453–460

    Article  PubMed  Google Scholar 

  21. Rarey KE, Luttge WG (1989) Presence of type I and type 2/IB receptors for adreno corticosteroid hormones in the inner ear. Hear Res 41:217–221

    Article  CAS  PubMed  Google Scholar 

  22. Stockroos RJ, Albers FW, Schirm J (1998) The etiology of idiopathic sudden sensorineural hearing loss. Experimental herpes simplex virus infection of the inner ear. Am J Otol 19:447–452

    Google Scholar 

  23. Nagura M, Iwasaki S, Wu R, Mizuta K, Umemura K, Hoshino T (1999) Effects of corticosteroid, contrast medium and ATP on focal microcirculatory disorders of the cochlea. Eur J Pharmacol 366:47–53

    Article  CAS  PubMed  Google Scholar 

  24. Tabuchi K, Oikawa K, Uemaetomari I, Tsuji S, Wada T, Hara A (2003) Glucocorticoids and dehydroepiandrosterone sulfate ameliorate ischemia-induced injury of the cochlea. Hear Res 180:51–56

    Article  CAS  PubMed  Google Scholar 

  25. Lamm K, Arnold W (1998) The effect of prednisolone and non-steroidal anti-inflammatory agents on the normal and noise- damaged guinea pig inner ear. Hear Res 115:149–161

    Article  CAS  PubMed  Google Scholar 

  26. Yao X, Buhi WC, Alvarez IM, Curtis LM, Rarey KE (1995) De novo synthesis of glucocorticoid hormone regulated inner ear proteins in rats. Hear Res 86:183–188

    Article  CAS  PubMed  Google Scholar 

  27. Lin DW, Trune DR (1997) Breakdown of stria vascularis blood-labyrinth barrier in C3H/lpr autoimmune disease mice. Otolaryngol Head Neck Surg 117:1–8

    Article  Google Scholar 

  28. Trune DR, Wobig RJ, Kempton JB, Hefeneider SH (1999) Steroid treatment improves cochlear function in the MRL.MpJ-Fas (lpr) autoimmune mouse. Hear Res 137:160–166

    Article  CAS  PubMed  Google Scholar 

  29. Shirwany NA, Seidman MD, Tang W (1998) Effect of trans tympanic injection of steroids on cochlear blood flow, auditory sensitivity, and histology in the guinea pig. Am J Otol 19:230–235

    CAS  PubMed  Google Scholar 

  30. El-Hennawi DM, El-Deen MHB, Abou-Halawa AS, Nadeem HS, Ahmed MR (2005) Efficacy of intratympanic methylprednisolone acetate in treatment of drill-induced sensorineural hearing loss in guinea pigs. J Laryngol Otol 119:2–7

    Article  PubMed  Google Scholar 

  31. Yilmaz I, Yilmazer C, Erkan AN, Aslan SG, Ozluoglu LN (2005) Intratympanic dexamethasone injection effects on transient- evoked otoacoustic emission. Am J Otololaryngol 26:113–117

    Article  CAS  Google Scholar 

  32. Araujo MFS, Oliveira CA, Bahmad F Jr (2005) Intratympanic dexamethasone injections as a treatment for severe, disabling tinnitus. Does it work? Arch Otolaryngol 131:113–117

    Article  Google Scholar 

  33. Fukushima M, Kitahara T, Uno Y, Fuse Y, Doi K, Kubo T (2002) Effects of intratympanic injection of steroids on changes in rat inner ear aquaporin expression. Acta Otolaryngol 122:600–606

    Article  CAS  PubMed  Google Scholar 

  34. Sone M, Hayashi H, Yamamoto H, Tominaga M, Nakashima T (2003) A comparative study of intratympanic steroid and NO synthase inhibitor for treatment of cochlear lateral wall damage due to acute otitis media. Eur J Pharmacol 482:313–318

    Article  CAS  PubMed  Google Scholar 

  35. Himeno C, Komeda M, Izumikawa M, Takemura K, Yagi M, Weiping Y et al (2002) Intra-cochlear administration of dexamethasone attenuates aminoglycoside ototoxicity in the guinea pig. Hear Res 167:61–70

    Article  CAS  PubMed  Google Scholar 

  36. Sharma D, Shekhar D, Kumar D, Pal D, Bajpayi D (2017) Role of intratympanic methylprednisolone in sudden sensorineural hearing loss. A clinical study. IOSR J Dent Med Sci 16(05):43–47

    Article  Google Scholar 

  37. Kumar D, Singh D, Thakur D (2018) Intratympanic steroid treatment for idiopathic sudden sensorineural hearing loss after failure of intravenous therapy. IOSR J Dent Med Sci 17(2):28–31

    Google Scholar 

  38. Chandrasekhar SS, Rubinstein RY, Kwartler JA, Gatz M, Connelly PE, Huang E et al (2003) Dexamethasone pharmacokinetics in the inner ear: comparison of route of administration and use of facilitating agents. Otolaryngol Head Neck Surg 122:521–528

    Google Scholar 

  39. Bachmann G, Su J, Zumegen C, Wittekindt C, Michel O (2001) Permeabilitat derrunden Fenster membrane fur Prednisolon-21-Hydrogensuccinat. Prednisolongehalt der Perilymphe nach lokaler Applikation vs. system ischer injektion. HNO 49:538–542

    Article  CAS  PubMed  Google Scholar 

  40. Saijo S, Kimura RS (1981) Distribution of HRP in the inner ear after injection into the middle ear cavity. Acta Otolaryngol 97:593–610

    Article  Google Scholar 

  41. Salt AN, Ohyama K, Thalmann R (1991) Radial communication between the peri lymphatic scalae of the cochlea I: estimation by tracer perfusion. Hear Res 56:29–36

    Article  CAS  PubMed  Google Scholar 

  42. Salt AN, Ohyama K, Thalmann R (1991) Radial communication between the peri lymphatic scalae of the cochlea 2: estimation by bolus injection of tracer into the sealed cochlea. Hear Res 56:37–43

    Article  CAS  PubMed  Google Scholar 

  43. Plontke S, Zenner HP (2002) Pharmacokinetic considerations in intratympanic drug delivery to the inner ear. Acta Otorhinolaryngol Belg 56:369–370

    CAS  PubMed  Google Scholar 

  44. Salt AN, Ma Y (2001) Quantification of solute entry into cochlear perilymph through the round window membrane. Hear Res 154:88–97

    Article  CAS  PubMed  Google Scholar 

  45. Shaia FT, Sheehy J (1976) Sudden sensorineural hearing impairment: a report of 1220 cases. Laryngoscope 86:389–398

    Article  CAS  PubMed  Google Scholar 

  46. Fuse T, Aoyagi M, Funakubo T, Sakakibara A, Yoshida S (2010) Short term outcome and prognosis of acute low-tone sensorineural hearing loss by administration of steroid. ORL J Otorhinolaryngol Relat Spec 64:6–10

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anita Bhandari.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhandari, A., Jain, S. Early Intratympanic Methylprednisolone in Sudden SNHL: A Frequency-wise Analysis. Indian J Otolaryngol Head Neck Surg 71, 390–395 (2019). https://doi.org/10.1007/s12070-019-01582-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-019-01582-5

Keywords

Navigation