The Combination Effects of Early Intratympanic Dexamethasone Injection for the Patients with Sudden Sensorineural Hearing Loss

이승환,Hyun Jung Min,Yong Hee Cho,성의숙,Seok Hyun Cho,박철원 대한청각학회 2011 Journal of Audiology & Otology Vol.15 No.3

Introduction Spontaneous recovery rate of sudden sensorineural hearing loss (SSNHL) is up to 38-65%, including partial response.1,2,3) Systemic steroid therapy and peripheral vasodilator might be helpful to recover the hearing.3) How steroids affect the inner ear still remains unclear. Steroids may increase labyrinthine circulation or influence the cochlear fluid homeostasis, possibly by attenuating an inflammatory progress.4,5) Most recovery occurs within 2 weeks after onset, so early treatment is important for prognosis.2)Animal studies demonstrate that the intratympanic route of administration results in significantly higher inner ear levels of steroids as compared with systemic administration.6,7) Intratympanic dexamethasone (ITD) offers the potential for directed delivery of high concentrations of therapeutic agents to the inner ear while avoiding systemic side effects of steroids. So recently, intratympanic dexamethasone injection (ITDI) is applied as salvage treatment for SSNHL patients who failed initial systemic treatment or for patients who concerned to have hazard risk on systemic steroids.8,9,10) And some reports show early intervention with ITD resulted in effective hearing recovery in patients with SSNHL.11,12) However, clinicians often follow cases in which hearing improves after a long period of time after discharge. Therefore the result of combination therapy is ambiguous between delayed effects of traditional systemic therapy and additional effects of ITDI. In this study, all patients including the control group were limited to Siegel's criteria IV right after initial systemic treatment. And then we investigated the effectiveness of combination therapy, early ITDI accompanied with systemic therapy on SSNHL by comparing the recovery rate of patients who only received traditional treatment. Materials and Methods We retrospectively reviewed the medical records and audiograms of the patients with SSNHL diagnosed from January 2005 to October 2010. SSNHL is defined as a hearing loss of 30 dB or more, affecting at least 3 consecutive audiometric frequencies, developing within 72 hours or less, and not attributable to any commonly identifiable cause of sudden hearing loss. In this study, we included subjects who hospitalized for 5 days within 1 week after symptoms developed and who showed no improvement of hearing (Siegel's criteria IV) at pure tone audiometry performed after 5 days of traditional systemic treatment, namely at discharge day. All patients were treated with traditional systemic treatment in the following manner; 12-day course of oral steroids (1 mg/kg prednisolone for 5 days, followed by tapering for 7 days) as well as agents that decrease blood viscosity (intravenous low molecular Dextran, 1,000 mL/day for 5 days) and vitamins. And then patients randomized to the ITDI group (n=47) were administered first ITDI at discharge day or first visiting day at outpatient clinic within 2 weeks after initiation of traditional treatment, whereas patients randomized to the control group (n=104) were administered traditional treatment only. All patients were followed up for at least 2 months. ITDI therapy The ITDI procedure was performed under a microscope. With the patient supine and the head turned to the opposite site, Xylocaine® 10% pump spray (lidocaine 10 mg/dose, Astrazeneca) was used to induce local anesthesia. The Dexamethasone (Dexamethasone®, 5 mg/mL) was loaded into a 1-mL tuberculin-type syringe with a long 25 gauge needle attached on it. One needle hole was made in the anesthetized area for air to escape during the middle ear injection. A second hole was made for the injection at anterosuperior portion of tympanic membrane and the drug solution was infused into the middle ear space in a quantity sufficient to fill the space or at least cover the round-window niche. After the injection, the head was placed slightly lower than the body, and the subject was instructed to lie... Background and Objectives: Intratympanic dexamethasone injection (ITDI) offers the potential for directed delivery of high concentrations of steroids to the inner ear while mitigating the risks involved with high doses of systemic steroids. We investigated the effectiveness of combination therapy, sequential early ITDI accompanied with systemic therapy on sudden sensorineural hearing loss (SSNHL). Materials and Methods: We gathered 151 SSNHL patient's data, who were refractory to systemic treatment for 5 days. Injection group (n=47) were administered systemic therapy and 4 times of ITDI within 2 weeks after break of SSNHL. Control group (n=104) only received traditional treatment. We compared last concreted hearing level and recovery rate according to initial hearing level and frequency. Results: Overall hearing improvement was observed in 47 of 104 (45.2%) control patients and in 30 of 47 (63.8%) ITDI patients (p=0.034). Depending on the degree of initial hearing loss, the patients with severe hearing loss who treated with ITDI showed significant higher recovery rate than control group (83.8% vs. 50.0%)(p=0.049). When we analyzed hearing improvements according to the frequency, clinically significant hearing improvements were observed at lower and mid-frequencies (250, 500 and 1,000 Hz) in the ITDI group than in the control group. Conclusions: Early combination therapy of intratympanic dexamethasone injection within 2 weeks accompanied with initial systemic treatment is effective for patients with refractory SSNHL, especially for patients with severe hearing loss

Comparison of the Efficacy of Systemic and Combined Highly Frequent Intratympanic Steroid Treatment on Sudden Sensorineural Hearing Loss

Yee-Hyuk Kim,Sung-Yong Choi,Young-Ho Lee 대한청각학회 2011 Journal of Audiology & Otology Vol.15 No.3

Background and Objectives: Corticosteroids have been used for therapeutic management of sudden sensorineural hearing loss (SSNHL). Because of the complications associated with systemic steroid therapy and low levels of steroid in the inner ear after systemic administration, intratympanic steroid injection (ITSI) is currently used. The purpose of this study was to compare the efficacy of systemic steroid therapy with systemic combined high frequency ITSI therapy. Subjects and Methods: Forty-six SSNHL patients were divided into the only systemic dexamethasone therapy group (systemic steroid IV group, 27 patients) and the systemic with frequent intratympanic dexamethasone injection group (combined ITSI group, 19 patients). In the systemic steroid IV group, dexamethasone was administered intravenously for 5 days followed by oral tapered doses for 10 days. In the combined ITSI group, intratympanic dexamethasone was administered 5 times per day for 5 consecutive days in addition to intravenous administration of dexamethasone. Hearing was assessed both before therapy and at 15 days, 4 weeks, and 8 weeks after the initiation of therapy. Results: The recovery rate and hearing gain were 74% (20 out of 27 patients) and 33 dB mean improvement in the systemic steroid IV group and 73.6% (14 out of 19 patients) and 41.5 dB mean improvement in the combined ITSI group. There was no statistically significant difference in hearing gain and the recovery rate between the two groups. Conclusions: The therapeutic effect of a combination of highly frequently administered intratympanic dexamethasone and systemic steroid therapy was not superior to only systemic steroid injection therapy. Introduction Sudden sensorineural hearing loss (SSNHL) is considered as an otologic emergency. Evaluation of treatments has been hampered by the low incidence of SSNHL, unknown natural history and the tendency for spontaneous hearing recovery (30-60%).1) The spontaneous hearing improvement in untreated patients usually occurs within 2 weeks after the onset of hearing loss.2) After 2 weeks of the onset of hearing loss, it becomes difficult to expect a spontaneous recovery. The current treatment of choice for hearing loss is either oral or intravenous administration of systemic steroids. However, the effectiveness of steroids in the treatment of idiopathic SSNHL still remains unproven.3) Treatment modalities that have been tried include the use of combination of corticosteroids, vasodilators, anti-viral agents, diuretics, hyperbaric oxygen, stellate ganglion block and low-salt diet.3)Intratympanic steroids are being increasingly used as a therapeutic option for SSNHL because of the advantages of intratympanic steroid injection like, nil occurrences of systemic effects of steroid treatment and increase in the amount of steroid entering the inner ear when compared to systemic injections. In particular, intratympanic steroids have been shown to be effective as a salvage treatment for SSNHL patients, who had no relief from the initial systemic treatment.4,5,6)Endolymphatic dexamethasone level shows the highest concentration within 1-2 hours after intratympanic dexamethasone injection and then there is a sharp reduction.7) We consider that it is useful to maintain a high concentration of dexamethasone in the endolymph by highly frequent intratympanic steroid injection (ITSI) therapy. The purpose of this study was to compare the efficacy of systemic steroid therapy with systemic combined high frequency ITSI therapy. Subjects and Methods Study design and patients The study included hospitalized patients that were diagnosed with SSNHL between August 2008 and January 2010. The diagnostic criteria for SSNHL were the acute onset of hearing loss of 30 dB or more over at least three contiguous audiometric frequencies, which may have occurred within 3 days. The treatments were initiated within 7 days after the occurrence of SSNHL. A total of 46 SSNHL patients were divided into 2 different treatment groups on a random basis. One group (systemic steroid IV group, 27 patients) was treated with systemic dexamethasone therapy and the other group (combined ITSI group, 19 patients) was treated with systemic dexamethasone and frequent intratympanic dexamethasone injection. In the systemic steroid IV group, dexamethasone was administered intravenously for 5 days followed by tapered doses orally for 10 days. In the combined ITSI group, intratympanic dexamethasone was administered 5 times per day for 5 consecutive days (from 9 AM to 9 PM at intervals of 3 hours) in addition to intravenous dexamethasone administration. Informed consent was obtained from every individual study subject. All the patients underwent medical history, physical and laboratory examinations and brain magnetic resonance image MRI scanning. Subjects with medical or central nervous system conditions, including syphilis, chronic renal disease, cardiovascular disease and retrocochlear lesion were excluded from the study. Subjects with true whirling type vertigo, family history of hearing loss, history of fluctuating hearing loss, head trauma and otologic surgery were also excluded from the investigation. Treatment protocol All the patients in both the groups were hospitalized for 5 days and treated with intravenous dexamethasone (10 mg) (dexamethasone®, Jeil Pharm, Seoul, Korea) for 5 days and subsequently with oral methylprednisolone (Methylon®, 4 mg/1T, KunWha Pharm, Seoul, Korea) for 10 days in tapered doses (48 mg, 40 mg, 32 mg, 24 mg, each for 2 days decreasing by 8 mg each 2 day, and 12 mg at the last 2 days), after which the patients were discharged from the hosp...

Medulloblastoma Manifesting as Sudden Sensorineural Hearing Loss

Terakawa, Yuzo,Tsuyuguchi, Naohiro,Takami, Toshihiro,Ohata, Kenji The Korean Neurosurgical Society 2011 Journal of Korean neurosurgical society Vol.50 No.1

We present a rare case of medulloblastoma which presented with unilateral sudden sensorineural hearing loss as an initial symptom. A 19-year-old man was admitted to our hospital with a chief complaint of dizziness and facial numbness on the right side. His illness had begun two years previously with sudden hearing loss on the right side, for which he had been treated as an idiopathic sudden hearing loss. Magnetic resonance imaging demonstrated abnormal signals located mainly in the right middle cerebellar peduncle. We performed partial resection of the tumor by suboccipital craniotomy. The histopathological diagnosis was medulloblastoma. Intrinsic brain tumor is an extremely rare cause of sudden sensorineural hearing loss and is therefore easily overlooked as was in the present case. The present case highlights not only the need to evaluate patients with sudden sensorineural hearing loss by magnetic resonance imaging but also the importance of paying attention to intrinsic lesions involving the brainstem. Although this condition like the presented case might be rare, intrinsic brain tumor should be considered as a potential cause of sudden sensorineural hearing loss, as it may be easily missed leading to a delay in appropriate treatment.

돌발성 난청에서 스테로이드 투여 방법에 따른 치료 결과의 차이

정재호,김인식,김동환,윤형준,박철원,이승환 대한이비인후과학회 부산,울산,경남 지부회 2017 임상이비인후과 Vol.28 No.1

The aims of the study was to compare the treatment outcomes associated with the steroid administration routes in unilateral sudden sensorineural hearing loss. Methods:From January 1998 to December 2014, three hundred and eighteen patients with unilateral sudden sensorineural hearing loss were assessed. Among them, 34 patients received the intravenous dexamethasone (16 mg/day)while the others 284 patients received 1mg/kg prednisolone daily with a subsequently tapered dose. We performed a propensity score matching analysis using previously known prognostic factors including initial hearing level, presence of vertigo and duration of onset of treatment to compare treatment outcome of IV and oral steroid. The hearing recovery between the IV steroid group and propensity score matched oral steroid group was assessed according to the AAO-HNS guideline and Siegel’s criteria. Results:In the comparison between oral and IV steroid group, mean age, the initial hearing level was significantly higher in the oral steroid group than in IV steroid group (p=0.002, p=0.003) After propensity score matching, initial hearing level, age, sex and other clinical parameters were not significantly different between IV steroid and matched oral steroid group. In the treatment outcome, the complete recovery rate in IV steroid and the oral steroid group were 64.7% and 47.1% respectively. Although the recovery rate of the IV steroid group was higher than that of the oral steroid group, statistical significance was not identified. Conclusions:The administration route of systemic steroid did not affect the clinical outcomes of idiopathic sudden sensorineural hearing loss.

돌발성난청 환자 치험 6례

윤회성,이승은,한은정,김윤범,Yoon, Hui-sung,Lee, Seung-eun,Han, Eun-jung,Kim, Yoon-bum 대한한방안이비인후피부과학회 2003 한방안이비인후피부과학회지 Vol.16 No.2

Sudden sensorineural hearing loss may be defined as a severe loss of hearing occurring within a short space of time without any obvious cause. Its etiology is not verified yet, treatment and prognosis are uncertain. Objectives: We reviewed 6 cases of patients who hospitalized in Kyunghee Oriental Medical Center Dept. of Otolaryngology. Using the criteria of Siegel and Research Team of the Japanese Ministry of Health and Welfare of Japan, We are to evaluate the effect of Herb medication, Acupuncture therapy, and Negative therapy. We also attempted to search effective methods of therapy of sudden sensorineural hearing loss. Methods: We treated them with Oyaksunki-san(烏藥順氣散) for softening qi-stagnation and supressing 'Wind'(順氣治風), Chungsimjihwang-tang(淸心地黃湯) for strengthening 'Heart' and 'Kidney'(補心益腎), Boikyangwi-tang(補益養胃湯) for strengthening 'Wi-qi' and 'Stomach'(補衛(胃)氣). We also used acupuncture therapy and negative therapy based on the textbook of Acupuncture and Moxibustion. Results: One patient recovered completely after 5 days therapy, two patient markedly, another two patient slightly and one patient had no improvement. Conclusions: To treat sudden hearing loss, we can use Oyaksunki-san(烏藥順氣散) in the early stage of the disease. We can treat with Chungsimjihwang-tang(淸心地黃湯) and Boikyangwi-tang(補益養胃湯) in the late period of the disease, and administer Jaeumgenby-tang(滋蔭健脾湯) for suppressing tinnitus. If there is evidence of viral infection and the patient have too severe hearing loss, We can also use steroid in combination with Herb medication in the early stage of the disease. The Western medicine demonstrated that the start time of treatment had influence on recovery. If we started Oriental medical treatment within a week from the onset of sudden deafness. we will obtain the desired results. As the Western medical treatment does, Oriental medical therapy may have no effect after one month from onset of the disease.

돌발성 난청 성인의 청능훈련 사례

조새림,오수희,방정화 한국청각언어재활학회 2018 Audiology and Speech Research Vol.14 No.1

Purpose: A 43-year-old woman diagnosed with a sudden sensorineural hearing loss. She did not accept her hearing loss and did not want to wear hearing aids, but her communication ability was the problem in her workplace. The purpose of this study was to investigate the efficacy of auditory training for improving communication ability through listening activities, and for accepting her hearing loss and wearing a hearing aid continuously through informational counseling. Methods: Receiver in canal hearing aid was selected for the left ear. Auditory training was conducted seven sessions for 30 mins listening activities and 10 minutes informational counseling. For listening activities, long stories were used, and for informational counseling, effects of hearing loss on communication, knowledge of hearing aids and emotional well-being were provided. Also, we simulated her workplace for training sessions. As objective assessments, word and sentence recognition scores were tested and as a subjective assessment, Korean Version of Profile Hearing Aid Benefit (K-PHAB) was conducted. Results: The recognition scores of word and sentence were improved after the auditory training. However, scores of KPHAB were not changed. The subject reported that she did not feel that her communication ability did not improve a lot, but she would maintain to use her hearing aid. Conclusion: Even though the subjective hearing aid benefit was not improved, behaviors of the subject were changed after the auditory training. Informational counseling is efficacy to understand and accept hearing loss and hearing aids.

대전한방병원 한방안이비인후피부과로 내원한 돌발성 난청 환자 특성 분석 - 2013년 1월부터 2021년 12월까지 -

최윤영,변정아,백종찬,황미리,안재현,정현아 대한한방안이비인후피부과학회 2022 한방안이비인후피부과학회지 Vol.35 No.4

Objectives : The purpose of this study is to analyze outpatients who visited for treatment for sudden sensorineural hearing loss in ophthalmology & otolaryngology & dermatology clinic of Daejeon Korean medical hospital from January 1 st , 2013 to December 31 th , 2021. Methods : We retrospectively analyzed outpatients who visited for treatment for sudden sensorineural hearing loss in ophthalmology & otolaryngology & dermatology clinic of Daejeon Korean medical hospital from January 1 st , 2013 to December 31 th , 2021. according to year, season, gender, age, clinical symptoms, number of visits and initial degree of hearing loss. The statistical analysis performed using IBM SPSS 25.0 for Windows. Results : The results of analyzing the medical records of 194 patients are as follows. 1. The number of patients showed a gradual increase from 2014 to 2021 and spring was highest in season. Acc ording to gender, women visited more than men and the age group that visited the most was middle-aged, including 40s and 50s. 2. Patients experienced 13 symptoms and the average number was 4.06. In the analysis of the major symptoms according to gender, hyperacusis and headache were found to be more common in female. 3. The average of initial hearing loss was 52.54㏈ and was higher in male. The loss was relatively higher in 60s or older than in the younger age group. Conclusions : If treatment and management methods that reflect these symptoms are developed, it is thought that it will greatly helpful to improve the quality of life of patients with sudden hearing loss.

돌발성난청 환자에서 항바이러스제 병용요법의 효과

김재영,조재준,김진국,이민우,남태욱 대한이비인후과학회 2000 대한이비인후과학회지 두경부외과학 Vol.43 No.12

특발성 돌발성 난청으로 오인된 청신경 종양 1례

고혜연,김재호,이마음,김민희,Ko, Hye-Yeon,Kim, Jae-Ho,Lee, Ma-Eum,Kim, Min-Hee 대한한방안이비인후피부과학회 2021 한방안이비인후피부과학회지 Vol.34 No.3

1. 청신경 종양 진단의 표준 검사는 두부 가돌리늄 조영 증강 자기 공명 영상 촬영이며, 경제적 문제 등으로 조영 증강 자기 공명 영상 촬영이 어려울 경우에는 청성 뇌간 반응(auditory brainstem response) 검사를 시행할 수 있다. 2. 특발성 돌발성 난청으로 진단 받은 후, 한의 의료기관에 내원한 환자에서도 기존 검사결과를 검토하여 후미로성 질환을 배제한 후 치료를 시작해야한다. 3. 비조영 증강 자기 공명 영상 촬영을 통해 후미로성 질환을 배제한 환자에서도 임상적으로 후미로성 질환이 의심되는 경우에는 표준 검사인 가돌리늄 조영 증강 자기 공명 영상 재촬영을 통해 청신경종을 감별하는 것이 바람직하다. 4. 청신경 종양에서 한방 치료를 표준 치료와 병행하여 제반 증상에 대한 관리를 기대해 볼 수 있다. Objective : The purpose of this study is to discriminate the vestibular schwannoma misdiagnosed as Idiopathic Sudden Sensorineural Hearing Loss. Methods : A 46-year-old female patient who was suffering left sudden sensorineural hearing loss(SSNHL), visited after diagnosed as Idiopathic SSNHL by previous hospital. For diagnosing the vestibular schwannoma, we conducted the Puretone audiometry, auditory brainstem response threshold test and magnetic resonance imaging(MRI) for temporal bone with enhancement. Result : Auditory Brainstem Response threshold test was abnormal and in enhanced MRI, the vestibular schwannoma in left side was detected. The patient was discharged from the hospital for tertiary hospital care. Conclusions : When the patient with SSNHL visits a hospital even if after diagnosed as Idiopathic SSNHL by previous hospital, a doctor should keep in mind the possibility of vestibular schwannoma.

Comparison of Steroid Treatment with and without Hyperbaric Oxygen Therapy for Idiopathic Sudden Sensorineural Hearing Loss

Yücel Abitter,Özbuğday Yaşar 대한청각학회 2020 Journal of Audiology & Otology Vol.24 No.3

Background and Objectives: In this study, we compared the outcomes of patients with idiopathic sudden sensorineural hearing loss who underwent steroid treatment with or without hyperbaric oxygen (HBO) therapy and were followed-up in our clinic.Subjects and Methods: Patients were divided into two groups according to their treatment regimen. Steroid group received intravenous 1 mg/kg methylprednisolone which was due to be completed in 2-3 weeks with decreasing doses, and five doses of 0.5 mL intratympanic dexamethasone. Steroid+HBO group received the same steroid treatment with the addition of HBO therapy. The audiologic results of both treatment groups were compared after considering the patients’ risk factors.Results: There was no significant difference between the steroid and Steroid+HBO groups in terms of hearing gain and degree of recovery, both at all degrees of hearing loss, and in severe and profound hearing loss. Hearing gain was similar when evaluated by audiogram type and admission time in both treatment groups.Conclusions: We found that the addition of HBO therapy to systemic plus intratympanic steroid treatment did not affect hearing gain at all degrees of hearing loss in this study. Furthermore, audiogram type and admission time did not affect hearing gain between the two groups.