Intratympanic steroids for sudden sensorineural hearing loss a systematic review

In extremely severe cases, treatments that deaden the inner ear such as gentamicin injections or surgery may be considered. This is a last resort for persons who have severe attacks which are disabling. At present, we favor gentamicin for most instances where destructive treatments are being considered. Injections of gentamicin are given through the ear drum, through a small hole or through a small tube. This procedure allows the doctor to treat one side alone, without affecting the other. Typically, about four injections are given over a period of one month. Some authors have reported improvements in 60 to 90 percent of patients with gentamicin (Driscoll et al., 2009; Bodmer, 2007; Boleas-Aguirre, 2007; Chung, 2007), and Chung reported equally effective results with a single injection compared to multiple injections (Chung, 2007). Dizziness may reoccur one year later, requiring another series. Gentamicin injection can also result in hearing loss (Silvertein 2009; Colletti, 2007).

The remaining two procedures, vetibular neurectomy and labyrinthectomy, are ways of eliminating the balance function of the faulty ear. It is known that individuals will function better with one normal balance system than with one normal and one faulty system. The labyrinthectomy is a procedure in which the mastoid bone is removed and the inner ear is eliminated. This procedure is for patients that have lost usable hearing in the affected ear, as it entails removing all function of the inner ear, including hearing and balance. The change from having two balance systems to having one balance system alone does require a recovery or "compensation" period. It takes the brain a period of weeks to figure out that only one system is active and that it is no longer receiving information from the faulty system which it had come to expect. The second procedure, the vestibular neurectomy, is a good option if the hearing is good in the ear with the failing balance system. In this surgical procedure, the balance nerve (vestibular nerve) is cut between the inner ear and the brain. The inner ear is completely preserved but the faulty balance information is not able to reach the brain and cause the vertigo. Like the labyrinthectomy, this procedure requires a recovery period while the brain "figures out" the new situation.

A single trial containing 22 patients, with a low risk of bias was included. This trial found that after 24 months, compared with placebo , the use of intratympanic dexamethasone demonstrated a statistically significant improvement in vertigo as defined by a respective improvement in functional level (90% versus 42%), class (82% versus 57%), change in Dizziness Handicap Inventory scores ( versus ) and mean vertigo subjective improvement (90% versus 57%). The treatment regime described by the authors involved daily injections of dexamethasone solution 4 mg/ml for five consecutive days. These results were clinically significant. No complications were reported.

Other physical examination tests include the Romberg test and observation of gait. Swaying toward one side with the Romberg test is indicative of vestibular dysfunction in the ipsilateral side. Also, a patient's gait will lean toward the side of a vestibular lesion. Ataxia is indicative of cerebellar dysfunction, and the patient's gait is usually slow, wide-based, and irregular. 9 , 20 Observation of gait is also important to detect symptoms suggestive of parkinsonism in patients presenting with disequilibrium. 4 In early Parkinson disease, gait is usually slower with smaller steps and reduced arm swing, and progresses to freezing and hesitation in later stages of the disease. 20 Screening for peripheral neuropathy is also important in patients presenting with disequilibrium. 4

The most common treatment for sudden deafness, especially in cases where the cause is unknown, is corticosteroids. Steroids are used to treat many different disorders and usually work by reducing inflammation, decreasing swelling, and helping the body fight illness. Steroids are usually prescribed in pill form. In recent years, direct injection of steroids behind the eardrum into the middle ear (from here the steroids travel into the inner ear), called intratympanic corticosteroid therapy, has grown in popularity. In 2011, a clinical trial supported by the NIDCD showed that intratympanic steroids were no less effective than oral steroids , but were less comfortable overall for patients. They remain an option for people who can’t take oral steroids.

Intratympanic steroids for sudden sensorineural hearing loss a systematic review

intratympanic steroids for sudden sensorineural hearing loss a systematic review

Other physical examination tests include the Romberg test and observation of gait. Swaying toward one side with the Romberg test is indicative of vestibular dysfunction in the ipsilateral side. Also, a patient's gait will lean toward the side of a vestibular lesion. Ataxia is indicative of cerebellar dysfunction, and the patient's gait is usually slow, wide-based, and irregular. 9 , 20 Observation of gait is also important to detect symptoms suggestive of parkinsonism in patients presenting with disequilibrium. 4 In early Parkinson disease, gait is usually slower with smaller steps and reduced arm swing, and progresses to freezing and hesitation in later stages of the disease. 20 Screening for peripheral neuropathy is also important in patients presenting with disequilibrium. 4

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