Potential benefits of salvage intratympanic dexamethasone injection in profound idiopathic sudden sensorineural hearing
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OTOLOGY
Potential benefits of salvage intratympanic dexamethasone injection in profound idiopathic sudden sensorineural hearing loss Jin Woong Choi1 · Chi Kyou Lee2 · Sang Bin Kim2 · Dong Yun Lee2 · Sung Chul Ko2 · Kye Hoon Park2 · Seong Jun Choi2 Received: 30 January 2020 / Accepted: 3 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purposes To compare hearing recovery levels after initial treatment or salvage intratympanic dexamethasone injection (ITDI), and to find the prognostic factor on salvage ITDI therapy in profound ISSNHL. Methods We retrospectively reviewed 115 patients with profound ISSNHL. All patients were treated with combination or systemic steroid therapy as the initial treatment. Next, we used salvage ITDI therapy on patients who showed slight or no improvement according to Siegel’s criteria. To find the prognostic factors for the effectiveness of salvage ITDI therapy, we analyzed clinical data, such as, age, sex, vertigo, symptom duration, diabetes, hypertension, initial PTA, pre-salvage PTA, and treatment methods, using multiple regression analyses. Results The rate of serviceable hearing recovery were 10.4% (12/115) in the initial-treatment group and 20.4% (21/103) in the salvage group. The difference was statistically significant (p = 0.041). Pre-salvage PTA, diabetes mellitus, and symptom duration were affective factors for the effectiveness of salvage ITDI therapy in profound ISSNHL refractory to initial treatment, with odds ratios of 1.169 (95% confidence interval, 1.088–1.256), 0.069 (95% confidence interval, 0.005–0.889), and 9.242 (95% confidence interval, 1.079–79.146). Conclusions Salvage therapy should be considered for profound ISSNHL, which is expected to result in poor prognosis or hearing recovery: ITSI therapy might be an effective treatment as salvage therapy. Keywords Hearing loss · Sudden · Salvage therapy · Injection · Intratympanic · Prognosis
Introduction Idiopathic sudden sensorineural hearing loss (ISSNHL) is an emergency disease in the otologic field, because patients can lose their hearing without prompt treatment. The incidence of ISSNHL has been reported to be between 5 and 20 per 100,000 cases annually [1], and its frequency has been increasing in recent years. The first hypothesis involves a Jin Woong Choi and Chi Kyou Lee have contributed equally to this study. * Seong Jun Choi [email protected] 1
Department of Otorhinolaryngology‑Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
Department of Otolaryngology‑Head and Neck Surgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea
2
decrease in the blood supply to the inner ear, and the second hypothesis involves viral inflammation of the inner ear [2, 3]. Based on these hypotheses, various treatments for ISSNHL have been used: corticosteroids (systemic and/ or intratympanic), antivirals, vasodilators, osmotic agents, plasma expanders, anticoagulants, and hyperbaric oxyg
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