Levent RENDA, Güleser SAYLAM, Ali ÖZDEK, Emel Ç. TATAR, Ali GÜL, Hakan KORKMAZ

Sistemik steroid ve vazoaktif tedaviye yanıt alınamayan ani işitme kayıplı hastalarda intratimpanik steroid tedavisinin etkileri

Amaç: Sistemik steroid tedavisine yanıt vermeyen ani işitme kayıplı olgularda kurtarma tedavisi olarak uygulanan int- ratimpaniksteroidenjeksiyonunun işitme kaybı üzerine etkileri araştırıldı.Yöntem ve Gereçler: Çalışmada 2007-2009 yılları arasında ani işitme kaybı tanısı ile kliniğimizde takip edilen ve sistemik ve vazoaktif tedaviye yanıt alınamayan 13 hasta dahil edilmiştir. 9 hasta (%69) sistemik steroid tedavisi ile birlikte konkomitan olarak, 4 hasta (%31) ise sadece intratimpaniksteroid tedavisi aldı. Hastaların tedavi öncesi ve tedavi sonrası erken dönem (2 hafta) ve tedavi sonrası geç dönemdeki (3 ay) odyogramları karşılaştırıldı.Bulgular: 125,250,500,1000,2000 ve 4000 Hz frekanslarda intratimpanikenjeksiyon sonrası erken ve geç dönemkontrolleri ile tedavi öncesi odyogramlar karşılaştırıldığında işitmede istatistiksel olarak anlamlı düzelme bulundu.8000 Hz frekansda anlamlı düzelme izlenmedi. Konuşmayı ayırt etme skorlarında anlamlı artış, konuşmayı alma eşiklerinde anlamlı düşüş izlendi.Sonuç: Ani işitme kayıplı hastalarda geç dönemde kurtarma tedavisi olarak yapılan intratimpaniksteroidenjeksiyonunun işitmenin düzelmesine olumlu katkı sağladığı gösterilmiştir.

The efects of intratympanic steroıd enjection in the treatment of sudden sensorineural hearıng loss after failure of systemic steroıd and vasoactive theraphy

Aim: The impacts of intratympanic steroid injection implemented as a salvage treatment in the cases with sudden he-aring loss not responding to the systemic steroid treatments have been analysed.Material And Methods: 13 patients with the diagnosis of sudden hearing loss and not responding to systemic steroidand vasoactive treatment who were hospitalized in our clinic between the years of 2007 and 2009 have been includedin the study. 9 patients (69%) receiving concomitant with systemic steroid treatment and yet 4 patients (31%) under-went intratympanic steroid treatment alone. Audiograms of the patients prior to the treatment period and during earlypost-treatment (twoweeks) and late post treatment (3 months) have been compared.Results: When the audiograms between the early and late period controls after the intratympanic injections at the fre-quencies of 125, 250, 500, 1000, 2000 and 4000 Hz and those prior to the treatment have been compared, a statisticallysignifcant recovery has been determined. No signifcant difference at 8000 Hz has been shown. A signifcant increasein the scores in speech discrimination and a signifcant decrease in the threshold level of speech have been determined.Conclusion: Intratympanic steroid injections implemented so as to treat the patients with sudden hearing loss as a sal-vage treatment in the late period have been shown to favourably contribute to recovery in hearing.

PDF

___

1. MattoxDE,Simmons FB. Natural history of suddensensorineural- hearingloss. AnnOtol 1977;86: 463-80. (PMID: 889223)
2. Arts HA. Suddensensorineuralhearingloss. In: Cummings CW, Frederickson JM, Harker LA eds. OtolaryngolHeadandNeckSurg, 3th ed. St.Louis,1998:2923-2933.
3. Byl FM. Suddenhearingloss: eightyearsexperienceandsuggested- prognostictable. Laryngoscope 1984; 647-661. (PMID: 6325838)
4. Yoshida Y, Yamauchi S, Shinikawa A, Horiuchi M, Sakai M. Im- munologicalandvirologicalstudy of suddendeafness. AurisNasu- sLarynx 1996; 23: 63-68. (PMID: 8809325)
5. Shikowitz MJ. Suddensensorineuralhearingloss. MedClin North Am 1991; 75(6): 1239-1250. (PMID: 1943316)
6. Moskowitz D, Lee KJ, Smith HW. Steroiduse in idiopathicsud- densensorineuralhearingloss. Laryngoscope 1984; 94: 664-666. (PMID: 6717224)
7. Celenk F, Bayramoglu I. Suddensensorineuralhearingloss. Turkiye Klinikleri J SurgMedSci 2006; 2(28): 28-35.
8. Jaffe BF. Hypercoagulationandothercauses of suddenhearingloss. OtolaryngolClin North Am 1975; 8(2): 395-403. (PMID: 1153203)
9. Pereira DT, Vendramini RC, David RB, Nozaki PN, Menari JV. IsotonicNaClintakeby Cell-Dehydratedrats. Physiology&Behavior 2002; 76(4-5): 501-505. (PMID: 12126985)
10. Nomuro Y. Diagnosticcriteriaforsuddendeafness, mumpsdeaf- nessandperilympathicfstula. ActaOtolaryngol 1988; 456: 7-8. (PMID: 3227833)
11. Itoh A, Sakata E. Treatment of vestibulerdisorders. ActaOtolaryn- golSuppl 1991; 481: 617-623. (PMID: 1927485)
12. Silverstein H,Choo D, Rosenberg SI, Kuhn J. Intratympanictreat- ment in theinnereardiseaseandtinnitus. EarNoseThroat J 1996 ; 75: 468-471. (PMID: 8828271)
13. Slattery WH, Fisher LM, Iqbal Z, Freidman RA, Liu N. Intratym- panicsteroidforthetreatment of suddenhearingloss. Otolaryngol- HeadNeckSurg 2005; 133: 251-259. (PMID: 16087204)
14. Herr BD, Marzo SJ. Intratympanicsteroidperfusionforrefracto- rysuddensensorineuralhearingloss. OtolaryngolHeadNeckSurg 2005; 132: 527-531. (PMID: 15806039)
15. Lauterman J, Sudhoff H, Junker R. Transtympaniccorticoidthera- pyforacuteprofoundloss. EurArchOtorhinolaryngol 2005; 262(7): 587-591.(PMID:15744509)
16. Xenellis J, Papadimitriou N, Nikolopoulos T.,Managoudakis P,Segas T, Tzagaroulakis A, Ferekidis E. Intratympanic- steroidtreatment in idipathicsuddensensorineuralhearingloss: a controlstudy. OtolaryngolHeadNeckSurg 2006; 134: 940-945. (PMID: 16730534)
17. Gianoli GJ, Li JC. Transtympanicsteroidsfortreatment of sudden- sensorineuralhearingloss. OtolaryngolHeadNeckSurg 2001; 125: 142-146. (PMID: 11555744)
18. Battista RA. Intratympanicdexamethasoneforprofoundidiopath- icsuddensensorineuralhearingloss. OtolaryngolHeadNeckSurg 2005; 132: 902-905. (PMID: 15944562)
19. Choung YH, Park K, Shin YR, Cho MJ. Intratympanicdexametha- soneinjectionforrefractorysuddensensorineuralhearingloss. Laryn- goscope 2006; 116: 747-752. (PMID: 16652082)
20. Rarey KE, Luttge WG. Presence of type 1 andtype 2/1B receptors- foradrenocorticosteroidhormones in theinnerear. HearRes 1989; 41: 217-221. (PMID: 2530200)
21. Gross ND, Kempton JB, Trune DR. Spironolactoneblocksgluco- corticoid-mediatedhearingpreservation in autoimmunemice. La- ryngoscope 2002; 112: 298-303. (PMID: 11889387)
22. Stokroos RJ, Albers FW, Tenvergert EM. Antiviraltreatment of idiopathicsuddensesorineuralhearingloss: a prospective, random- ized, double-blindclinicaltrial. ActaOtolaryngol (Stockh) 1998; 118(4): 488-495. (PMID: 9726671)
23. Nagura M, Iwasaki S, Wu R, Mizuta K, Umemura K, Hoshino T. Effects of corticosteroid, contrastmediumand ATP on focalmicro- circulatorydisorders of thecochlea. Eur J Pharmacol 1999; 366(1): 47-53. (PMID: 10064151)
24. Tabuchi K, Oikawa K, Uemaetomari I, Tsuji S, Wada T, Hara A. Glucocorticoidsanddehydroepiandrosteronesulfateameliorateisch- emia-inducedinjury of thecochlea. HearRes 2003; 180: 51-56. (PMID: 12782352)
25. Lamm K, Lamm C, Arnold W. Effects of isobaricoxygenversushy- perbaricoxygen on the normal andnoisedamagedhypoxicandisch- emicguineapiginnerear. AdvOtorhinolaryngol 1998; 54: 59-85. (PMID: 9547878)
26. Lin DW, Trune DR. Breakdown of striavascularisbloodlabyrinth- barrier in C3H/1pr autoimmunediseasemice. OtolaryngolHead- NeckSurg 1997; 117: 1-8. (PMID: 9374179)
27. Yılmaz I, Erkan AN, Aslan SG, Ozluoglu LN. Intratympanicdexa- methasoneinjectioneffects on transient-evokedotoacousticemis- sion. Am J Otolaryngol 2005; 26: 113-117. (PMID: 15742264)
28. Lefebvre PP, Staecker H. Steroidperfusion of theinnerearforsud- densensorineuralhearinglossafterfailure of conventionalthera- py: a pilot study. ActaOtolaryngol 2002; 122: 698-702. (PMID: 12484644)
29. Kopke RD, Hoffer ME, Wester D, OLeary MJ, Jackson RL. Tar- getedtopicalsteroidtherapy in suddensensorineuralhearingloss. OtolNeurotol 2001: 22; 475-479. (PMID: 11449103)
30. Ho HG, Lin HC, ShuMT,Yang CC, Tsai HT. Effectiveness of in- tratympanicdexamethasoneinjection in suddendeafnesspatients as salvagetreatment. Laryngoscope 2004; 114(7): 1184-1189. (PMID: 15235345)
31. Parnes LS, Sun AH, Freeman DJ. Corticosteroidspharmacokinet- ics in theinnerearfuids: an animalstudyfollowedbyclinicalapplica- tion. Laryngoscope 1999; 109: 1-17. (PMID: 10399889)
32. Chandrasekhar SS, Rubinstein RY, Kwartler JA, Gatz M, Con- nelly PE, Huang E, Baredes S. Dexamethasonepharmacokinetics in theinnerear: comparison of route of administrationanduse of fa- cilitatingagents. OtolaryngolHeadNeckSurg 2000; 122: 521-528.