Endoscopic intratympanic methylprednisolone injection for treatment of refractory sudden sensorineural hearing loss and one case in pregnancy.

摘要

OBJECTIVE: to evaluate the effectiveness of transtympanic methylprednisolone injection in patients with refractory sudden sensorineural hearing loss via endoscopic diode laser myringotomy. SUBJECTS AND METHODS: thirty-six sudden sensorineural hearing loss patients who failed routine oral steroid therapy and two patients with a contraindication to systemic steroid received intratympanic methylprednisolone injections at the round window by endoscopic diode laser myringotomy once every other day with a maximum of four injections. One of the two patients with a contraindication to oral steroid was a normal pregnant woman, whereas the other was an active digestive ulcer patient. Hearing level, dizziness, and tinnitus were evaluated before the first procedure and 20 days after the last injection. RESULTS: thirteen of 38 patients (34.2%) showed an improvement in hearing levels. The average improvement 20 days after treatment was 54 dB in the hearing thresholds of 125 to 8000 Hz. The complete recovery rate of intratympanic methylprednisolone injection (mean 2.6 times) was 21% (8 of 38). There were no serious unexpected adverse events in the 38 patients except one aggravation of hearing loss occurred after intratympanic injection. Temporary dizziness in seven subjects and otalgia in six subjects occurred after injection, which was relieved after 0.5 to 2 hours without special treatment. No perforation of tympanic membrane or infection occurred 20 days after the last injection. CONCLUSIONS: topical intratympanic injection may be considered a substitute for the systemic administration in patients with refractory sudden hearing loss, especially those who have contraindications to systemic steroid administration. The endoscope is helpful for ensuring the effective delivery of drugs into the round window. Prospective randomized controlled trials should be designed for further investigation.