The Efficacy Of Tympanic Perfusion Hormone In The Treatment Of Sudden Hearing Loss And The Role Of Nrf2

Intratympanic methylprednisolone perfusion as a salvage treatment for profound idiopathic sudden sensorineural hearing lossObjective: This study aimed to examine the effectiveness of intratympanic methylprednisolone perfusion as salvage treatment for profound idiopathic sudden sensorineural hearing loss.Methods: A retrospective clinical study of 97 patients with unilateral profound idiopathic sudden sensorineural hearing loss was performed.In all,83 patients who received salvage intratympanic methylprednisolone perfusion plus conventional treatment(except for steroids)as the second-line therapy were assigned to the study group,while 14 patients who received conventional treatment alone were assigned to the comparison group.Hearing was assessed by pure tone audiometry after disease onset,before and after first-line conventional treatment and second-line treatment,and at three months after the second-line treatment.Pure tone average change was used to evaluate the hearing recovery.Results: In the study group,treatments in patients with a shorter interval from disease onset to intratympanic methylprednisolone perfusion(up to 15 days)had significantly greater improvements in the overall effective rate and pure tone average change compared with patients with a longer interval(over 15 days).For patients with a short interval from disease onset to intratympanic methylprednisolone perfusion,those in the study group had significantly greater improvements in the overall effective rate and pure tone average change compared with those in the comparison group.In both the study and comparison groups,hearing improvements were greater at low frequencies than at medium and high frequencies.Conclusion: The interval from disease onset to intratympanic methylprednisolone perfusion was the major factor affecting hearing recovery.Early second-line salvage intratympanic methylprednisolone perfusion significantly improved the degree of hearing recovery in profound idiopathic sudden sensorineural hearing loss patients after failure of systemic steroid treatment.A preliminary study of Nrf2 effects on sudden sensorineural hearing lossObjective: To explore the effects of nuclear factor erythroid-derived factor 2-ralated factor 2(Nrf2)on the treatment and prognosis of sudden sensorineural hearing loss(SSNHL),by observing sulforaphane(SUL,an agonist of Nrf2)effects on proliferation inhibition of peripheral blood mononuclear cells(PBMC)and by Peggy Sue detection of PBMC Nrf2 protein.Methods:(1)Fourty-nine patients with SSNHL were collected.Peripheral venous blood was collected before receiving treatment to isolate PBMCs for proliferation inhibition.PBMCs were cultivated in vitro,and PBMCs proliferation were induced by lipopolysaccharide(LPS).PBMCs were divided into five groups.Group A(control group): Including PBMCs,culture medium,CCK-8 solution;Group B(LPS group): Group A +LPS(1?g/ml);Group C(DEX group): Group B +DEX(10-6 mol/L);Group D(SUL group): Group B + SUL(15?mol/L);Group E(DEX+SUL group): Group B + DEX(10-6 mol/L)+SUL(15?mol/L).PBMC proliferation inhibitions were observed by absorptiometry after culturing 48 hours.(2)Twenty-eight patients with SSNHL and ten healthy controls were collected.Peripheral venous blood was collected before and right after treatment to isolate PBMCs for Peggy Sue detection of Nrf2 protein.The Nrf2 protein expression were compared between patients with SSNHL and controls,between the effective group and ineffective group,between before treatment and after treatment of the same patients.Results:(1)The PBMC proliferation inhibition rate of Group C,Group D and Group E were 3.38%(-1.98%,9.79%),24.12%(7.00%,40.66%)and 24.12%(7.00%,40.66%),respectively.The PBMC proliferation inhibition rate of SUL group was higher than DEX+SUL group(P=0.009),and DEX+SUL group was higher than DEX group(P=0.014).(2)The PBMC Nrf2 protein of patients with SSNHL and the controls were 0.0245(0.0097,0.4188)and 0.0040(0.0018,0.0161),respectively.The difference between the two groups was significant(P=0.001);Within the SSNHL group,the PBMC Nrf2 protein of the effective group and the ineffective group were 0.0103(0.0080,0.0167)and 0.0412(0.0266,0.0474),respectively.The difference between the two groups was also significant(P=0.001);The PBMC Nrf2 protein of patients with SSNHL before treatment and after treatment were 0.0245(0.0097,0.0419)and 0.0152(0.0090,0.0376),respectively.There was no statistical difference between the two groups.Conclusion:(1)SUL,as an agonist of Nrf2,has a powerful proliferation inhibition for PMBC and the proliferation inhibition rate of SUL was significantly higher than DEX in this study.SUL has the potential to be used for the treatment of SSNHL.(2)The expression of PBMC Nrf2 protein in patients with SSNHL reflects the severity of oxidative stress injury and can be used to predict the hearing recovery of SSNHL.