Intratympanic Dexamethasone Treatment Of Sudden Sexy Deafness Of Clinical Studies

Profound sudden sensorineural hearing loss has a much worse prognosis than mild and middle degree one.There is no other good method available except the systemic use of steroids.These years,attentions have been drew towards transtympanic administration of steroids because of its advantages including higher local concentration and lower risk of systemic complications.But most of the studies focuses on using intratympanic steroids as a salvage treatment after systemic failure.Few studies have used it as initial treatment.Objective:Clinical study on intratympanic dexamethasone as initial management of patients with profound sudden sensorineural hearing loss.Materials and MethodsPatient selection and assignmentAll patients with sudden sensorineural hearing loss,who were treated in Hyperbaric Oxygen Chamber of EENT Hospital between May 2007 to February 2008,were enrolled if no definite etiology was identified.The patients should also meet the criteria as follows:1.Ages rang from 18 to 70 2.No contraindication for general steroid use 3.Less than 2 weeks after the onset of sudden hearing loss 4.No treatment was used before included in the study 5.The average threshold of pure tone audiogram(250-4000 Hz) was more than 90 dB.All patients were informed of the side effects of general or local dexamethasone administration.The patients were divided into 3 groups according to their choices: 1.GroupⅠ(local and general dexamethasone administration,22 cases ). 2.GroupⅡ(intratympanic dexamethasone injection,12 cases).3.GroupⅢ(Intravenous dexamethasone injection,44 cases).In addition, Vasodilator and neurotrophy were used to all patients intravenously for 15 days together with hyperbaric oxygen therapy for 30 days.Steroid and Hyperbaric Oxygen Treatment Systemic dexamethasone--Dexamethasone was injected intravenously for 9 days,the initial dosage was 15 mg,and every 5 mg was reduced every 3 days.Intratympanic dexamethasone(ITD)--Patients was in supine position with head turning contralaterally,1%decaine was locally used and 0.8ml dexamethasone of the concentration of 5mg/ml was injected into tympanic cavity.Patients were instructed to avoid speaking or swallowing for the next 30 mins.ITD was performed every other day for 10 consecutive days.Hyperbaric oxygen therapy(HBOT)--Patients were sitting in hyperbaric oxygen chamber,in which they inhaled 100%oxygen at a pressue of 2.2 ATA for 60 min,once daily for 30 days.Data collection and analysisPure tone threshold audiometry was conducted before treatment and on 10th day,20th day,30th day after intervention respectively.Outcomes were analyzed based on the criteria made by the Chinese Otolaryngology Head Neck Surgery Association in 2005.StatisticsAll values are expressed as mean±SD,and stata 8.0 is used for statistics with p＜0.05 defined as the cutoff for statistical significance.Results1.The age,sex,initial PTA,the duration from onset to intervention were almost matched among the three groups.Vertigo has a lower occurrence rate in groupⅢ,and total deafness was less in groupⅢthan that in the other two groups,but without statistically significant difference.2.Based on the criteria of outcomes judgment,the proportion of threshold improvement≥30 dB was 81.82%in groupⅠ,83.3%in groupⅡand 88.64%in groupⅢ.There is no statistically significant difference among 3 groups.3.On the 30th day after intervention,pure tone threshold improvement was 41.36 dB in groupⅠ,43.08 in groupⅡand 51.70 dB in groupⅢ, and no statistically significant difference was indicated among 3 groups.On the 10th day after intervention,compared to the other groups,significant pure tone threshold improvement was noted in groupⅢ.The most significant hearing improvement showed in the first ten days,which can also be detected in the second ten days but the hearing threshold nearly remain the same after 20 days of treatment.4.The hearing threshold improvement among different frequencies were variable,significant hearing improvement was noted in 125 Hz,the frequencies increased while the improvement reduced.Conclusions1.Intratympanic dexamethasone,as a new method of drug administration in the management of patients with profound sudden sensorineural hearing loss,had no significant difference in effect compared to systemic administration.These patients did not get more benefit from combination of local and general administration.2.Obvious hearing improvement was noticed in the first 10 days after intervention on patients with profound sudden hearing loss.No further hearing improvement showed after 20 days.3.Variable hearing improvement was identified in different frequencies. Generally,greater hearing improvement was showed in the lower frequencies.