A Comparative Study between the Efficacy of Intratympanic Steroid Injection and Conventional Medical Treatment in Resistant Cases of Otitis Media with Effusion

Introduction Otitis media with effusion (OME) is a multifactorial disease and the treatment options for it are limited and controversial. The aim of the present study was to compare the efficacy of intratympanic steroid injection and conventional medical treatment in resistant cases of OME with hearing loss. Materials and Methods A comparative study was conducted among 20 patients of OME with hearing loss, resistant to conventional medical treatment between December 2019 to November 2020. ‘Intratympanic dexamethasone injection’ (ITDI) was given every week for 3 consecutive weeks to one group and the other group continued to receive medical treatment. Hearing was assessed by performing pure tone audiogram before every ITDI and also at 12 weeks follow up after completion of treatment. Results Hearing improvement was found to be better in the group which received ITDI (Mean AC-PTA hearing gain = 22.88 dB) than the group where conventional medical treatment was continued (Mean AC-PTA hearing gain = 6.83 dB). Conclusion Intratympanic dexamethasone injection has significantly better outcome in term of improvement of hearing loss in resistant cases of OME than conventional medical management, and is an effective and safe therapy.

Randomised controlled clinical study to evaluate the efficacy of IV injection of caroverine and intratympanic steroid injection in the treatment of cochlear synaptic tinnitus with sensorineural hearing loss

<p class="abstract"><strong>Background:</strong> Cochlear synaptic tinnitus with sensorineural hearing loss (SNHL) is the most common type of subjective tinnitus. Many therapies were tried, but nothing is well proven to cure this. Hence, our present study aims to assess the efficacy of intravenous (IV) injection of caroverine and intratympanic steroid injection in treatment of cochlear synaptic tinnitus with SNHL.</p><p class="abstract"><strong>Methods:</strong> This study was carried out at the ear, nose and throat (ENT) department with 60 patients (22 male, 38 female) between the ages of 20 and 70 who had idiopathic tinnitus. Patients who met inclusion criteria were randomized by simple randomization and divided into two groups. The study group receives intratympanic dexamethasone, twice weekly for total three weeks and stat dose of IV caroverine. The control group receives an intratympanic isotonic solution with an IV caroverine placebo. Tinnitus handicap index (THI) score and pure tone averages (PTA) were done before treatment and in the first week, first month, and six months after completing the study protocol. </p><p class="abstract"><strong>Results:</strong> In the study group, pre-treatment results, and post-treatment first, sixth month THI scores, PTA results were different to a significant extent, whereas in the control group, the same scores were not different significantly. The THI scores between the groups revealed considerably lower scores in the first and six months for the study group. Successful treatment was defined as a decrease in PTA by 10 dB or more after six months.</p><p class="abstract"><strong>Conclusions:</strong> The effect of the intratympanic injection of dexamethasone along with IV injection of caroverine on the efficacy of treatment of tinnitus severity and improving hearing was statistically significant.</p>

Intratympanic steroid therapy for Bell’s palsy with poor prognostic results

In Bell’s palsy, electrodiagnosis by electroneurography (ENoG) is widely used to predict a patient’s prognosis. The therapeutic options for patients with poor prognostic results remain controversial. Here, we investigated whether early intervention with intratympanic steroid therapy (ITST) is an effective treatment for Bell’s palsy patients with poor electrodiagnostic test results (≤ 10% electroneurography value). Patients in the concurrent ITST group (n = 8) received the standard systemic dose of prednisolone (410 mg total) and intratympanic dexamethasone (16.5 mg total) and those in the control group (n = 21) received systemic prednisolone at the standard dose or higher (average dose, 605 ± 27 mg). A year after onset, the recovery rate was higher in the ITST group than in the control group (88% vs 43%, P = 0.044). The average House-Brackmann grade was better in the concurrent ITST group (1.13 ± 0.13 vs 1.71 ± 0.16, P = 0.035). Concurrent ITST improves the facial nerve outcome in patients with poor electroneurography test results, regardless of whether equivalent or lower glucocorticoid doses were administered. This may be ascribed to a neuroprotective effect of ITST due to a higher dose of steroid reaching the lesion due to dexamethasone transfer in the facial nerve.

N-Acetylcysteine Combined With Dexamethasone Treatment Improves Sudden Sensorineural Hearing Loss and Attenuates Hair Cell Death Caused by ROS Stress

Sudden sensorineural hearing loss (SSNHL) is a common emergency in the world. Increasing evidence of imbalance of oxidant–antioxidant were found in SSNHL patients. Steroids combined with antioxidants may be a potential strategy for the treatment of SSNHL. In cochlear explant experiment, we found that N-acetylcysteine (NAC) combined with dexamethasone can effectively protect hair cells from oxidative stress when they were both at ineffective concentrations alone. A clinic trial was designed to explore whether oral NAC combined with intratympanic dexamethasone (ITD) as a salvage treatment has a better therapeutic effect. 41 patients with SSNHL were randomized to two groups. 23 patients in control group received ITD therapy alone, while 18 patient s in NAC group were treated with oral NAC and ITD. The patients were followed-up on day 1st (initiation of treatment) and day 14th. Overall, there was no statistical difference in final pure-tone threshold average (PTA) improvement between those two groups. However, a significant hearing gain at 8,000 Hz was observed in NAC group. Moreover, the hearing recovery rates of NAC group is much higher than that in control group. These results demonstrated that oral NAC in combination with ITD therapy is a more effective therapy for SSNHL than ITD alone.