简介：ObjectiveToevaluatetheeffectofdifferentprotocolsofintratympanicdexamethasoneinjectioninpatientswithunilateralsuddensensorineuralhearingloss(SSNHL)whohavefailedtorespondtotypicalmedicaltreatment(includingsystemicsteroidtreatment).MethodsFromJanuary2005toJanuary2008,71patientswhowerediagnosedwithunilateralSSNHLandfailedtypicalmedicaltreatmentreceivedintratympanicdexamethasoneinjection.Fourinjectionprotocolswereemployed:injectionof0.3mldexamethasone(5mg/ml)threetimesaweekfor3weeksforatotaldoseof13.5mg(GroupI,n=16);injectionof0.6ml(5mg/ml)dexamethasonethreetimesaweekfor3weeksforatotaldoseof27mg(GroupII,n=18);injectionat0.3ml(5mg/ml)weekfor6weeksforatotaldoseof9mg(GroupIII,n=18);injectionat0.3ml(5mg/ml)/2daysforatotaldoseof4.5mg(GroupIVn=19).Hearingrecoverywasassessedbypuretoneaudiogram.ResultsThetotaleffectiveratewas37.5%,38.89%,33.33%and36.84%foreachtreatmentprotocol,respectively,withnostatisticaldifferencebetweenthem(P>0.05).Theresultssuggestthatatotaldoseof4.5mg(injectedonceaweekfor3weeks)isthemostadequateprotocol,andincreasingdoseorinjectionfrequencyyieldsnoadditionalbenefits.ConclusionIntratympanicdexamethasonesignificantlyimprovestheprognosisofSSNHL.Smalldoseatlowinjectionfrequencyissufficient.Furthermulticenterstudiesareneededtodeterminethestandardtreatmentprotocol.

简介：ThisarticlereviewstheeffectivenessofintratympaniccorticosteroidsforvertigocontrolinM_eni_ere'sdiseaseat2-yearsfollow-upaccordingtotheguidelinesexpressedbytheAmericanAcademyofOtolaryngology-Head&NeckSurgery.DespitetheincreaseduseofintratympaniccorticosteroidsforvertigocontrolinM_eni_ere'sdiseasethereisdebateastotheireffectiveness,particularlycomparedtogentamicin.Evenso,afterjustasinglecourseofinjections,corticosteroidscanreliablyprovidecompletevertigocontrol(ClassA)at2-yearsinabout50%ofcasesasindicatedinarecentdouble-blindrandomizedcontrolledclinicaltrial(Pateletal.,2016).Buttheeffectivenessofintratympaniccorticosteroidstrulyincreaseswhentreatmentisprovided'as-needed',wherebycompletevertigocontrolisestablishedinupto91%ofcases.Onthebasisofavailableliterature,thereisgoodevidencetorecommendtheuseofintratympanicsteroidtreatmentforvertigocontrolinM_eni_ere'sdisease,butpatientsmustbemonitoredfornon-response.Therationalefortreatingpatientsas-neededandthepossiblereasonsforcorticosteroidnonresponsearediscussed.

简介：Objective:ToevaluatetheefficacyandsafetyofintratympanicandsystemicsteroidtherapiesintheinitialtreatmentofSuddenSensorineuralHearingLoss(SSNHL)patients.Methods:AcomprehensivesearchofPubMed,WanfangdatabaseandCNKI(ChinaNationalKnowledgeInfrastructure)wasperformedcoveringtheperiodfromJanuary1990toJuly2014.Ameta-analysiswasconductedafterfilteringbythecriteriaofCochraneCollaboration.Threehundredfiftysixsubjectsinninestudiesallocatedtothegroupofintratympanicsteroidtherapiesand343controlsreceivingsystemicsteroidtherapiesmetthecriteriaformeta-analysis.ThedatawereextractedandanalyzedusingtheRevMan5.3meta-analysissoftware.Results:ThetotaleffectivenessrateinSSNHLpatientsreceivingintratympanicsteroidtherapiesdidnotdifferstatisticallyfrompatientsreceivingsystemictherapies(RR=1.08,95%CI=0.99-1.99,P=0.10),althoughtherateoffullhearingrecoveryinthisgroupdifferedsignificantlyfrompatientsreceivingsystemictherapies(RR=1.29,95%CI=1.00-1.66,P=0.05).Conclusion:LocalsteroidtherapyappearstogeneratehigherrateofcompletehearingrecoverythansystemicsteroidtreatmentasaninitialtreatmentforSSNHL,whichmaybeespeciallyusefulforpatientsinwhomsystemicsteroidsarecontraindicated.

简介：Togaininsightsintotheototoxiceffectsofaminoglycosideantibiotics(AmAn)anddelayedperipheralganglionneurondeathintheinnerear.experimentalanimalmodelswerewidelyusedwithseveraldifferentapproachesincludingAmAnsystemicinjections,combinationtreatmentofAmAnanddiuretics,orlocalapplicationofAmAn.Intheseapproaches,systemicAmAntreatmentaloneusuallycausesincompletedamagetohaircellsintheinnerear.Co-administrationofdiureticandAmAncancompletelydestroythecochlearhaircells,butitisimpossibletodamagethevestibularsystem.OnlytheapproachofAmAnlocalapplicationcanselectivelyeliminatemostsensoryhaircellsintheinnerear.Therefore,AmAnlocalapplicationismoresuitableforstudiesforcompletehaircelldestructionsincochlearandvestibularsystemandthefollowingdelayedperipheralganglionneurondeath.Incurrentstudies,guineapigswereunilaterallytreatedwithahighconcentrationofgentamicin(GM,40nig/ml)throughthetympanicmembraneintothemiddleearcavity.AuditoryfunctionsandvestibularfunctionsweremeasuredbeforeandafterGMtreatment.Thelossofhaircellsanddelayeddegenerationofganglionneuronsinbothcochlearandvestibularsystemwerequantified30daysor60daysaftertreatment.TheresultsshowedthatbothauditoryandvestibularfunctionswerecompletelyabolishedafterGMtreatment.Thesensoryhaircellsweretotallymissinginthecochlea,andseverelydestroyedinvestibularend-organs.Thedelayedspiralganglionneurondeath60daysafterthedeafeningprocedurewasover50%.However,noobviouspathologicalchangeswereobservedinvestibularganglionneurons60dayspost-treatment.Theseresultsindicatedthatahighconcentrationofgentamycindeliveredtothemiddleearcavitycandestroymostsensoryhaircellsintheinnerearthatsubsequentlycausesthedelayedspiralganglionneurondegeneration.Thismodelmightbeusefulforstudiesofhaircellregenerations,delayeddegenerationofperipheralauditoryne