Intratympanic steroid delivery by an indwelling catheter in refractory severe sudden sensorineural hearing loss

Objective: Many studies over the last decade showed favorable outcomes with intratympanic (IT) steroid treatment, alone as salvage treatment or in combination with conventional systemic therapy (ST). However, in severe to profound sensorineural hearing loss resistant to ST, the optimal infusion mode, the type and concentration of the solution, the preferable drug, its total amount, and the duration and fractionation of the treatment are still debated. Aim of the study was to investigate the feasibility and the outcomes of a direct and constant IT delivery of dexamethasone (DEX) by means of a new indwelling catheter. Methods: A prospective case-control study in a tertiary referral university hospital. Ninety-nine subjects treated with ST only and 28 with additional IT DEX have been included in the study. A 4 Fr catheter inserted in a sub-annular fashion with a minimal postero-inferior tympanotomy through and endocanalar approach under local anesthesia. DEX 4 mg/ml delivered daily, up to 7 days. Daily bone and air-conducted pure tone and speech audiometry were performed with a follow-up at 1, 3, 6 months after treatment. Results: Twenty-one out of 28 patients (75%) refractory to ST gained on average 24.0 dB +/- 20.5 dB HL after IT-DEX, compared to 35.4% (average 6.7 dB +/- 16.6 dB HL) of those receiving only medical ST (p < 0.001). No significant side effects were noted. Conclusion: In severe to profound sudden deafness refractory to conventional ST, the daily perfusion of 4 mg/ml DEX through an intratympanic catheter is an easy, well accepted procedure that enables patients to receive a drug in the middle ear in a repeatable or sustained form, with minimal discomfort and a partial rescue (67.86%) and a speech recognition gain of 39%. (C) 2017 Elsevier B.V. All rights reserved.