An International Journal of Otorhinolaryngology Clinics

Register      Login

VOLUME 14 , ISSUE 1 ( January-April, 2022 ) > List of Articles

RESEARCH ARTICLE

Safety of Intratympanic Dexamethasone to Treat Inner Ear Diseases

Inmaculada Moreno, Antonio Belinchon

Citation Information : Moreno I, Belinchon A. Safety of Intratympanic Dexamethasone to Treat Inner Ear Diseases. Int J Otorhinolaryngol Clin 2022; 14 (1):12-16.

DOI: 10.5005/jp-journals-10003-1425

License: CC BY-NC 4.0

Published Online: 22-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: Corticoids are often used in medicine, mainly for their anti-inflammatory properties. Although their action in the inner ear is not well known, they are employed to treat diseases like sudden hypoacusis or Ménière's disease with good results. Nowadays, the intratympanic (IT) delivery is frequently used as a treatment strategy to reduce the systemic secondary effects of corticoids. Administering IT dexamethasone (DXM) is considered a safe treatment and does not alter the hearing function. Objective: Demonstrate the safety of IT dexamethasone treatment at high doses over long periods. Materials and method: This study forms part of a clinical trial. The sample comprises a group of patients with neoplastic disease, managed by using cisplatin. The treatment protocol consists in applying a daily IT dexamethasone dose of 8 mg/24 hour for the time that chemotherapy treatment lasts. The auditory threshold was evaluated by tone audiometry. A basal examination was performed and, before each cisplatin cycle, both treated ears and control contralateral ears were explored. Results: Twenty-three patients were recruited with a mean age of 60 years. The mean IT dexamethasone treatment time, with a daily administered dose of 8 mg/mL, was 8.3 weeks, within a 2- to 18-week range and a median of 8 weeks. At the end of IT dexamethasone treatment, the difference between the mean auditory threshold between the treated and the control ears did not exceed 10 dB, which was considered to be clinically significant. Discussion: The safety of IT treatment with corticoids has been demonstrated in experimental studies with animals, in which hearing did not become worse. In the works performed with patients diagnosed with sudden hypoacusis or Ménière's disease and treated with IT dexamethasone, the incidence of hypoacusis related to treatment was very low, although the typical characteristics of these pathologies may have influenced the results (fluctuating hypoacusis or spontaneous improvement). The data obtained in our study about previously healthy ears showed no significant hearing alterations in the ears treated with IT dexamethasone, even after maintaining treatment for longer periods and at higher doses than those of previously published works. Conclusion: Using high doses of IT dexamethasone treatment for long periods does not lead to significant clinical hearing alterations in humans.


HTML PDF Share
  1. Spandow O, Anniko M, Hellström S. Hydrocortisone applied into the round window niche causes electrophysiological dysfunction of the inner ear. ORL J Otorhinolaryngol Relat Spec 1989;51(2):94–102. DOI: 10.1159/000276040.
  2. Alexiou C, Arnold W, Fauser C, et al. Sudden sensorineural hearing loss: does application of glucocorticoids make sense? Arch Otolaryngol Head Neck Surg 2001;127(3):253–258. DOI: 10.1001/archotol.127.3.253.
  3. Hamid M, Trune D. Issues, indications, and controversies regarding intratympanic steroid perfusion. Curr Opin Otolaryngol Head Neck Surg 2008;16(5):434–440. DOI: 10.1097/MOO.0b013e32830ce796.
  4. González R, Caro J. Intratympanic corticosteroids: a systematic review. Rev Otorrinolaringol Cir Cabeza Cuello 2007;67:178–185. DOI: 10.4067/S0718-48162007000200014.
  5. Yorgason JG, Luxford W, Kalinec F. In vitro and in vivo models of drug ototoxicity: studying the mechanisms of a clinical problem. Expert Opin Drug Metab Toxicol 2011;7(12):1521–1534. DOI: 10.1517/17425255.2011.614231.
  6. Plaza G. Tratamiento intratimpánico en la sordera súbita idiopática: Fundamentos farmacodinámicos y farmacocinéticos. En: Sordera súbita Diagnóstico y tratamiento. Madrid: ERGON; 2018. p. 197–215. ISBN: 978-84-17-19468-0.
  7. Shimazaki T, Ichimiya I, Suzuki M, et al. Localization of glucocorticoid receptors in the murine inner ear. Ann Otol Rhinol Laryngol 2002;111(12 Pt 1):1133–1138. DOI: 10.1177/000348940211101213.
  8. ten Cate WJ, Curtis LM, Rarey KE. Immunochemical detection of glucocorticoid receptors within rat cochlear and vestibular tissues. Hear Res 1992;60(2):199–204. DOI: 10.1016/0378-5955(92)90021-E.
  9. ten Cate WJ, Curtis LM, Small GM, et al. Localization of glucocorticoid receptors and glucocorticoid receptor mRNAs in the rat cochlea. Laryngoscope 1993;103(8):865–871. DOI: 10.1288/00005537-199308000-00007.
  10. Yildirim A, Coban L, Satar B, et al. Effect of intratympanic dexamethasone on noise-induced temporary threshold shift. Laryngoscope 2005;115(7):1219–1222. DOI: 10.1097/01.MLG.0000163748.55350.89.
  11. Zhou Y, Zheng G, Zheng H, et al. Primary observation of early transtympanic steroid injection in patients with delayed treatment of noise-induced hearing loss. Audiol Neurootol 2013;18(2):89–94. DOI: 10.1159/000345208.
  12. Calli C, Pinar E, Oncel S, et al. Recovery of hearing in Cisplatin-induced ototoxicity in the Guinea pig with intratympanic dexamethasone. Indian J Otolaryngol Head Neck Surg 2012;64(1):46–50. DOI: 10.1007/s12070-011-0160-7.
  13. Cesarani A, Capobianco S, Soi D, et al. Intratympanic dexamethasone treatment for control of subjective idiopathic tinnitus: our clinical experience. Int Tinnitus J 2002;8(2):111–114. PMID: 14763222.
  14. Araújo MFS, Oliveira CA, Bahmad FM. Intratympanic dexamethasone injections as a treatment for severe, disabling tinnitus: does it work? Arch Otolaryngol Head Neck Surg 2005;131(2):113–117. DOI: 10.1001/archotol.131.2.113.
  15. Bird PA, Murray DP, Zhang M, et al. Intratympanic versus intravenous delivery of dexamethasone and dexamethasone sodium phosphate to cochlear perilymph. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 2011;32(6):933–936. DOI: 10.1097/MAO.0b013e3182255933.
  16. Plontke SK, Biegner T, Kammerer B, et al. Dexamethasone concentration gradients along scala tympani after application to the round window membrane. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 2008;29(3):401–406. DOI: 10.1097/MAO.0b013e318161aaae.
  17. Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. Laryngoscope 1999;109(7 Pt 2):1–17. DOI: 10.1097/00005537-199907001-00001.
  18. Murphy D, Daniel SJ. Intratympanic dexamethasone to prevent cisplatin ototoxicity: a guinea pig model. Otolaryngol–Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 2011;145(3):452–457. DOI: 10.1177/0194599811406673.
  19. Hoffmann KK, Silverstein H. Inner ear perfusion: indications and applications. Curr Opin Otolaryngol Head Neck Surg 2003;11(5): 334–339. DOI: 10.1097/00020840-200310000-00005.
  20. ASHA. American Speech-Language Hearing Association. Audiologic management of individuals receiving cochleotoxic drug therapy, vol. 36. 1994; p. 11–19.
  21. Lavigne P, Lavigne F, Saliba I. Intratympanic corticosteroids injections: a systematic review of literature. Eur Arch Otorhinolaryngol 2016;273(9):2271–2278. DOI: 10.1007/s00405-015-3689-3.
  22. Patel M. Intratympanic corticosteroids in Ménière's disease: amini-review. J Otol 2017;12(3):117–124. DOI: 10.1016/j.joto.2017.06.002.
  23. Doyle KJ, Bauch C, Battista R, et al. Intratympanic steroid treatment: a review. Otol Neurotol 2004;25(6):1034–1039. DOI: 10.1097/00129492-200411000-00031.
  24. Hill GW, Morest DK, Parham K. Cisplatin-induced ototoxicity: effect of intratympanic dexamethasone injections. Otol Neurotol 2008;29(7):1005–1011. DOI: 10.1097/MAO.0b013e31818599d5.
  25. Chandrasekhar SS, Rubinstein RY, Kwartler JA, et al. Dexamethasone pharmacokinetics in the inner ear: comparison of route of administration and use of facilitating agents. Otolaryngol–Head Neck Surg 2000;122(4):521–528. DOI: 10.1067/mhn.2000.102578.
  26. Silverstein H, Isaacson JE, Olds MJ, et al. Dexamethasone inner ear perfusion for the treatment of Meniere's disease: a prospective, randomized, double-blind, crossover trial. Am J Otol 1998;19(2):196–201. PMID: 9520056.
  27. Arriaga MA, Goldman S. Hearing results of intratympanic steroid treatment of endolymphatic hydrops. Laryngoscope 1998;108 (11 Pt 1):1682–1685. DOI: 10.1097/00005537-199811000-00017.
  28. Sakata E, Itoh A, Itoh Y. Treatment of cochlear-tinnitus with dexamethasone infusion into the tympanic cavity. Int Tinnitus J 1996;2:129–135. PMID: 10753351.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.