- Original article
- Open Access
The effect of direct application of dexamethasone on the round window membrane in patients with sudden sensorineural hearing loss
The Egyptian Journal of Otolaryngology volume 33, pages631–636(2017)
The aim of this study was to test the effect of direct application of dexamethasone on the round window (RW) after its adequate exposure following a transcanal approach in patients with sudden sensorineural hearing loss (SSNHL).
This investigation was designed to be a prospective cohort study.
Patients and methods
This study included eighteen adult patients with SSNHL who attended our outpatient clinic at Alexandria Main University Hospital between 1 July 2015 and 1 July 2016. Under general anesthesia the small tympanomeatal flap was elevated to visualize the RW. If it was fully exposed, dexamethasone (4 mg/ml) was applied directly over a piece of gel foam; if not fully exposed the overhang was removed first and then dexamethasone was applied. After 2 weeks, a repeat audiogram was taken in all patients in order to evaluate the efficacy of the treatment on their hearing ability.
Post-treatment assessment revealed 50% of patients with variable levels of improvement, whereas 50% did not respond to the given treatment. Of the patients showing improvement, 16.7% had normal hearing levels restored. Thus, direct application of dexamethasone on the RW membrane after its adequate exposure may reverse the hearing deficits in a few patients with SSNHL.
There is a definitive improvement in hearing in patients with SSNHL on direct application of dexamethasone on the RW membrane after its adequate exposure in patients.
Na SY, Kim MG, Hong SM, Chung JH, Kang HM, Yeo SG. Comparison of sudden deafness in adults and children. Clin Exp Otorhinolaryngol 2014; 7:165–169.
Chau JK, Lin JR, Atashband S, Irvine RA, Westerberg BD. Systematic review of the evidence for the etiology of adult sudden sensorineural hearing loss. Laryngoscope 2010; 120:1011–1021.
Lee SH, Choi SK, Lim YJ. Otologic manifestations of acoustic neuroma. Acta Otolaryngol 2015; 135:140–146.
Stachler RJ, Chandrasekhar SS, Archer SM. Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg 2012; 146(3 Suppl):S1–S35.
Kim YH, Park KT, Choi BY. Early combination treatment with intratympanic steroid injection in severe to profound sudden sensorineural hearing loss improves speech discrimination performance. Eur Arch Otorhinolaryngol 2012; 269:2173–2178.
Fu Y, Zhao H, Zhang T, Chi F. Intratympanic dexamethasone as initial therapy for idiopathic sudden sensorineural hearing loss: clinical evaluation and laboratory investigation. Auris Nasus Larynx. 2011; 38:165–171.
Alexander TH, Harris JP. Incidence of sudden sensorineural hearing loss. Otol Neurotol 2013; 34:1586–1589.
Rarey KE, Luttge WG. Presence of type I and type II/IB receptors for adrenocorticosteroid hormones in the inner ear. Hear Res 1989; 41:217–221.
Hargunani CA, Kempton JB, DeGagne JM, Trune DR. Intratympanic injection of dexamethasone: time course of inner ear distribution and conversion to its active form. Otol Neurotol 2006; 27:564–569.
Sun JJ, Liu Y, Kong WJ. In vitro permeability of round window membrane to transforming dexamethasone with delivery vehicles – dosage estimation. Chin Med J (Engl) 2007; 120:2284–2289.
Harris JP. Inner ear medicine: targeted therapy. Editorial. Audiol Neurootol 2009; 14:349.
Goycoolea MV. Clinical aspects of round window membrane permeability under normal and pathological conditions. Acta Otolaryngol 2001; 121:437–447.
Byl FM Jr Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope 1984; 94:647–661.
Wu CS, Lin HC, Chao PZ. Sudden sensorineural hearing loss: evidence from Taiwan. Audiol Neurootol 2006; 11:151–156.
Bogaz EA, Maranhao ASA, Inoue DP, Suzuki FAB, Penido NO. Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss. Braz J Otorhinolaryngol 2015; 81:520–526.
Ben-David J, Luntz M, Podoshin L. Vertigo as a prognostic sign in sudden sensorineural hearing loss. Int Tinnitus J 2002; 8:127–128.
Marcucci R, Alessandrello Liotta A, Cellai AP. Cardiovascular and thrombophilic risk factors for idiopathic sudden sensorineural hearing loss. J Thromb Haemost 2005; 3:929–934.
Ullrich D, Aurbach G, Drobik C. A prospective study of hyperlipidemia as a pathogenic factor in sudden sensorineural hearing loss. Eur Arch Otolarhinolaryngol 1992; 249:273–276.
Chang NC, Ho KY, Kuo WR. Audiometric patterns and prognosis in sudden sensorineural hearing loss in Southern Taiwan. Otolaryngol Head Neck Surg 2005; 133:916–922.
Silverstien H, Choo D, Rosenberg SI, Kuhun J, Seidman M, Stein I. Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report). Ear Nose Throat J 1996; 75:468–471.
Loader B, Atteneder C, Kaider A, et al. Tympanotomy and sealing of the round window membrane in sudden sensorineural hearing loss. HNO 2013; 61:314–320.
Salt AN, King EB, Hartsock JJ, Gill RM, O’leary SJ. Marker entry into vestibular perilymph via the stapes following applications to the round window niche of guinea pigs. Hear Res 2012; 283:14–23.
Gouveris H, Selivanova O, Mann W. Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy. Eur Arch Otorhinolaryngol 2005; 262:131–134.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
About this article
Cite this article
Abdel Baki, F.A., Omran, A.A., Asal, S.I. et al. The effect of direct application of dexamethasone on the round window membrane in patients with sudden sensorineural hearing loss. Egypt J Otolaryngol 33, 631–636 (2017). https://doi.org/10.4103/ejo.ejo_49_17
- round window
- sudden hearing loss