ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Optimal Usage of Intratympanic Drug Therapy for Sudden Hearing Loss Unclear

by David Bronstein • January 1, 2013

  • Tweet
  • Email
Print-Friendly Version

Multiple studies have shown that intratympanic (IT) drug therapy can be safe and effective for treating idiopathic sudden sensorineural hearing loss (ISSNHL) in adults. However, beyond those broad outcomes, the literature gets a bit opaque. Among the management issues that lack consensus among researchers are optimal patient selection, the best dosage and duration of therapy and the most effective drugs to use. And, while new ISSNHL treatment guidelines have shed some light on the role IT drug therapy should play in treating the condition, questions—and controversies—still remain.

You Might Also Like

No related posts.

Explore This Issue
January 2013

To gain more insight into how clinicians can interpret these results and use IT drug therapy optimally in their ISSHNL patients, ENTtoday spoke with several leading experts, including Richard K. Gurgel, MD, assistant professor in the division of otolaryngology-head and neck surgery at the University of Utah Health Care in Salt Lake City, who has extensive practice experience offering IT drug therapy to his patients with the disorder.

To best understand how and why IT drugs work, it is necessary to realize that “the term ‘intratympanic’ is something of a misnomer because it only describes the route of administration,” Dr. Gurgel told ENTtoday. “What we’re really accomplishing with this modality is inner-ear perfusion of medications into the inner ear via the transtympanic route.”

Before the advent of this approach, “there was no reliable method for altering the pathophysiology of the inner ear without destroying it or obliterating its normal function,” he said. With IT drug therapy, medication can be injected into the middle ear space, where it then travels by diffusion into the inner ear and acts upon structures that govern hearing. “This really is a very elegant, compelling modality,” Dr. Gurgel said, adding that it also has rigorous science to support it. In one study, researchers found that perilymph steroid concentrations were significantly higher after IT steroid therapy than after systemic steroid administration (Laryngoscope. 1999;109(7, Pt 2):1-17).

Impact on Disease

In reviewing the literature on the impact IT drug therapy has on actual disease, a less clear picture emerges, said Dr. Gurgel. “Most clinical studies are retrospective, single-institution studies with small patient numbers lacking adequate controls. The design, outcome measures and efficacy results of most studies tend to be all over the map.”

But there are some studies that do offer some useful insights, he added. He pointed to a 2011 study by Rauch and colleagues published in JAMA that he feels is one of the best-designed trials of its type. The prospective, randomized study compared oral versus IT steroid therapy for ISSNHL and found that both modalities were equivalent in the amount of improvement they achieved in final pure tone average (PTA), word recognition scores and other key measurements of hearing recovery (2011;305:2071-2079).

Pages: 1 2 3 4 | Single Page

Filed Under: Departments, Otology/Neurotology, Practice Focus, Special Reports Tagged With: hearing loss, intratympanic drug therapy, treatmentIssue: January 2013

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Some Studies Predict a Shortage of Otolaryngologists. Do the Numbers Support Them?
    • Vertigo in the Elderly: What Does It Mean?
    • Complications for When Physicians Change a Maiden Name
    • Neurogenic Cough Is Often a Diagnosis of Exclusion
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • Tympanoplasty Tips: Otology Experts Give Advice on the Procedure
    • How Treatment for Obstructive Sleep Apnea (OSA) Is Evolving to Give Patients a Better Night’s Sleep
    • Vestibular Schwannoma Position Relative to Internal Auditory Canal Helps Predict Postoperative Facial Function
    • Vocal Fold Lipoaugmentation Provides Long-Term Voice Improvements for Glottal Insufficiency
    • Upper Lateral Cartilage Mucosal Flap Enables the Successful Closure of Larger Septal Perforations

Polls

Do you think there will be a shortage of otolaryngologists in the next five to 10 years?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2022 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.