Maintenance Intratympanic Dexamethasone Therapy for Endolymphatic Hydrops
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- Category: Vol. 84, June 2016
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Maintenance Intratympanic Dexamethasone Therapy for Endolymphatic Hydrops, WAEL A. ALZAMIL, ESSAM FATHY, MOHAMMED EL-SHABBOURY and SAID ABD EL-MONEM
Abstract
Background: Steroids have been generally administered orally and parenterally in clinical practice to treat inner ear disorders. Due to a considerable unwanted side effects and complications of enteral or parenteral steroids, intratympanic root, as an alternative way proved efficacy with minimal side effects. Many patients accepted intratympanic dexamethasone injection as the first option due to its fair responsiveness and temporary relief of vertigo, also its advantage of preserving the structures of the inner ear so that inner ear changes may be reversible.
Aim of the Work: In this study, we aimed to measure the results and outcome of maintenance strategy of intratympanic dexamethasone injections in the treatment of patients with endolymphatic hydrops.
Methods: A retrospective study conducted from January 2012 to March 2015 including 25 outpatients (18 left ear, 5 right ear and 2 bilateral) at the Department of Otolaryngology Hearing and Speech Institute with a clinical diagnosis of definite Meniere's disease according to the diagnostic scale of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). The intratympanic steroid injection procedure was performed in the outpatient clinic for all patients using a binocular microscope after informed consent. Intra tympanic injections were done once weekly for 2 weeks and then after 2 weeks, after 1 month, and then every 3-4 months as maintenance therapy.
Results: Detailed history and vestibular functions measured by Vestibular Ocular Reflex (VOR) gain and caloric test showed improvement of the episodic attacks of vertigo in 20 patients (80%) after the first injection of dexamethasone and complete improvement in 24 patients (96%) after the 2nd injection and there after. There was no recurrence of vertigo during the maintenance therapy. Meanwhile, audiology data suggests that during the episodic attacks of vertigo, 11 patients (44%) who gave history of more hearing deterioration or fluctuant hearing loss, this complaint has dramatic improve-ment in 9 patients (36% of all patients) or 81% of patients with this particular symptom, after the 1st injection, and relief in 10 of the complaining patients after the 2nd injection. There was no hearing deterioration after the start of and during the maintenance intratympanic steroid therapy. Furthermore, the symptom of tinnitus, 1 patient (4%) said that tinnitus has been stopped. The tinnitus decreased in 3 (12%) patients and un-changed in 21 (84%) patients. The tinnitus did not aggravate in any patient after or during the therapy. In 20 patients (80%) aural fullness showed marked improvement after the second injection and markedly diminished in 22 patients (88%) after the 4th injection. No recurrence of fullness during the main-tenance therapy. One patient in the study was complaining of (distressing and risky) drop attacks or otolith crisis along his coarse of the disease, fortunately, this symptom disappeared after starting the therapy and didn't recur thereafter. There was no reported complications in our study.
Previous data conclude that maintenance intratympanic dexamethasone may represent an effective treatment for endolymphatic hydrops, in addition to its safety regarding the side effects that may complicate systemic steroids or ablative treatment. These results are similar to results in other previous studies in addition, the maintenance itself provides prevention of symptom deterioration and recurrence.