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Intratympanale Injektionstherapie bei therapierefraktärem Hörsturz

Eine sichere Therapieoption zur Sekundärtherapie

Intratympanic injection therapy for therapy refractory acute hearing loss

A safe option for secondary treatment

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Zusammenfassung

Hintergrund

Aktuell wird die Behandlung des Hörsturzes mit hoch dosierten Kortikosteroidgaben empfohlen. Insbesondere bei therapieresistenten Hörstürzen gewinnt die intratympanale Injektionstherapie (ITI) zunehmend an Bedeutung. Die genaue Abgrenzung der Indikation ist insbesondere beim Hörsturzereignis bislang noch nicht hinreichend untersucht.

Studiendesign

77 Patienten mit einem akuten pantonalen Hörverlust wurden nach nicht effektiver systemischer Vorbehandlung mit intratympanaler Gabe von Dexamethason und Hyaluronsäure therapiert. Die Verbesserung wurde durch Reintonaudiometrie beider Ohren vor Therapie und des betroffenen Ohrs nach Therapie bestimmt.

Ergebnisse

Die Patienten (34 w, 43 m) wiesen einen Altersdurchschnitt von 57 Jahren und vor Beginn der ITI einen Hörverlust von 35 dB im Tiefton- bis 69 dB im Hochtonbereich auf. Der mittlere Hörgewinn betrug 10 dB, die Ansprechrate 62 %. In der Auswertung des absoluten Hörgewinns zeigten sich signifikante Ergebnisse bei 500 Hz, 1 und 2 kHz. In der Einbeziehung des Hörvermögens vom Gegenohr fanden sich kaum Unterschiede bis 4 kHz, in der Einzelbetrachtung der verbesserten Patienten waren auch in den hohen Frequenzen gute Verbesserungsraten zu beobachten. Relevante unerwünschte Wirkungen traten nicht auf.

Schlussfolgerung

Die Behandlung des therapieresistenten Hörsturzes erfährt mit der intratympanalen Gabe von Steroiden eine Option, die dem betroffenen Patienten zusätzliche Chancen auf Hörverbesserung ermöglicht. Die vorliegenden Ergebnisse geben Hinweise, dass diese Modalitäten in analoger Weise für Patienten mit pantonalem Hörsturzereignis gelten.

Abstract

Background

High-dose corticosteroids are currently recommended for idiopathic sudden sensorineural hearing loss (ISSNHL) treatment. Intratympanic injections (ITI) are of growing importance, especially in cases of therapy resistance. The selection of patients for this procedure in SSNHL has not been adequately examined so far.

Study design

A total of 77 patients with ISSNHL after ineffective systemic pretreatment underwent intratympanic administration of dexamethasone and hyaluronic acid. Improvement after treatment was determined by pure tone audiometry for both ears before and of the treated ear after ITI.

Results

In this study 34 female and 43 male patients with mean age of 57 years showed a pre-ITI hearing loss of 35 dB in the lower frequencies and 69 dB in the higher frequencies. The mean hearing gain was 10 dB and the response rate was 62 %. Absolute hearing gain revealed significant improvements at 500 Hz, 1 kHz and 2 kHz. Under inclusion of contralateral thresholds there were hardly any differences up to 4 kHz. In a detailed analysis of responders moderate improvements could be observed even in higher frequencies. Overall, no relevant adverse events occurred.

Conclusion

Treatment of ISSNHL resistant to systemic regimens by ITI of steroids provides an option that offers additional prospects of auditory improvement for affected patients. The presented results indicate that these modalities are also valid for patients with pancochlear ISSNHL.

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Authors and Affiliations

  1. Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    G. Mühlmeier, S. Maier & H. Maier

  2. Hals-Nasen-Ohren-Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    M. Maier

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  1. G. Mühlmeier
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Correspondence to G. Mühlmeier.

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Interessenkonflikt

G. Mühlmeier, S. Maier, M. Maier und H. Maier geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Mühlmeier, G., Maier, S., Maier, M. et al. Intratympanale Injektionstherapie bei therapierefraktärem Hörsturz. HNO 63, 698–706 (2015). https://doi.org/10.1007/s00106-015-0067-9

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