Hearing Changes After Intratympanic Steroids for Secondary (Salvage) Therapy of Sudden Hearing Loss: A Meta-Analysis Using Mathematical Simulations of Drug Delivery Protocols
| Autor: | Olivia Pogorzelski, Arne Liebau, Stefan K. Plontke, Alec N. Salt |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Hearing loss Hearing Loss Sensorineural MEDLINE Salvage therapy Methylprednisolone Article Dexamethasone 03 medical and health sciences 0302 clinical medicine Hearing Intratympanic Injections otorhinolaryngologic diseases Humans Medicine Computer Simulation 030223 otorhinolaryngology Glucocorticoids Salvage Therapy Injection Intratympanic business.industry Hearing Loss Sudden Middle Aged Sensory Systems Sudden Hearing Loss Catheter Treatment Outcome Otorhinolaryngology Anesthesia Meta-analysis Drug delivery Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Otology & Neurotology. 39:803-815 |
| ISSN: | 1537-4505 1531-7129 |
| DOI: | 10.1097/mao.0000000000001872 |
| Popis: | OBJECTIVE: The use of glucocorticoids for secondary (salvage/rescue) therapy of idiopathic sudden hearing loss (ISSHL), including controlled and uncontrolled studies with intratympanic injections or continuous, catheter mediated applications, were evaluated by means of a meta-analysis in an attempt to define optimal local drug delivery protocols for ISSHL. STUDY DESIGN: A total of 30 studies with 33 treatment groups between January 2000 and June 2014 were selected based on sufficiently detailed description of application protocols. Cochlear drug levels were calculated by a validated computer model of drug dispersion in the inner ear fluids based on the concentration and volume of glucocorticoids applied, the time drug remained in the middle ear, and on the specific timing of injections. Various factors were compared with hearing outcome, including baseline data, individual parameters of the application protocols, calculated peak concentration (C(max)), and total dose (Area under the curve, AUC). RESULTS: There was no dependence of hearing outcome on individual parameters of the application protocol, C(max) or AUC. Hearing gain and final hearing thresholds were independent of treatment delay. CONCLUSION: Based on the available data from uncontrolled and controlled randomized and non-randomized studies no clear recommendation can be made so far for a specific application protocol for either primary or secondary (salvage) intratympanic steroid treatment in patients with ISSHL. For meta-analyses, change in pure tone average (PTA) may not be an adequate outcome parameter to assess effectiveness of the intervention especially with inhomogeneity of patient populations. Final PTA might provide a better outcome parameter. |
| Databáze: | OpenAIRE |
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