Possibilities in the Therapy of Sudden Hearing Disorders

Overview

Sudden hearing disorders are defined as deterioration of hearing at three adjacent frequencies by 30 dB in tone audiometry, which last more than 3 days. Sudden sensorineural hearing disorders of cochlear type are at the present time treated in a standard combination of several therapies (hyperbaroxytherapy, vasodilatation therapy, systemic administration of corticoids, ad local administration of corticoids). At the KDORL Clinic, Faculty Hospital Brno and Medical Faculty MU we have performed the therapy of sudden sensorineural hearing disorders by the administration of corticoids in a form of drops via a tympanostomy tube (with introduced porous wick via tube lumen) directly into the area of oval window. At the child age the hearing disorder (also a heavy unilateral one) exerts a significant effect on the learning performance of the child and other societal fulfillment. For a low efficiency and compliance of the patient is the indication of presently available therapy frequently questionable. Local administration of corticoids into the tympanus cavity with penetration through the oval window into the inner ear provides, according to many studies, manifold higher corticoid levels in perilymph and, at the same time, there are several-fold lower systemic concentrations as compared with systemic administration. (2) It is possible to use higher dosages and to administer them for a longer period of time than those with systemic administration are common without the risk of untoward general side effects. After a local administration of corticoids some studies have made it clear that hearing improvement was better than those after systemic administration. (7). Therapy is often efficient and safe also in cases of previous unsuccessful therapy with systemic administration of corticoids. The administration of corticoids in the form of drops via tympanostomy tube with an administered wick (9) enables only two short-term applications of general anesthesia, at the adult age two interventions in local anesthesia which are necessary for introduction and subsequent removal of the tube. The introduced wick is the source of continuous input of corticoid solution into the area of oval window. The administration of drops 3 times daily without the need of going to the doctor provides, for a long time (for the period of 4 weeks) a continuous corticoid level in inner ear, increases the patient’s comfort, is of more advantage from the time point of view and decreases general cost of therapy as compared with other forms of corticoid administration.

Key words:
sudden hearing disorder, local corticoid therapy.