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Sains Malaysiana 47(11)(2018): 2777–2782 http://dx.doi.org/10.17576/jsm-2018-4711-20
Intratympanic Methylprednisolone
Injection in Idiopathic Sudden Sensorineural Hearing Loss after
Failure of Systemic Corticosteroid Therapy (Suntikan Metilprednisolon Intratimpanum
dalam Idiopati Kurang Pendengaran Sensorineuron Mengejut selepas
Kegagalan Terapi Kortikosteroid Sistemik) HO HON
LIAN1,3,
RUSZYMAH
BINTI IDRUS2, LOKMAN BIN SAIM1
& AMINUDDIN BIN SAIM1,3* 1KPJ Healthcare University College,
Lot PT 17010, Persiaran Seriemas, Kota Seriemas, 71800 Nilai,
Negeri Sembilan Darul Khusus, Malaysia 2Department of Physiology, UKM Medical
Faculty, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala
Lumpur, Federal Territory, Malaysia 3Department of Otorhinolaryngology
Head and Neck Surgery, KPJ Ampang Puteri Specialist Hospital,
Jalan Mamanda 9, Taman Ahmad Razali, Ampang Jaya, 68000 Ampang,
Selangor Darul Ehsan, Malaysia Received: 28 March 2018/Accepted:
30 July 2018 ABSTRACT Idiopathic sudden sensorineural
hearing loss (ISSNHL) is considered to be an
otological emergency. The intratympanic (IT) steroid injection technique
is introduced to decrease the side effects of systemic steroids
and assumed to deliver a higher concentration of corticosteroids
into the affected cochlea. The objective of the current study
was to evaluate the hearing outcomes of high dose IT methylprednisolone among ISSNHL patients
after failure of systemic corticosteroid therapy (SCT).
Hearing outcomes of SCT were evaluated over a 15 months period.
Upon failure of SCT, the treatment was continued with
higher dose IT steroid (methylprednisolone 62.5 mg/mL). Pre-treatment
and post-treatment audiometric evaluations were analysed using
pure tone audiogram (PTA). There were 36 patients diagnosed with ISSNHL
included in the study. After two weeks of SCT,
eighteen (56.3%) patients had hearing improvement of more than
10 dB. Another fourteen (43.7%) patients had no hearing improvement
(less than 10 dB). Following that, twelve patients were recruited
for weekly IT methylprednisolone
for three weeks. During the one month follow up after completion
of IT
therapy, six patients (50%) showed more than 10
dB improvement in the PTA with
a mean of 19.37 dB (p<0.05). Out of the six, two patients had more than 20 dB hearing
improvement. Almost all patients in this study had an improvement
in their symptoms of tinnitus and vertigo. High dose IT methylprednisolone
after failure of SCT resulted in significant improvement
in the patients’ hearing outcome during one month follow up. The
IT
therapy not only improved the patients’ hearing
but in addition reduced the symptoms of tinnitus and vertigo.
Keywords: Intratympanic; methylprednisolone;
sudden hearing loss ABSTRAK Kehilangan pendengaran sensorineuron
mengejut idiopati (ISSNHL) dianggap sebagai kecemasan
otologi. Teknik suntikan steroid intratimpanum (IT)
diperkenalkan untuk mengurangkan kesan sampingan steroid sistemik
dan diandaikan memberi tumpuan yang lebih tinggi daripada kortikosteroid
ke koklea yang terjejas. Objektif kajian adalah untuk menilai
hasil pendengaran dos yang tinggi metilprednisolon IT dalam kalangan pesakit ISSNHL
selepas kegagalan terapi sistemik kortikosteroid
(SCT).
Laporan hasil SCT telah dinilai dalam tempoh 15 bulan. Atas kegagalan
SCT,
rawatan diteruskan dengan dos IT steroid yang tinggi (metilprednisolon
62.5 mg/mL). Penilaian pra dan pasca rawatan audiometrik dianalisis
menggunakan audiogram bernada tulen (PTA).
Terdapat 36 pesakit yang didiagnosis dengan ISSNHL terlibat
dalam kajian ini. Selepas dua minggu SCT, lapan belas (56.3%) pesakit
mempunyai peningkatan pendengaran melebihi 10 dB. Empat belas
(43.7%) pesakit lain tidak mempunyai sebarang kemajuan pendengaran
(kurang daripada 10 dB). Berikutan itu, dua belas pesakit telah
diambil bekerja untuk mingguan IT
metilprednisolon selama tiga minggu. Pada bulan
pertama susulan selepas selesai terapi IT,
enam pesakit (50%) menunjukkan lebih daripada 10 dB peningkatan
dalam PTA
dengan min 19.37 dB (p<0.05). Daripada enam, dua pesakit mempunyai lebih daripada
20 dB penambahbaikan pendengaran. Hampir semua pesakit dalam kajian
ini menunjukkan penambahbaikan dalam mereka gejala tinitus dan
vertigo mereka. Dos tinggi IT
metilprednisolon selepas kegagalan SCT telah mengakibatkan peningkatan yang
ketara dalam keputusan pendengaran pesakit sepanjang sebulan susulan.
Terapi IT bukan sahaja memperbaiki pendengaran pesakit tetapi mengurangkan
gejala tinitus dan vertigo. Kata kunci: Intratimpanum; metilprednisolon; kehilangan pendengaran
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