Sealing of the round and oval window niches with triamcinolone-soaked fascia as salvage surgical therapy in sudden sensorineural hearing loss

Abstract

Conclusions: Triamcinolone-soaked fascia seems to show better hearing improvement when added to tympanotomy for sudden idiopathic sensorineural hearing loss (SSHL), compared to fascia round window occlusion without triamcinolone.

Objectives: To analyse if adding triamcinolone to sealing the round and oval window niches with fascia results in improved audiological outcome for acute SNHL.

Methods: Fifty-three patients (27m:43 ± 12 years, 26f:45 ± 14 years) with acute SSHL ≥50dB over 3 frequencies, who failed primary therapy, underwent transcanal tympanotomy. Twenty-five patients (Group A;cortisone:14m, 11f:46 ± 9 years) received sealing of the round and oval window with fascia soaked in triamcinolone (1ml; 40mg/ml) and 28 controls (Group B;no-cortisone:13m, 15f, 42 ± 12 years) without triamcinolone. Frequency specific and pure tone average (PTA =500–1000–2000–3000Hz) results were compared between Group A and B pre- and postoperatively.

Results: In Group A the PTA improved by ≥10dB in 21/25(83%) cases; in Group B 18/28(63%). Group A showed a statistically significantly better improvement across all frequencies, while linear regression revealed a significant decrease of posttherapeutic PTA to 94.96% of the initial PTA (p = .037). The overall PTA improved by 24dB. Group A improved from 73dB to 41dB(-32dB) PTA, Group B improved from 76dB to 56dB PTA (-20dB) (p < .05). Group A showed a significant additional decrease of 12.8dB (p < .001).

Chinese abstract

结论: 与没有曲安奈德的筋膜圆窗闭塞相比, 为治疗突发特发性感觉神经性听力损失 (SSHL), 当将曲安奈德浸泡的筋膜加入鼓室切开术中, 它似乎显现出更好的听力改善作用。

目的: 分析如果添加曲安奈德来密封带筋膜的圆形和椭圆形的窗口小龛是否会导致改善急性SNHL患者的听力结果。

方法: 五十七例患者 (27位男性: 43 ± 12岁；26位女性: 45 ± 14岁) 患有急性SSHL ≥50dB, 超过3个频率, 接受了鼓室切开术, 初次治疗失败。 25例患者 (A组: 可的松: 14位男性, 11位女性: 46 ± 9岁) 接受浸泡曲安奈德 (1ml; 40mg/ml) 和28例对照组 (B组: 无可的松: 13位男性, 15位女性, 42 ± 12岁), 没有曲安奈德。术前和术后比较A组和B组的频率特异性和纯音平均值 (PTA =500-1000-2000-3000Hz)。

结果: A组中, 25例中有21例 (83％) PTA改善了≥10dB; B组中, 28例中有18例 (63％) 的到改善。 A组在所有频率上显示出统计学意义的显著改善, 而线性回归显示, 治疗后PTA显著降低至初始PTA的94.96％ (p = 0.037)。整体PTA提高了24dB。 A组从73dB改善到41dB (-32dB) PTA, B组从76dB改善到56dB PTA (-20dB) (p <.05)。 A组显示出额外降低12.8dB (p <0.001)。

Keywords:

• Tympanotomy
• acute sensorineural hearing loss
• triamcinolone
• cortisone
• triamcinolone

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.