OpenLB
Open Library of Bioscience
Advanced Search
The Laryngoscope
09, 2021;131 (9): E2583-E2591.

Residual Perforation Risk Assessment of Intratympanic Steroids via Tympanostomy Tube Versus Transtympanic Injections.

Liam Simani, Shahaf Shilo, Yahav Oron, Rani A Eta, Ophir Handzel, Nidal Muhanna, Anton Warshavsky, Gilad Horowitz, Omer J Ungar
Author Information
  1. Liam Simani: Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ORCID
  2. Shahaf Shilo: Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ORCID
  3. Yahav Oron: Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ORCID
  4. Rani A Eta: Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
  5. Ophir Handzel: Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ORCID
  6. Nidal Muhanna: Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
  7. Anton Warshavsky: Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ORCID
  8. Gilad Horowitz: Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
  9. Omer J Ungar: Department of Otolaryngology Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ORCID
PMID: 34002883 DOI: 10.1002/lary.29609

Abstract

OBJECTIVES/HYPOTHESIS: To investigate the risk of residual tympanic membrane (TM) perforation after intratympanic (IT) steroidal treatment administered via transtympanic injection compared with trans-tympanostomy tube (TyT).
STUDY DESIGN: Case series, systematic review and meta analysis.
METHODS: Data were retrieved from the medical files of an original cohort of all consecutive patients with sudden sensorineural hearing loss necessitating IT steroidal treatment in a tertiary medical center between January 1, 2016 and November 20, 2020. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" on comparable published cases was performed and meta-analysis was established.
RESULTS: Eighteen studies describing 818 ears were included in the quantitative meta-analysis in addition to a local cohort of 140 ears. The proportion of residual TM perforation was 1.11% and 1.14% (95% confidence interval: 0.01%-3.27% and 0.028%-2.38%) in the TyT and trans-tympanic groups, respectively, suggesting no significant difference in residual TM perforation risk between these techniques.
CONCLUSION: IT steroid therapy via trans-TyT is not associated with more residual perforations than IT steroid therapy via transtympanic injections.
LEVEL OF EVIDENCE: NA Laryngoscope, 131:E2583-E2591, 2021.

Keywords

Tympanostomy tube intratympanic steroids residual perforation sudden sensorineural hearing loss tympanic membrane perforation

References

  1. Wilson WR, Byl FM, Laird N. The efficacy of steroids in the treatment of idiopathic sudden hearing loss: a double-blind clinical study. Arch Otolaryngol 1980;106:772-776.
  2. Chen CY, Halpin C, Rauch SD. Oral steroid treatment of sudden sensorineural hearing loss: a ten year retrospective analysis. Otol Neurotol 2003;24:728-733.
  3. Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. Laryngoscope 1999;109:1-17.
  4. Wu HP, Chou YF, Yu SH, Wang CP, Hsu CJ, Chen PR. Intratympanic steroid injections as a salvage treatment for sudden sensorineural hearing loss: a randomized, double-blind, placebo-controlled study. Otol Neurotol 2011;32:774-779.
  5. Mattsson C, Stierna P, Hellström S. Treatment with dexamethasone arrests the development of myringosclerosis after myringotomy. Otol Neurotol 2000;21:804-808.
  6. Tan CT, Escoubet B, Den Abbeele TV, Friedlander G, Ba Huy PT, Herman P. Modulation of middle ear epithelial function by steroids: clinical relevance. Acta Otolaryngol 1997;117:284-288.
  7. Johnson AP, Smallman LA, Kent SE. The mechanism of healing of tympanic membrane perforations. Acta Otolaryngol 1990;109:406-415.
  8. Johnson A, Hawke M. The function of migratory epidermis in the healing of tympanic membrane perforations in Guinea-pig: a photographic study. Acta Otolaryngol 1987;103:81-86.
  9. Schwartz KM, Orvidas LJ, Weaver AL, Thieling SE. Ventilation tube removal: dose treatment affect perforation closure? Arch Otolaryngol Head Neck Surg 2002;126:665.
  10. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
  11. Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
  12. Meikle AW, Tyler FH. Potency and duration of action of glucocorticoids. Am J Med 1977;63:200.
  13. Wang YW, Ren JH, Lu YD, Yin TF, Xie DH. Evaluation of intratympanic dexamethasone for treatment of refractory sudden sensorineural hearing loss. J Zhejiang Univ Sci B 2012;13:203-208.
  14. Chang WT, Zee B, Lee HSH, Tong MCF. Dexamethasone eardrop with grommet placement vs intratympanic steroid injection for sudden sensorineural hearing loss: a randomized prospective clinical trial. Am J Otolaryngol 2020;41:102515.
  15. Taha A, Shlamkovitch N, Abu-Eta R, et al. High dose of intratympanic steroids for sudden sensorineural hearing loss salvage. Otol Neurotol 2019;40:1134-1138.
  16. Kakehata S, Sasaki A, Oji K, et al. Comparison of intratympanic and intravenous dexamethasone treatment on sudden sensorineural hearing loss with diabetes. Otol Neurotol 2006;27:604-608.
  17. Erdur O, Kayhan FT, Cirik AA. Effectiveness of intratympanic dexamethasone for refractory sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 2014;271:1431-1436.
  18. Oue S, Jervis-Bardy J, Stepan L, Chong S, Shaw CK. Efficacy of low-dose intratympanic dexamethasone as a salvage treatment for idiopathic sudden sensorineural hearing loss: the Modbury Hospital experience. J Laryngol Otol 2014;128:S27-S30.
  19. Gianoli GJ, Li JC. Transtympanic steroids for treatment of sudden hearing loss. Otolaryngol Head Neck Surg 2001;125:142-146.
  20. Kosyakov S, Atanesyan A, Gunenkov A, Ashkhatunyan E, Kurlova A. Intratympanic steroids for sudden sensorineural hearing loss. J Int Adv Otol 2011;7:323-332.
  21. Banerjee A, Parnes LS. Intratympanic corticosteroids for sudden idiopathic sensorineural hearing loss. Otol Neurotol 2005;26:878-881.
  22. Li L, Ren J, Yin T, Liu W. Intratympanic dexamethasone perfusion versus injection for treatment of refractory sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 2013;270:861-867.
  23. Choi SY, Lee YH, Kim YH. Comparison of the efficacy of systemic and combined highly frequent Intratympanic steroid treatment on sudden sensorineural hearing loss. J Audiol Otol 2011;15:133-136.
  24. Topf MC, Hsu DW, Adams DR, et al. Rate of tympanic membrane perforation after intratympanic steroid injection. Am J Otolaryngol 2017;38:21-25.
  25. Liu YC, Chi FH, Yang TH, Liu TC. Assessment of complications due to intratympanic injections. World J Otorhinolaryngol Head Neck Surg 2016;2:13-16.
  26. Xenellis J, Papadimitriou N, Nikolopoulos T, et al. Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: a control study. Otolaryngol Head Neck Surg 2006;134:940-945.
  27. Slattery WH, Fisher LM, Iqbal Z, Friedman RA, Liu N. Intratympanic steroid injection for treatment of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg 2005;133:251-259.
  28. Lyu Y, Zeng F, Yan M, et al. Comparison of 2 different Intratympanic methylprednisolone injection schedules in combination with intravenous dexamethasone for unilateral sudden sensorineural hearing loss. Ear Nose Throat J 2020;2020:145561320904816.
  29. Park MK, Lee CK, Park KH, Lee JD, Lee CG, Lee BD. Simultaneous versus subsequent intratympanic dexamethasone for idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 2011;145:1016-1021.
  30. Li P, Zeng XL, Ye J, Yang QT, Zhang GH, Li Y. Intratympanic methylprednisolone improves hearing function in refractory sudden sensorineural hearing loss: a control study. Audiol Neurootol 2011;16:198-202.
  31. Alexander TH, Harris JP. Incidence of sudden sensorineural hearing loss. Otol Neurotol 2013;34:1586-1589.
  32. Klemm E, Deutscher A, Mösges R. A present investigation of the epidemiology in idiopathic sudden sensorineural hearing loss. Laryngo-Rhino-Otol 2009;88:524-527.
  33. Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical practice guideline: sudden hearing loss (update). Otolaryngol Head Neck Surg 2019;161:S1-S45.
  34. Rauch SD, Halpin CF, Antonelli PJ, et al. Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial. JAMA 2011;305:2071-2079.
  35. Slattery WH, Fisher LM, Iqbal Z, Liu N. Oral steroid regimens for idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 2005;132:5-10.
  36. Zhao D, Tong B, Wang Q, Hellstrom S, Duan M. A comparison of effects of systemic and intratympanic steroid therapies for sudden sensorineural hearing loss: a meta-analysis. J Otol 2016;11:18-23. https://doi.org/10.1016/j.joto.2016.02.002.
  37. Crane RA, Camilon M, Nguyen S, Meyer TA. Steroids for treatment of sudden sensorineural hearing loss: a metaanalysis of randomized controlled trials. Laryngoscope 2015;125:209-217.
  38. Silverstein H, Choo D, Rosenberg SI, Kuhn J, Seidman M, Stein I. Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report). Ear Nose Throat J 1996;75:468-488.
  39. Sutton L, Schartinger V, Url C, et al. Intratympanic steroid use for idiopathic sudden sensorineural hearing loss: current otolaryngology practice in Germany and Austria. Eur Arch Otorhinolaryngol 2018;275:1103-1110.
  40. Thomsen J, Bonding P, Becker B, Stage J, Tos M. The non-specific effect of endolymphatic sac surgery in treatment of Meniere's disease: a prospective, randomized controlled study comparing “classic” endolymphatic sac surgery with the insertion of a ventilating tube in the tympanic membrane. Acta Otolaryngol 1998;118:769-773.
  41. Clyde JW, Oberman BS, Isildak H. Current management practices in Meniere's disease. Otol Neurotol 2017;38:e159-e167.
  42. Ungar OJ, Dadia S, Yahav O, Handzel O, Fliss DM, Cavel O. Tri-dimensional model for ventilation tube permeability. Eur Arch Otorhinolaryngol 2018;275:2627-2632.
  43. Marks NJ, Mills RP. Swimming and grommets. J R Soc Med 1983;76:23-26.
  44. Pashley NR, Scholl PD. Tympanostomy tubes and liquids-an in vitro study. J Otolaryngol 1984;13:296-298.
  45. Klingensmith MR, Strauss M, Conner GH. A comparison of retention and complication rates of large-bore (Paparella II) and small-bore middle ear ventilating tubes. Otolaryngol Head Neck Surg 1985;93:322-330.
  46. Matt BH, Miller RP, Meyers RM, Campbell JM, Cotton RT. Incidence of perforation with Goode T-tube. Int J Pediatr Otorhinolaryngol 1991;21:1-6.
  47. Levine S, Daly K, Giebink GS. Tympanic membrane perforations and tympanostomy tubes. Ann Otol Rhinol Laryngol 1994;103:27-30.
  48. Luxford WM, Sheehy JL. Myringotomy and ventilation tubes: a report of 1,568 ears. Laryngoscope 1982;92:1293-1297.
  49. von Schoenberg M, Wengraf CL, Gleeson M. Results of middle ear ventilation with Goode's tubes. Clin Otolaryngol Allied Sci 1989;14:503-508.
  50. Buyten J, Kaufman G, Ryan M. Effects of ciprofloxacin/dexamethasone and ofloxacin on tympanic membrane perforation healing. Otol Neurotol 2007;28:887-890.
  51. Antonelli PJ, Winterstein AG, Schultz GS. Topical dexamethasone and tympanic membrane perforation healing in otitis media: a short-term study. Otol Neurotol 2010;31:519-523.
  52. Dirain CO, Kosko B, Antonelli PJ. Effects of common ear drops on tympanic membrane healing in rats. Otolaryngol Head Neck Surg 2018;158:917-922. https://doi.org/10.1177/0194599818757972 Epub 2018 Feb 20. pmid: 29460666.
  53. Spandow O, Hellström S, Schmidt SH. Hydrocortisone delay of tissue repair of experimental tympanic membrane perforations. Ann Otol Rhinol Laryngol 1990;99:647-653. https://doi.org/10.1177/000348949009900812 pmid: 2382938.
  54. Wicke C, Halliday B, Allen D, et al. Effects of steroids and retinoids on wound healing. Arch Surg 2000;135:1265-1270. https://doi.org/10.1001/archsurg.135.11.1265.
  55. Ishimoto S, Ishibashi T. Induction of growth factor expression is reduced during healing of tympanic membrane perforations in glucocorticoid-treated rats. Ann Otol Rhinol Laryngol 2002;111:947-953. https://doi.org/10.1177/000348940211101015 pmid: 12389866.
  56. Vrabec JT. Tympanic membrane perforations in the diabetic rat: a model of impaired wound healing. 1998;118:304-308. https://doi.org/10.1016/s0194-5998(98)70305-5.
  57. Robertson A, Whitwell R, Osborne J. Is phenol a safe local anaesthetic for grommet insertion? J Laryngol Otol 2006;120:20.
  58. Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest 2007;117:1219-1222. https://doi.org/10.1172/JCI32169.
  59. Dangwal S, Stratmann B, Bang C, et al. Impairment of wound healing in patients with type 2 diabetes mellitus influences circulating MicroRNA patterns via inflammatory cytokines. Arterioscler Thromb Vasc Biol 2015;35:1480-1488. https://doi.org/10.1161/ATVBAHA.114.305048 Epub 2015 Mar 26.
  60. Gnuechtel MM, Schenk LL, Postma GN. Late effects of topical anesthetics on the healing of Guinea pig tympanic membranes after myringotomy. Arch Otolaryngol Head Neck Surg 2000;126:733-735.
  61. Lo Carson K-L, Mertz D, Loeb M. Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Medical Research Methodology. 2014;14(1). http://doi.org/10.1186/1471-2288-14-45.

MeSH Term

Hearing Loss, Sensorineural
Humans
Injection, Intratympanic
Middle Ear Ventilation
Risk Assessment
Steroids
Tympanic Membrane Perforation

Chemicals

Steroids
Journal Article Meta-Analysis

Word Cloud

Created with Highcharts 10.0.0residualperforationviaITTM1risktympanicmembraneintratympanicsteroidaltreatmenttranstympanictubeTyTsystematicmedicalcohortsuddensensorineuralhearingloss"meta-analysisears0steroidtherapyTympanostomyOBJECTIVES/HYPOTHESIS:investigateadministeredinjectioncomparedtrans-tympanostomySTUDYDESIGN:CaseseriesreviewmetaanalysisMETHODS:DataretrievedfilesoriginalconsecutivepatientsnecessitatingtertiarycenterJanuary2016November202020literaturesearch"MEDLINE""PubMed"Embase"WebScience"comparablepublishedcasesperformedestablishedRESULTS:Eighteenstudiesdescribing818includedquantitativeadditionlocal140proportion11%14%95%confidenceinterval:01%-327%028%-238%trans-tympanicgroupsrespectivelysuggestingsignificantdifferencetechniquesCONCLUSION:trans-TyTassociatedperforationsinjectionsLEVELOFEVIDENCE:NALaryngoscope131:E2583-E25912021ResidualPerforationRiskAssessmentIntratympanicSteroidsTubeVersusTranstympanicInjectionssteroids

Similar Articles

Cited By