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One of the exciting new developments in inner ear research is the ability to place medicine directly into the inner ear. There is much research focusing on this topic. Imagine the possibilities of removing toxins directly from the inner ear to prevent or even reverse deafness. Imagine being able to focus high concentrations of certain medicines that would otherwise too powerful to give intravenously. Imagine being able to stop vertigo. The list of imagines goes on and on. For example: Sometimes one inner ear can become so damaged and so problematic that it causes terrible vertigo. In the past, one would have to resort to a neurosurgical (brain surgery) approach to cut the balance nerve to prevent further attacks of vertigo. Now we simply need to make a small pin hole in the eardrum and infuse medicine directly into the affected ear. (If you gave the medications intravenously or intramuscularly, both ears might be damaged.) Sometimes, people lose hearing the suddenly without any apparent reason. The treatment for this sudden onset hearing loss is typically oral or intravenous steroids. However, sometimes patients cannot tolerate the doses required by oral or intravenous administration. In these cases, direct application to the inner ear through the transtympanic route may be the only option. Transtympanic medications can be administered using one of several methods. The simplest method is through a tiny needle puncture of the eardrum. This can be done easily in the office with or without a little bit of numbing medicine. If multiple injections are required, a small ear tube (myringotomy tube) can be done in the office with a little bit of numbing medicine.
Streptomycin or Gentamicin Perfusion: An outpatient procedure. An antibiotic that is toxic specifically to the balance nerve is placed through a small puncture in the eardrum. This antibiotic essentially kills the already damaged balance nerve and usually (85-95%) spares the hearing. Success has been reported to be about 80 -- 90% although relapses are possible. Steroid perfusion: Done in a similar fashion, Steroids calm inflamed balance organs and nerves. If taken by mouth or intravenously, steroids have many potentially bad side effects. These side effects are greatly reduced because the medicine is directly placed into the ear. Steroid perfusion has been used in the treatment of sudden onset sensorineural hearing loss and Meniere's disease. It may have applications in hearing protection and regeneration.
Patient
information and answers to frequently asked questions: Please
be advised that the standard treatment for sudden onset sensorineural hearing
loss is oral steroids. Sudden
hearing loss that occurred more than six months ago is not likely to respond to
transtympanic steroids (or oral steroids for that matter.) The
best way to have your problem analyzed is to find a neurotologist in your area.
Neurotologists are ear nose and throat physicians who have specialized in
the treatment of ear problems. Steroids
are used to treat sudden onset sensorineural hearing loss because they are
potent anti-inflammatory medications. When
the cells of the inner ear suddenly stop working, giving steroids is like doing
CPR. The idea is to resuscitate the
hearing hair cells before they die. The
time window for doing this can be up to six months.
However, the sooner the steroids are given, the better.
We prefer to get it done before two weeks have elapsed. The
idea behind transtympanic medication is that we can concentrate the dose of
medication and deliver it to the target ear by delivering it directly to the
target. Oral medications and
intravenous medications need to be distributed throughout the whole body before
it gets to the target. Oftentimes,
the drug is degraded (metabolized) and thus less effective by the time it gets
to the intended site. Transtympanic
medication should have less systemic (bodily) side effects, and smaller amounts
of drug can be used. The
downside of transtympanic medication is that it requires that a minor procedure
be performed. A small incision
needs to be made in the ear drum to get the medication to the target organ. This
minor procedure can be done in the office with local anesthesia. There is
usually little in the way of pain. It usually takes about 15 or 20 minutes to
perform. Complications: the risks and complications of the surgery are the same as for the insertion of tympanostomy (myringotomy) tubes. In general, they are very minimal and rare. As with any surgery; pain, bleeding, infection and drainage can occur. If a tube is placed, it usually falls out on its own within a few weeks or months. Usually the hole will close on its own. In rare instances (< 3 percent), the hole persists and will require closure at a later date. Temporary dizziness is quite possible. On the other hand, long-term dizziness, ringing in the ears, and hearing loss are quite rare. Typically, as with any office procedure, I recommend that the patient does not drive or operate heavy machinery for at least six hours (or more) afterwards.
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Questions or problems regarding this web site should be directed to Dr-Li@Dr-Li.net.
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