Intratympanic Injection With Methylprednisolone Or Gentamicin For Treating Endolymphatic Hydrops Patients Induced By Autoimmune Inner Ear Disorder

Objectives To explore and realize the curative effect and untoward reaction fortreating endolymphatic hydrops patients induced by autoimmune inner ear disorderswith methylprednisolone or gentamicin locally injected into tympanic cavity. At thesame time, the curative effects of two kind of therapeutic methods was contrasted andanalysised.Methods According to the diagnostic and effective criteria of Meniere’s diseaseissued by Otolaryngology branch of the Chinese Medical Association (Shanghai1996and Guiyang2006), and judging by no effect with conventional medical treatmentand effect with immunosuppressant,62cases of autoimmune endolymphatic hydrops(including49cases of unilateral Meniere’s disease and13cases of unilateralautoimmune delayed endolymphatic hydrops) were diagnosed. They were randomlydivided into two groups,29cases in methylprednisolone (MP) group and33cases ingentamicin (GM) group. Before therapy, pure tone test were performed andconfirmed that the contralateral average threshold (0.5kHz,1kHz,2kHz and3kHz)were less than30dB (HL) in all patients. Acoustic immittance measurement weremade for excluding middle ear disorders. The tests of the specific and non-specificimmune against to inner ear antigens of guinea pigs were performed. Before and aftertherapy, some of hearing function and vestibular function tests (including pure tonetest, auditory brain-stem response (ABR), electrocochleography (ECochG) orGlycerine test, and electronystagmography (ENG)) were performed. Operation was performed under microscope for putting tube into tympanic cavity under-through flapthe posterior wall of the external auditory and annulus tympanicus and the end of tubewas locally fixed at round window niche. MP was injected into tympanic cavitythrough tubes on alternate days for two weeks. GM was injected on alternate days for4times. Next day following injection, the pure tone test was performed, and theinjection was stopped immediately if hearing loss aggravating was found.Results Before therapy,-SP/AP≥0.37(EcochG) or positive reaction of Glycerinetest were founded in all patients. Circulating immune complex (CIC) showed positivein7cases and antinuclear antibodies showed positive in2cases. Specific immunereaction against to inner ear antigens were positive in45cases (22cases in MP groupand23cases in GM group). The average pure tone hearing threshold and the ABRwave V threshold were reduced in MP group post-therapy. The average pure tonehearing threshold had no significant difference between the two groups beforetreatment, but it had significant difference after treatment. The positive rate of shortincrement sensitivity index (SISI) were reduced in two groups after treatment. Thepositive rate of SISI had significant difference between before and after treatmentwithin each group. Hydrolabyrinth tests were changed into negative in52cases aftertreatment. The conversion rate after treated had no significant difference between MPgroup and GM group. The results of vestibular examination showed that the incidencerate of channel-paralysis was reduced in MP group following therapy, and theincidence rate of directional preponderance were re significantly duced in two groups.It had significant difference between before and after treatment within each group.According to criteria for evaluating vertigo-control and hearing function improving,the treatment efficiency of18month after therapy reached respectively to69%in MPgroup and63.64%in GM group.Conclusion Therapeutic effects of intratympanic methylprednisolone was similar to intratympanic gentamicin’s, and no side-effects were found. This micro-surgery isvery convenient for manipulation with less invasive. The purpose of therapy withmethylprednisolone is against to autoimmune inner ear disorder, so which could notonly control clinical symptoms but also restore inner ear physiological function. Theaverage hearing threshold was significant reduced. SISI was was significant reducedalso. The efficacy of intratympanic methylprednisolone can not be achieved bygentamicin treatment, which is the difference based on treatment principle. There isno danger of the application of gentamicin ototoxicity also. Intratympanicmethylprednisolone could obviate side-effects induced by systemic administration,which have widespread application prospect following some details refined.