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. 2020 Jul;277(7):1931-1937.
doi: 10.1007/s00405-020-05920-0. Epub 2020 Mar 23.

Intratympanic application of triamcinolone in sudden hearing loss-radiologic anatomy in cone beam CT and its' correlation to clinical outcome

Willi Roßberg  1 , Friedrich Goetz  2 , Max Eike Timm  1 , Thomas Lenarz  1 , Victor Helmstaedter  3
Affiliations

Intratympanic application of triamcinolone in sudden hearing loss-radiologic anatomy in cone beam CT and its' correlation to clinical outcome

Willi Roßberg et al. Eur Arch Otorhinolaryngol. 2020 Jul.

Abstract

Purpose: To evaluate temporal bone cone-beam CT in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) being treated with primary and secondary intratympanic (IT) triamcinolone and to possibly correlate these results to the clinical outcome.

Methods: Retrospective analysis of patients treated with IT triamcinolone for ISSNHL at our department in 2018. Pre- and post-therapeutic audiologic examinations included four-tone average (FTA) at 0.5, 1, 2 and 3 kHz. Using a clinical questionnaire, pre-therapeutic CBCT scans were re-evaluated looking at items, which might interfere with adequate drug diffusion into the inner ear (e.g. bony overhangs or secondary membranes at the round or oval window).

Results: Thirty-one patients were included. Twenty-four (77%; group A) had experienced ineffective systemic steroid therapy before and seven (23%; group B) received primary IT injections. Four group A-patients (21%) and two group B-patients (33%) showed a post-therapeutic FTA improvement of more than 15 dB HL. Bony overhangs at the round window niche (RWN) were present in seven cases (26%), a secondary membrane at the RWN in four (15%) and soft tissue in eight (30%) cases, respectively.

Conclusion: Most patients present radiological findings in CBCT imaging, which might interfere with drug diffusion through the RW membrane. Interestingly, soft or bony tissue obstructing the RWN or the OWN was found in 50% of patients, who showed improvement of hearing. We conclude that radiologic 'tiny' findings are either clinically irrelevant or improvement in hearing is independent from intratympanic drug delivery.

Keywords: Cone-beam CT; Intratympanic injection; Sensorineural hearing loss; Triamcinolone.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Pre- and post-therapeutic FTA (four-tone average at 0.5, 1, 2 and 3 kHz) of group A-patients. Full circles indicate the patients with a post-therapeutic hearing improvement of more than 15 dB. The black square shows the overall mean of measurements. Only patients with pre- and post-therapeutic audiograms are shown (n = 19)
Fig. 2
Fig. 2
Pre- and post-therapeutic FTA (four-tone average at 0.5, 1, 2 and 3 kHz) of group B-patients. Full circles indicate the patients with a post-therapeutic hearing improvement of more than 15 dB. The black square shows the overall mean of measurements. Only patients with pre- and post-therapeutic audiograms are shown (n = 7)
Fig. 3
Fig. 3
Sagittal slices of temporal bone CBCT. The RWN ( >) can be clearly identified on the right (a) and on the left (b) patient side. On the right side there is an additional bony overhang ( →), while the left side seems open
Fig. 4
Fig. 4
Coronal view of a left temporal bone in CBCT imaging. The RWN (a) and the OWN (b) are completely opacified ( →). The soft tissue extents to the ossicular chain in (b)
Fig. 5
Fig. 5
Sagittal view of a left temporal bone in CBCT imaging. The RWN ( >) can be clearly identified but seems capped by a secondary membrane ( →)
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