L Sutton1,2, V Schartinger3, C Url3, J Schmutzhard3, D Lechner3, C Kavasogullari4, J S Sandhu5, A Shaida6, R Laszig7, J Loehler8, S Plontke9, H Riechelmann3, M Lechner10,11,12,13. 1. Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK. 2. UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6DD, UK. 3. Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria. 4. , Lanarkshire, Scotland, UK. 5. Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AT, UK. 6. Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, 330 Grays Inn Road, London, WC1X 8DA, UK. 7. Department of Otorhinolaryngology, University Hospital of Freiburg, Breisacher Str., Freiburg, Germany. 8. ENT Clinic, Maienbeeck, Bad Bramstedt, Germany. 9. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle, Ernst-Grube-Str., Halle, Germany. 10. Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK. m.lechner@ucl.ac.uk. 11. UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6DD, UK. m.lechner@ucl.ac.uk. 12. Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria. m.lechner@ucl.ac.uk. 13. Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, 330 Grays Inn Road, London, WC1X 8DA, UK. m.lechner@ucl.ac.uk.
Abstract
AIMS: The frequency of the use of intratympanic steroids (ITS) as a treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) in Europe is still unknown and remains a contentious issue amongst otolaryngologists. We undertook a survey of otolaryngologists in Germany and Austria to establish if there is any professional consensus with which to form a protocol for its use. METHODS: A survey of 21 questions was distributed electronically to otolaryngologists in Germany and Austria and data on demographics, indications for intratympanic treatment, procedure, follow-up, and outcomes were analysed. RESULTS: We received 908 responses. 49.1% of otolaryngologists used ITS for ISSNHL. Of those otolaryngologists who use ITS, 73.7% do not use it as primary treatment. 20.6% use ITS in conjunction with oral steroids for primary treatment and only 5.8% use ITS as monotherapy for primary treatment. 90.5% use ITS as salvage therapy. 81.1% do not consider the use of ITS after 2 weeks from the onset of symptoms. 8.3% used a tympanostomy tube and while the most commonly used steroid was dexamethasone at a concentration of 4 mg/ml (61%), a wide variety or other steroids and concentrations were used. CONCLUSIONS: This survey illustrates wide variation of current practice of intratympanic corticosteroid injection for ISSHL in Germany and Austria. In the absence of high-level evidence, knowing what current practice is allows clinicians to assess what they do against what their colleagues are doing, and if they do something very different, make them question their practice. Moreover, the obtained data will help to direct future clinical trials with the aim to compare the outcomes of more commonly used protocols.
AIMS: The frequency of the use of intratympanic steroids (ITS) as a treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) in Europe is still unknown and remains a contentious issue amongst otolaryngologists. We undertook a survey of otolaryngologists in Germany and Austria to establish if there is any professional consensus with which to form a protocol for its use. METHODS: A survey of 21 questions was distributed electronically to otolaryngologists in Germany and Austria and data on demographics, indications for intratympanic treatment, procedure, follow-up, and outcomes were analysed. RESULTS: We received 908 responses. 49.1% of otolaryngologists used ITS for ISSNHL. Of those otolaryngologists who use ITS, 73.7% do not use it as primary treatment. 20.6% use ITS in conjunction with oral steroids for primary treatment and only 5.8% use ITS as monotherapy for primary treatment. 90.5% use ITS as salvage therapy. 81.1% do not consider the use of ITS after 2 weeks from the onset of symptoms. 8.3% used a tympanostomy tube and while the most commonly used steroid was dexamethasone at a concentration of 4 mg/ml (61%), a wide variety or other steroids and concentrations were used. CONCLUSIONS: This survey illustrates wide variation of current practice of intratympanic corticosteroid injection for ISSHL in Germany and Austria. In the absence of high-level evidence, knowing what current practice is allows clinicians to assess what they do against what their colleagues are doing, and if they do something very different, make them question their practice. Moreover, the obtained data will help to direct future clinical trials with the aim to compare the outcomes of more commonly used protocols.
Entities:
Keywords:
Adult; Hearing loss; Intratympanic; Steroids; Sudden hearing loss
Authors: S S Chandrasekhar; R Y Rubinstein; J A Kwartler; M Gatz; P E Connelly; E Huang; S Baredes Journal: Otolaryngol Head Neck Surg Date: 2000-04 Impact factor: 3.497