Document Detail


Alternatives to systemic steroid therapy for refractory immune-mediated inner ear disease: A physiopathologic approach.
MedLine Citation:
PMID:  16802138     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Immune-mediated inner ear disease (IMIED) is one of the few forms of reversible sensorineural hearing loss. Corticosteroids-responsive patients are usually associated with hearing improvement. Due to the long clinical course of IMIED that frequently present recurrences (hearing loss and vertigo), alternatives to corticosteroids such as methotrexate and recently TNF-alpha blockers have been proposed. Likewise new procedures for delivering corticosteroids to the inner ear have been developed. The aim of this article is to assess the efficacy of methotrexate and transtympanic 6-methylprednisolone in refractory IMIED. From a database of 200 patients affected by IMIED, 16 selected patients with refractory disease were included in the present study. Five patients were treated with methotrexate and 11 by means of transtympanic injection of 6-methylprednisolone. All patients treated with methotrexate had an improvement in their vestibular symptoms. However, hearing loss did not improve. Most patients treated with local 6-methylprednisolone (68.75%) showed an improvement in hearing loss and vestibular symptoms. Methotrexate has been shown to be ineffective in maintaining long-term remissions of hearing relapses although patients presented an improvement in vestibular symptoms. However, transtympanic 6-methylprednisolone has been shown to be a safe, easy and useful therapy in refractory IMIED and it may actually become the first-line treatment for these patients based on the existence of glucocorticoid receptors and the possible targets of immune-mediated damage within the inner ear.
Authors:
José Ramón García-Berrocal; Andrés Ibáñez; Antonio Rodríguez; José Angel González-García; José María Verdaguer; Almudena Trinidad; Rafael Ramírez-Camacho
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-06-27
Journal Detail:
Title:  European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery     Volume:  263     ISSN:  0937-4477     ISO Abbreviation:  Eur Arch Otorhinolaryngol     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-09-21     Completed Date:  2007-03-20     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9002937     Medline TA:  Eur Arch Otorhinolaryngol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  977-82     Citation Subset:  IM    
Affiliation:
Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro, San Martin de Porres 4, 28035 Madrid, Spain. jrgarciab@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adolescent
Adult
Autoimmune Diseases / complications*
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Glucocorticoids / administration & dosage*
Hearing Loss, Sensorineural / drug therapy*,  immunology,  physiopathology
Humans
Immunosuppressive Agents / administration & dosage*
Injections
Male
Methotrexate / administration & dosage*
Methylprednisolone / administration & dosage*
Middle Aged
Retrospective Studies
Round Window, Ear
Chemical
Reg. No./Substance:
0/Glucocorticoids; 0/Immunosuppressive Agents; 59-05-2/Methotrexate; 83-43-2/Methylprednisolone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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