During treatment of inner ear diseases, the blood-cochlear barrier limits the drug delivery into the cochlea. Intratympanic drug injection for inner ear diseases is a safe procedure where drugs reach high concentrations in the cochlea and systemic side effects are minimized. This paper reviews the updated status of intratympanic drug injections for the treatment of inner ear disease. Intratympanic drug injection is an effective procedure for the control of inner ear disorders such as Meniere's disease and sudden sensorineural hearing loss. Although the effect of intratympanic injection on tinnitus and noise-induced hearing loss is open to discussion, its indications could be extended, like as drug, gene, and cell-based therapy.
Aminoglycosides ; Cochlea ; Ear, Inner ; Hearing Loss, Noise-Induced ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Labyrinth Diseases* ; Meniere Disease ; Tinnitus

BACKGROUND AND OBJECTIVES: In this study, we tried to study the criteria and characteristics of patients with noise-induced hearing loss by analyzing the pure tone audiogram such as "C5 dip" or "4 kHz notch". SUBJECTS AND METHOD: Out of 553 patients who complained of tinnitus and hearing loss, medical examination by interview, physical examination, hearing test, brain MRI and survey of tinnitus were performed from January 2010 to December 2012, targeting 81 patients who underwent pure tone hearing test. We analyzed the clinical characteristics of 81 patients with the exception of systemic disease or a history of otologic disease, conductive hearing loss, and vestibular schwannomas. Patients consisted of 70 men and 11 women (34 persons on both sides, 31 persons on right side, and 16 persons on left side), with an average of 48.1+/-12.9 years. 4 kHz notch-type sensorineural hearing loss was compared with contralateral hearing. RESULTS: The audiogram of 4 kHz notch was analyzed, and the results were as follows; 0.5 kHz (11.2+/-9.9 dB HL), 1 kHz (13.2+/-9.9 dB HL), 2 kHz (19.4+/-15.4 dB HL), 3 kHz (38.1+/-18.7 dB HL), 4 kHz (49.3+/-16.2 dB HL), 8 kHz (27.2+/-16.2 dB HL). Among all frequencies of 4 kHz notch audiogram, there was no significant hearing loss in 0.5 kHz and 1 kHz, but significant hearing loss was noted in higher frequencies (paired t-test, p>0.05). The contralateral ear showed a ski-slope hearing loss in about half of the patients. CONCLUSION: Remarkable points of the 4 kHz notch audiogram analysis, known as a typical characteristic of noise-induced hearing loss, were as follows; First, there was hearing loss of about 50 dB HL at 4 kHz. Second, the hearing threshold was improved to about 30 dB HL at 8 kHz. Third, the 4 kHz-notch audiogram showed a significant hearing loss in a high-pitched tone of over 2 kHz, but otherwise there were no significant hearing loss observed in 0.5 kHz and 1 kHz. Fourth, even if there were no symptoms, contralateral ear can still show the ski-slope type of hearing loss.
Brain ; Ear ; Ear Diseases ; Female ; Hearing Loss* ; Hearing Loss, Conductive ; Hearing Loss, Noise-Induced ; Hearing Loss, Sensorineural ; Hearing Tests ; Hearing* ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroma, Acoustic ; Noise* ; Physical Examination ; Tinnitus

BACKGROUND AND OBJECTIVES: Intratympanic steroid serves as a good therapeutic alternative for various inner ear diseases presenting with vertigo, hearing loss, and tinnitus. This study reports the effect of intratympanically injected dexamethasone (ITDEXA) on tinnitus in various cochlear pathologies. SUBJECTS AND METHOD: 19 patients with cochlear tinnitus (7 sudden sensorineural hearing loss (SSNHL), 5 noise induced hearing loss, 4 Meniere's disease and 3 acoustic trauma) were subjected to the IT-DEXA. The injection was performed with a spinal needle through the posterior superior quadrant of the tympanic membrane for 2 to 5 consecutive days. RESULTS: The overall improvement rate was 31.6%. Tinnitus was improved in 4 patients with SSNHL and 2 patients with Meniere's disease. Tinnitus was not improved in noise induced hearing loss or acoustic trauma. CONCLUSION: IT-DEXA is a therapeutic modality for tinnitus in SSNHL and Meniere's disease.
Acoustics ; Dexamethasone* ; Ear, Inner* ; Ear, Middle ; Hearing Loss ; Hearing Loss, Noise-Induced ; Hearing Loss, Sensorineural ; Humans ; Labyrinth Diseases* ; Meniere Disease ; Needles ; Noise ; Pathology ; Tinnitus* ; Tympanic Membrane ; Vertigo

Autoimmune inner ear disease (AIED) is a rare disease, accounting for < 1% of all cases of hearing impairment or dizziness. It is characterized by sensorineural hearing loss (SNHL) or vestibular dysfunction that results from an immunemediated process. Clinical features of AIED is SNHL that progresses over weeks to month with fluctuating hearing symptoms. Because there are no diagnostic laboratory and clinical feature, response to immunosuppressive therapy were important for diagnosis of AIED. Many diseases such as sudden SNHL and Meniere disease may also mimic AIED, a broad differential must be maintained in patients suspected of having AIED. We report a case of a 46-year-old female who presented with sudden hearing loss and vertigo. We could diagnose her as AIED with systemic lupus erythematous. The symptoms were improved treated with steroids.
Diagnosis ; Dizziness ; Ear, Inner ; Female ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Labyrinth Diseases ; Meniere Disease ; Middle Aged ; Rare Diseases ; Steroids ; Vertigo

OBJECTIVE: To investigate the current situation of early diagnosis and intervention in 0-9 months old infants with hearing loss and analysis factors that will affect early diagnosis and intervention. METHOD: One hundred and eighty-six infants referred to the West China hospital from February 2014 to September 2014 were included. All 186 children were referred due to the fact that either they failed infant hearing screening or outer ear malformation. Early diagnosis and/or intervention were performed on those 186 children and their records of early diagnosis and intervention were analyzed. RESULT: Among the 186 infants, 167 (89.8%) were diagnosed with an average age at (4.0 ± 1.4) months. Among the 167 infants with final diagnosis, there were 31 (18.6%) infants diagnosed as conductive hearing loss (CHL), and 99 cases (59.3%) diagnosed as sensorineural hearing loss (SNHL), among whom, there were 75 (44.9%) bilateral SNHL and 24 (14.4%) unilateral SNHL. There were 2 cases (1.20%) with SNHL on one side and atresia on the other side. 5 (2.99%) of all conductive hearing loss cases with unilateral atresia and 2 cases with auditory neuropathy (AN) were found. 33 infants (19.8%) were found to have normal hearing. 30.7% (23/75) infants diagnosed as bilateral SNHL and 8.3% (2/24) infants diagnosed as unilateral SNHL were fitted with hearing aids. The fitting rate in infants with bilateral SNHL with mild, moderate, severe to profound degrees were 0 (0/23), 24.0% (6/25), 66.7% (6/9), 61.1% (11/18) respectively. The average intervention age was (5.0 ± 2.1) months. CONCLUSION Although the early diagnosis and intervention situation in this study are very close to international standard, there are still infants without final diagnosis and infants with hearing loss without hearing aid fitting. Further studies and efforts to promote early diagnosis and intervention in infants with hearing loss are needed.
China ; Deafness ; Early Diagnosis ; Hearing Aids ; Hearing Loss, Bilateral ; Hearing Loss, Central ; Hearing Loss, Conductive ; diagnosis ; Hearing Loss, Sensorineural ; diagnosis ; Hearing Tests ; Humans ; Infant ; Infant, Newborn

OBJECTIVES: The problem of noise-induced hearing loss (NIHL) was objectively and systematically investigated by diagnosing three workers who complained of tinnitus and hearing disturbance. METHODS: Atypical hearing loss is diagnosed as a work-related disease by using general medical methods, such as environmental survey, neurological examination, otoscopy, pure-tone audiometry, speech audiometry, otoacoustic emissions (OAE), auditory-evoked potentials, and interview on the history of past disease, family and occupation. RESULTS: Three results were found according to the work-related hearing loss as follows; (1) hearing loss that is caused by exposure to continuous noise of less than 85 dB(A) or impact noise of greater than 135 dB peak, (2) mixed hearing loss that has progressed due to noise with past otitis media, and (3) atypical hearing loss that showed remarkable differences between air and bone conduction due to tinnitus. CONCLUSIONS: The criteria for work-related hearing loss should be carefully investigated by considering exposure to impact noise, the effect of continuous noise on mixed hearing loss patients, and the hearing loss caused by tinnitus.
Audiometry, Pure-Tone ; Audiometry, Speech ; Bone Conduction ; Hearing ; Hearing Loss ; Hearing Loss, Mixed Conductive-Sensorineural ; Hearing Loss, Noise-Induced* ; Humans ; Neurologic Examination ; Noise ; Occupations ; Otitis Media ; Otoscopy ; Tinnitus

BACKGROUND AND OBJECTIVES: Management of chronic ear disease which affects the only hearing ear has been a topic of much debate since chronic ear disease runs the risk of damage to the inner ear. Cholesteatoma and uncontrolled otitis media can induce the sensorineural hearing loss, therefore, surgical removal of diseased tissue is sometimes unavoidable. MATERIALS AND METHOD: Tympanoplasty with mastoidectomy on the only hearing ears was performed in 9 patients. of whom four had cholesteatoma and five had mastoiditis. RESULTS: Compared to the preoperative air conduction hearing level, 3 cases showed improvement in the postoperative hearing level showed, whereas the remaining 6 cases did not show improvement.
Cholesteatoma ; Ear Diseases ; Ear* ; Ear, Inner ; Hearing Loss, Sensorineural ; Hearing* ; Humans ; Mastoid ; Mastoiditis ; Otitis Media ; Tympanoplasty

Tinnitus is a perception of sound without external stimuli. The increase of noise from industrialization, complex psychological state, increase of old age people, and excessive medication make tinnitus a more common disease than ever before. However, the knowledge regarding diagnosis and treatment of tinnitus is still limited. Tinnitus can be categorized into paraauditory tinnitus and sensory neural tinnitus. Paraauditory tinnitus may occur from the sound generated by the vessel near the ear such as an arteriovenous fistula, abnormal vessel, a tumor around vessel, palatal myoclonus, and patent E tube. Sensory neural tinnitus can arise from senile hearing loss, noise-induced hearing loss, sudden deafness, sensorineural hearing loss associated with chronic otitis media, excessive medication, and so on. But there are many cases in which the specific cause cannot be defined. Diagnosis needs thorough history taking, physical examination, and radiologic and audiologic examination. Treatments for the paraauditory tinnitus are vessel ligation or coil embolization of arteriovenous fistula and removal of the causative factors. Although there are many treatment modalities for managing sensory neural tinnitus, a standardized treatment modality has not been established. Sensory neural tinnitus can be managed with tinnitus retraing therapy and electrical stimulation therapy. Although tinnitus is essentially not a life-treatening disease, advancing quality of life and the increasing number of patients with tinnitus mandate health-care providers to be more concerned with the disease tinnitus.
Arteriovenous Fistula ; Classification ; Deafness ; Diagnosis ; Ear ; Electric Stimulation Therapy ; Embolization, Therapeutic ; Hearing Loss, Noise-Induced ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Ligation ; Myoclonus ; Noise ; Otitis Media ; Physical Examination ; Quality of Life ; Tinnitus*

Otitls media is one of the most common diseases during childhood with a peak incidence and prevalence from 6 to 20 months of age. It is the most frequent disease managed with antibiotics in children. The infection typically develops as a result of bacterial contamination through the Eustachian tube in the presence of preexisting inflammation in the middle ear. The optimal method of management remains open to question and is the subject of continuing controversy. Over-diagnosis of the disease and unnecessary prescription of antibiotics for this condition have contributed to the spread of antimicrobial resistance. Thus, the differential diagnosis between acute otitis media and otitis media with effusion is important to determine the management strategy; whether to use antibiotics and which antibiotics to use when necessary. Otitis media may be accompanied by a variable degree of conductive hearing loss. Both infectious and noninfectious complications of otitis media may result in significant morbidity and complications, including acute and chronic mastoiditis, petrositis, and intracranial infection.
Anti-Bacterial Agents ; Child* ; Diagnosis, Differential ; Ear, Middle ; Eustachian Tube ; Hearing Loss, Conductive ; Humans ; Incidence ; Inflammation ; Mastoid ; Mastoiditis ; Otitis Media with Effusion ; Otitis Media* ; Otitis* ; Petrositis ; Prescriptions ; Prevalence

BACKGROUND AND OBJECTIVES: We evaluated the clinical characteristics of hearing impairment in patients who suffered a blunt head trauma without any organic problems, including temporal bone fracture or intracranial hemorrhage. SUBJECTS AND METHOD: This retrospective study examined 42 patients presenting with hearing impairment after blunt head trauma within five recent years. This study included only patients without temporal bone fracture or intracranial hemorrhage. RESULTS: Most patients (90.5%) complained of associated auditory symptoms including tinnitus, dizziness, earfullness and otalgia as well as headache. In 38 patients (90.5%), the symptom was developed on the injured day. Fifteen ears of 13 patients showed sensorineural hearing loss, 2 ears of 2 patients conductive hearing loss, and 10 ears of 8 patients mixed hearing loss. Twenty-four ears of 22 patients showed sensorineural hearing loss only above 4 kHz, 8 ears of 7 patients mild hearing loss, 10 ears of 8 patients moderate hearing loss, 3 ears of 3 patients had a moderately-severe hearing loss, and 6 ears of 6 patients had a profound hearing loss. All cases (24 ears of 22 patients) who had a normal four-tone average complained many otologic symptoms other than a hearing loss. CONCLUSION: Blunt head injury is one of the most common causes of the neurologic disorders. It is important to perform thorough assessment of auditory symptoms as soon as possible. Otologic consultation should be sought in all cases for appropriate management.
Craniocerebral Trauma* ; Dizziness ; Ear ; Earache ; Head Injuries, Closed ; Head* ; Headache ; Hearing Loss* ; Hearing Loss, Conductive ; Hearing Loss, Mixed Conductive-Sensorineural ; Hearing Loss, Sensorineural ; Hearing* ; Humans ; Intracranial Hemorrhages ; Nervous System Diseases ; Post-Concussion Syndrome ; Retrospective Studies ; Temporal Bone ; Tinnitus