García-Berrocal José Ramón, Ibáñez Andrés, Rodríguez Antonio, González-García José Angel, Verdaguer José María, Trinidad Almudena, Ramírez-Camacho Rafael
Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro, San Martin de Porres 4, 28035 Madrid, Spain.
Eur Arch Otorhinolaryngol. 2006 Nov;263(11):977-82. doi: 10.1007/s00405-006-0096-9. Epub 2006 Jun 27.
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.
免疫介导性内耳疾病（IMIED）是少数几种可逆性感音神经性听力损失的形式之一。对皮质类固醇有反应的患者通常听力会有所改善。由于IMIED临床病程长且经常复发（听力损失和眩晕），已提出使用甲氨蝶呤和最近的肿瘤坏死因子-α阻滞剂等替代皮质类固醇的药物。同样，也开发了将皮质类固醇输送到内耳的新方法。本文的目的是评估甲氨蝶呤和经鼓膜注射6-甲基泼尼松龙治疗难治性IMIED的疗效。从一个包含200例IMIED患者的数据库中，选取了16例难治性疾病患者纳入本研究。5例患者接受甲氨蝶呤治疗，11例通过经鼓膜注射6-甲基泼尼松龙治疗。所有接受甲氨蝶呤治疗的患者前庭症状均有改善。然而，听力损失并未改善。大多数接受局部6-甲基泼尼松龙治疗的患者（68.75%）听力损失和前庭症状均有改善。尽管患者前庭症状有所改善，但甲氨蝶呤已被证明在维持听力复发的长期缓解方面无效。然而，经鼓膜注射6-甲基泼尼松龙已被证明是一种治疗难治性IMIED安全、简便且有效的方法，基于内耳中糖皮质激素受体的存在以及免疫介导损伤可能的靶点，它实际上可能成为这些患者的一线治疗方法。
