Department of Otorhinolaryngology, Hannover Medical University, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Neuroradiology, Hannover Medical University, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Eur Arch Otorhinolaryngol. 2020 Jul;277(7):1931-1937. doi: 10.1007/s00405-020-05920-0. Epub 2020 Mar 23.
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.
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).
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.
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.
评估原发性和继发性鼓室内（IT）曲安奈德治疗特发性突发性聋（ISSNHL）患者的颞骨锥形束 CT，并可能将这些结果与临床结果相关联。
对 2018 年在我院接受 IT 曲安奈德治疗 ISSNHL 的患者进行回顾性分析。治疗前后的听力检查包括 0.5、1、2 和 3 kHz 的四音平均（FTA）。使用临床问卷，对治疗前的 CBCT 扫描进行重新评估，观察可能影响药物充分扩散到内耳的项目（例如圆窗或卵圆窗处的骨突或二次膜）。
共纳入 31 例患者。24 例（77%；A 组）在接受 IT 注射前接受了无效的全身类固醇治疗，7 例（23%；B 组）接受了原发性 IT 注射。A 组 4 例患者（21%）和 B 组 2 例患者（33%）在治疗后 FTA 改善超过 15 dB HL。7 例（26%）存在圆窗龛（RWN）处的骨性突，4 例（15%）存在 RWN 处的二次膜，8 例（30%）存在软组织。
大多数患者在 CBCT 成像中存在影像学发现，这可能会干扰药物通过 RW 膜的扩散。有趣的是，在听力改善的患者中，50%的患者发现 RWN 或 OWN 处的软或骨组织阻塞。我们得出结论，影像学上的“微小”发现要么与临床无关，要么听力改善与鼓室内药物输送无关。
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