Steroid injections through the TM?

[JustPlainBill]

Had an interesting situation the other day....

Patient had a 'fullness' unilaterally. Said it felt like climbing/descending in an aircraft. Full set of hearing tests run, 20dB loss vs. good ear, sensorineural in nature....add a sinus infection on top of that.....

Patient received steroid injections through the TM, Oral steroids and tx for the sinus infection.....

I'm an FP intern and never seen/heard of this one...no big surprise there.

What's the prognosis on this case in general? Chances of hearing being restored? I'm assuming the 'fullness' is 2/2 the sinus infection/eustachian tube dysfunction.

I was also wondering if the sinus infection would/could add a non-observable via otoscope fluid leading to the 'hearing loss'....

I really don't know much about this and would like some general info....

Also, as an injection would perf the membrane, how long would that take to close and what effects would it have until closure?

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[otopico]

If the audiogram showed sensorineural hearing loss and not a mixed or conductive loss than the fullness is likely due to sensorineural loss and not fluid. The patient may have a sinus infection but likely this is not the cause of her symptoms. Typically intratympanic steroids are given to help exacerbations of Meniere's or a sudden sensorineural hearing loss. THe needle is small enough that there won't be a hole in the ear drum. Recovery is usually pretty good but depends on a lot of other factors (degree of loss, when the patient presented, presence of other symptoms...)

 

[JustPlainBill]

If the audiogram showed sensorineural hearing loss and not a mixed or conductive loss than the fullness is likely due to sensorineural loss and not fluid. The patient may have a sinus infection but likely this is not the cause of her symptoms. Typically intratympanic steroids are given to help exacerbations of Meniere's or a sudden sensorineural hearing loss. THe needle is small enough that there won't be a hole in the ear drum. Recovery is usually pretty good but depends on a lot of other factors (degree of loss, when the patient presented, presence of other symptoms...)

Sounds like grim stuff.....

Seeing pt again today. x4d of tapered 'roids and omnicef. Supposedly no improvement at this time. Audiogram ordered.

Read somewhere 30% spontaneously recover fully x2-4weeks, 60% spontaneously recover somewhat x3-6weeks.

No association with time of onset to time of presentation.

Supposed onset of Sunday and presentation to ENT on thursday PM.

What's the next step as I may be off service at that time...

 

[Fah-Q]

Sounds like grim stuff.....

Seeing pt again today. x4d of tapered 'roids and omnicef. Supposedly no improvement at this time. Audiogram ordered.

Read somewhere 30% spontaneously recover fully x2-4weeks, 60% spontaneously recover somewhat x3-6weeks.

No association with time of onset to time of presentation.

Supposed onset of Sunday and presentation to ENT on thursday PM.

What's the next step as I may be off service at that time...

What do you mean by "tapered 'roids?" The treatment is typically 1mg/kg prednisone x 7-10 days and then taper off. There really isn't a role for an audiogram before the treatment course is complete because you are not going to do anything different with the information. All patients with a sudden sensorineural hearing loss must have an MRI to rule out a cerebellopontine angle mass. There is no rush on the MRI but you do need to get it even if the patient fully recovers. In general, people who are young, don't have a serious to profound loss (20dB is a mild loss), get treated with steroids within a few days of onset, and don't have vertigo with the onset of the loss will have a better prognosis.

 

[JustPlainBill]

What do you mean by "tapered 'roids?" The treatment is typically 1mg/kg prednisone x 7-10 days and then taper off. There really isn't a role for an audiogram before the treatment course is complete because you are not going to do anything different with the information. All patients with a sudden sensorineural hearing loss must have an MRI to rule out a cerebellopontine angle mass. There is no rush on the MRI but you do need to get it even if the patient fully recovers. In general, people who are young, don't have a serious to profound loss (20dB is a mild loss), get treated with steroids within a few days of onset, and don't have vertigo with the onset of the loss will have a better prognosis.

Interesting....this appt was another injection, 8 days of 60mg followed by 10mg q 2 days step down....following another 40 dB loss (total of 60dB)...
MRI brain scheduled r/o neuroma....pt. getting frustrated w/not knowing definite prognosis and potential QOL impacts....