Chen F

Hearing evaluation of intratympanic methylprednisolone perfusion for refractory sudden sensorineural hearing loss

Objective: To investigate the effectiveness and safety of intratympanic methylprednisolone perfusion (IMP) through a microcatheter in patients with sudden sensorineural hearing loss (SSNHL) who failed a conventional treatment. Study Design: Prospective clinical study. Setting: This study was conducted in Nanjing Drum Tower Hospital, Nanjing University Medical School. Subjects and Methods: Patients who had failed a minimum 10-day conventional treatment were included. Twenty-six patients in the study group (SG) received methylprednisolone perfusion through a microcatheter placed into the tympanum once a day for 10 days and the conventional treatment. Twenty-three patients who received a second conventional treatment (no steroid) served as the comparison group (CG). All patients were followed up for three months after the end of treatment. Results: The effective rates for SG and CG were 50 percent (61.9% when only patients with an interval from onset to IMP ≤ 60 days were included) and 21.7 percent, respectively (χ2 = 4.194, P = 0.041). The pure-tone average improvement was 20.2 ± 15.6 dB in SG, and 9.2 ± 13.7 dB in CG (z = 2.51, P = 0.011). In SG, hearing improvement at low frequencies was better than that at high frequencies. The interval from onset to IMP affected the efficacy of IMP. Conclusion: IMP through a microcatheter is a promising treatment for refractory SSNHL. The data suggest that the treatment may be more effective when administered at the earlier stages of SSNHL when the conventional treatment has failed.

Relationship of Glucocorticoid Receptor Expression in Peripheral Blood Mononuclear Cells and the Cochlea of Guinea Pigs and Effects of Dexamethasone Administration

Background Glucocorticoids (GCs) are widely used to treat sudden sensorineural hearing loss (SSNHL) and significantly improve hearing. However, GC insensitivity has been observed in some patients of SSNHL. Objective To study the correlation between GR expression in peripheral blood mononuclear cells (PBMCs) and in the cochlea of guinea pigs at mRNA and protein levels. Methods One group of guinea pigs received dexamethasone (10 mg/kg/day) intraperitoneally for 7 consecutive days (dexamethasone group), and another group of guinea pigs received normal saline (control group). Real time PCR and Western blotting were used to detect the expression of GR mRNA and GR protein in PBMCs and the cochleae. Results The GR mRNA and GR protein were detected in both PBMCs and the cochlear tissue of guinea pigs. GR mRNA and GR protein levels in PBMCs were positively correlated with those in the cochlea. The expression of GR mRNA and GR protein was significantly increased in the dexamethasone group compared to the control group. Conclusions Levels of GR mRNA and GR protein in the PBMCs were positively correlated with those in the cochlea of guinea pigs. Systemic dexamethasone treatment can significantly up-regulate GR expression in PBMCs and in the cochlea. Measurement of the GR level in PBMCs could be used as an indicator of GR level in the cochlea.

Effect of glucocorticoids on aquaporin-1 in guinea pigs with otitis media with effusion

The aim of this study was to explore the pathological changes in water homeostasis and the effects of glucocorticoids on aquaporin-1 (AQP1) in guinea pigs with otitis media with effusion (OME). Immunohistochemistry and western blotting were used to detect AQP1 in the bullae of OME models, which were induced by reversible Eustachian tube (ET) obstruction. Animals in the dexamethasone (dexa) group received dexa via intraperitoneal injection for 7 days and the pathological changes and expression patterns of AQP1 were compared with those in the OME group. In this study, 22 guinea pigs exhibited effusion 3–7 days after surgery, of which two were sacrificed. Six (60%) animals in the OME group and 9 (90%) in the dexa group presented no sign of effusion on postoperative day 14. AQP1 was detected as an 28-kDa protein in the two groups. Immunohistochemical analysis revealed that AQP1 was expressed in subepithelial fibroblasts and capillary endothelial cells. Western blot analysis revealed that the levels of AQP1 protein were markedly higher in the dexa group compared with the OME group. In conclusion, our study emphasized the significance of AQP1 in the pathophysiology of OME and suggests that glucocorticoids may regulate water homeostasis via an AQP1-regulated pathway.

Schwannoma of the Sinonasal Tract and the Pterygopalatine Fossa with or without Intracranial Extension.

Aims: Compared with those in other head and neck regions, schwannomas in the nasal cavity or paranasal sinuses are rare. The aim of this study was to present the experience of the authors in 11 schwannoma cases of the sinonasal tract and pterygopalatine fossa over a decade. Methods: A retrospective study from 2003 to 2014. Results: Three female and 8 male patients from 22 to 61 years of age (mean age 42 years) were admitted. The most common complaints were unilateral nasal congestion. A total of 10 of the patients received surgery, including 6 functional endoscopic sinus surgeries (FESS). The postoperative course was generally uneventful. Among the patients, 10 remained regionally asymptomatic, and there has been no clinical or radiological evidence of recurrence or residual tumor. Conclusion: Surgical treatment is effective for schwannomas of the sinonasal tract and the pterygopalatine fossa with a low recurrence rate. Conducting CT and MRI (particularly fluid-attenuated inversion recovery) before surgery is mandatory. FESS could become the primary treatment of choice.