Trans Typmantic Dexamathasone Therapy
What does Trans Typmantic Dexamathasone therapy help correct?
- Ménière’s disease
- Sudden hearing loss syndrome where the patient has a sudden loss of hearing secondary to the cochlea not working normally
- Labyrinthitis or the sudden onset of dizziness or vertigo
- Sudden onset of tinnitus
What is Ménière’s disease?
This disorder causes repeating episodes of the following:
- Hearing loss
- Ear fullness or pain
It starts with an initial episode of inflammation from a bacterial of viral infection and results in intermittent episodes of swelling and inflammation of the inner ear over years. It is critical to treat the first episode with TTDT and it will make the long term outcome of Ménière’s disease less likely. Intermittent episodes that occur over time usually respond very nicely to this treatment.
What is Sudden sensorineural hearing loss?
Sudden hearing loss syndrome is an inflammation of the hearing organ (cochlea) from a viral or bacterial infection. It causes a significant hearing loss that can be permanent if not addressed within the first few weeks. It can or cannot be associated with dizziness or vertigo depending on whether the labyrinth (balance organ in the inner ear) is involved. These patients can benefit from TTDT.
What is labyrinthitis?
Labyrinthitis is inflammation of the inner ear balance organ. It causes severe initial dizziness or vertigo frequently with nausea and vomiting. After the initial episode the symptoms may lessen but the patient is still left off balance. These patients can benefit from TTDT.
What is Sudden onset of tinnitus?
Tinnitus is a ringing or noise in the ear. It can occur naturally and not be of significance and may also naturally occur as we age and lose hearing. Some patients may have a sudden onset of tinnitus after a respiratory tract infection, after a new medication, and also with chemotherapy. These patients have an inflammation of the inner ear hearing organ and may or may not have associated hearing loss. These patients can benefit from TTDT.
How does Trans Typmantic Dexamathasone therapy work?
The strong steroid placed in the middle ear will soak in to the inner ear and reduce and reverse the inflammation of the inner ear. It is this inflammation that causes the patient’s symptoms such as dizziness, vertigo, sudden hearing loss, and tinnitus.
the Trans Typmantic Dexamathasone therapy procedure
TTDT is an injection through the eardrum of a solution containing the steroid dexamethasone. It is done under a topical anesthesia that makes it painless and is performed using a high powered microscope. The intent is to fill the middle ear cavity with this solution so it can then be absorbed in to the inner ear. There is a small permeable membrane called the round window that allows this solution to enter the inner ear over a 15 minute period after the injection.
Benefits of Trans Typmantic Dexamathasone therapy
Patients can have a significant reduction or resolution of their Ménière’s disease, vertigo, dizziness, sudden hearing loss, and sudden onset tinnitus with this therapy.
How Many treatments will the patient need?
If there is a resolution of the patient’s symptoms after the first treatment then only one treatment is performed. Many patients will only need one treatment. Repeat injections can be performed weekly to get further gain if needed. Occasionally there will be no response to the injection and then a small tube may be placed in the ear drum. This tube allows the patient to treat themselves with the steroid ear drop 3 times a day for 1 month to see if the ear will respond and resolve the symptoms.
What are the risks and side effects of this treatment?
Fortunately this is a simple and safe procedure only requiring topical anesthesia. Although it is possible to have a hole in the ear drum after this procedure it is extremely unlikely.
What preventative actions can be used to avoid these disorders?
The primary issue for many patients is a nasal or sinus issue. Chronic sinus infection, septal deviation, nasal allergy, and associated eustachian tube dysfunction create an environment of inflammation that can go up the Eustachian tube and injure the inner ear. It is critical to have a thorough evaluation of the sinus area with a miniCT scan as part of the patient’s evaluation and management.
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