How long should patients remain in the supine treatment position after intratympanic dexamethasone injection?

Abstract

OBJECTIVES/HYPOTHESIS: Intratympanic dexamethasone injection (ITDI) is a widely accepted treatment for patients with sudden hearing loss. We investigated the appropriate patient wait time in the supine treatment position after ITDI. STUDY DESIGN: Prospective study. METHODS: In an in vivo animal study, 24 mice were injected intratympanically with dexamethasone. Perilymphatic fluid was sampled at 5, 10, 15, 20, 25, and 30 minutes postinjection. The dexamethasone concentration was analyzed using high-performance liquid chromatography. In a separate prospective clinical study, 79 patients with refractory sudden hearing loss underwent intratympanic injection. After the injection, patients remained in the supine position with the head rotated 45° to the unaffected side. Patients were divided into two groups according to the wait time in this treatment position postinjection: 30 minutes (n = 47) and 10 minutes (n = 32). Final hearing assessments were conducted 2 months after salvage treatment. RESULTS: In the in vivo animal study, the perilymphatic concentration of dexamethasone showed no significant increase after 10 minutes. In the clinical setting, hearing improvement according to Siegel's criteria was similar in the 30-minute (14/47) and 10-minute (10/32) groups (P = 0.999). No significant differences in relative hearing gain was observed between the two groups (13.80 ± 19.9 dB and 12.57 ± 14.9 dB, respectively; P = 0.766). CONCLUSION: We suggest that 10 minutes is a sufficient time to remain in the supine treatment position after ITDI in patients with sudden hearing loss. LEVEL OF EVIDENCE: N/A. Laryngoscope, 124:2807-2810, 2014.