Intratympanic steroid injections

Three weeks ago I had my appointment with the Lupus Unit at Guys Hospital to eliminate the possibility of my illness being an autoimmune condition. The consultant asked me tonnes of questions, pushed and prodded me and did lots of tests on me. He even tried to stick bits of paper in my eyes and leave them there for FIVE MINUTES!!! (no way Jose! Noone sticks anything in my eyes! especially now I am so dependent on them). He concluded that I have no symptoms of any systemic autoimmune disorder but he took a long list of blood tests to double check anyway. I breathed a big Phew and await the results which I will get next week.

Remember, proponents of the vascular theory are seeking a smoking gun: a direct linkage between some vascular event such as ischemia or infarction and definite changes associated with hearing loss. Changes in the temporal bones, such as labyrinthine ossification, if consistently found in patients with SSNHL, would be such a smoking gun. Saumil N. Merchant, ., and his colleagues at my institution, the Massachusetts Eye and Ear Infirmary, recently reviewed specimens of temporal bone in the Infirmary’s collection from 17 cases of SSNHL. 3 Only one specimen showed any evidence of new bone formation—the vascular theorists’ hoped-for smoking gun. Another strike against the vascular theory is the relationship of SSNHL prognosis to the site of cochlear injury. The cochlear artery runs from the base of cochlea, where high-frequency sounds are detected, to the apex, where low-frequency sounds are detected. Since there is no collateral blood supply to the cochlear apex, blockage of the cochlear artery should cause the most severe damage to low-frequency hearing. But clinical reports show exactly the opposite: SSNHL affecting low-frequency hearing of the cochlear apex actually has a better prognosis than SSNHL affecting high-frequency hearing in the cochlear base. Another difficulty is that if the labyrinthine artery itself were affected by some vascular event, both auditory and balance functions should be impaired, but only a few patients with SSNHL experience severe or sustained vertigo.  

Project Title: Otomicrobiome of the Ear Otitis media, or middle ear infection, is a major public health problem in young children. Rapid emergence of resistant bacterial pathogens has led to reconsideration of routine use of antibiotics. The challenge is to develop and utilize knowledge of the basic biology underlying bacterial colonization and infection of the middle ear to create new approaches to preventing infection. Elucidating the events triggering the transition from bacterial colonization to bacterial infection of the middle ear will be essential to developing preventative tools for otitis media (OM). To date, nearly all research on bacterial colonization and infection of the middle ear, nasopharynx, and oropharynx have relied on culture-based or targeted molecular methods, which are inherently limited against complex bacterial communities. We must evaluate the transition from bacterial colonization to infection in OM by fully characterizing the bacterial communities using community-scale molecular bacterial analysis. We hypothesize that disturbances in the ecologic balance of the bacterial community—specifically an increase in otopathogen and a decrease in otocommensals—lead to the transition from bacterial colonization to infection; which can only be elucidated using a community-scale molecular approach. Here, we propose to assess the transition from bacterial colonization to infection of the middle ear using two cutting-edge molecular methods—16S rRNA gene pyrosequencing and 16S rRNA qPCR—to fully characterize the bacterial communities in non-OM and OM nasopharynx, adenoid, and middle ear.  Our ability to develop novel OM preventions will be limited until we assess this critical interface between bacterial colonization and infection. Simultaneously, by understanding the pathophysiology of otitis media and more directed therapy, we will reduce the nation’s overall healthcare expenditure by minimizing the used of antibiotics. Working with Cindy Liu, MD, PhD, and Lance Price, PhD, of Translational Genomics Research Institute, we anticipate that this research will result in a more efficient use of resources for diagnoses, therapy and prevention of disease.

The remaining two procedures, vetibular neurectomy and labyrinthectomy, are ways of eliminating the balance function of the faulty ear. It is known that individuals will function better with one normal balance system than with one normal and one faulty system. The labyrinthectomy is a procedure in which the mastoid bone is removed and the inner ear is eliminated. This procedure is for patients that have lost usable hearing in the affected ear, as it entails removing all function of the inner ear, including hearing and balance. The change from having two balance systems to having one balance system alone does require a recovery or "compensation" period. It takes the brain a period of weeks to figure out that only one system is active and that it is no longer receiving information from the faulty system which it had come to expect. The second procedure, the vestibular neurectomy, is a good option if the hearing is good in the ear with the failing balance system. In this surgical procedure, the balance nerve (vestibular nerve) is cut between the inner ear and the brain. The inner ear is completely preserved but the faulty balance information is not able to reach the brain and cause the vertigo. Like the labyrinthectomy, this procedure requires a recovery period while the brain "figures out" the new situation.

Intratympanic steroid injections

intratympanic steroid injections

The remaining two procedures, vetibular neurectomy and labyrinthectomy, are ways of eliminating the balance function of the faulty ear. It is known that individuals will function better with one normal balance system than with one normal and one faulty system. The labyrinthectomy is a procedure in which the mastoid bone is removed and the inner ear is eliminated. This procedure is for patients that have lost usable hearing in the affected ear, as it entails removing all function of the inner ear, including hearing and balance. The change from having two balance systems to having one balance system alone does require a recovery or "compensation" period. It takes the brain a period of weeks to figure out that only one system is active and that it is no longer receiving information from the faulty system which it had come to expect. The second procedure, the vestibular neurectomy, is a good option if the hearing is good in the ear with the failing balance system. In this surgical procedure, the balance nerve (vestibular nerve) is cut between the inner ear and the brain. The inner ear is completely preserved but the faulty balance information is not able to reach the brain and cause the vertigo. Like the labyrinthectomy, this procedure requires a recovery period while the brain "figures out" the new situation.

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