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| 22KS-026 |
A new approach to salvage therapy for sudden sensorineural hearing loss (SSNHL)
Department of Anesthesiology and Pain Medicine, Seoul St. Mary\' s Hospital, College of Medicine, Korea
Case report
A 36-year-old woman presented to our pain center complaining of incomplete recovery from hearing loss in the right ear. Her symptoms had started 9 days prior to her visit to our clinic, and the patient had been treated with high-dose oral steroid therapy with methylprednisolone 48 mg daily and intratympanic dexamethasone every other day for 7 days at a local ear, nose, and throat (ENT) clinic.
Her initial audiogram demonstrated that her right ear had an air conduction threshold of 45-65 dB and a bone conduction threshold of 80-50 dB, while the air and bone conduction thresholds of her left ear remained normal.
We performed three sessions of right-sided SGB at 2-week intervals under ultrasound guidance. After 2 sessions of SGB, the patient experienced subjective recovery from hearing loss, and complete recovery was confirmed by an audiogram showing complete resolution after the 3rd session of SGB.
Discussion
This case is the first report of SGB used as a salvage therapy for an SSNHL patient who was refractory to systematic and intratympanic steroid therapy. The pathogenesis of SSNHL is still not well defined, but oxidative stress has been proposed as a possible mechanism. The mechanism of SGB in SSNHL patients is speculated to be improvement of inner ear circulation, similar to other applications of nerve blocks in orofacial regions, for example, to treat anosmia or laryngopharyngeal reflux disease. The effect of SGB is mediated by sympathetic blockade of the cervical region. The stellate ganglion is located at the C7-T1 level, and the correct spread of the injectate depends on the correct placement of the needle tip between the prevertebral fascia and the longus coli muscle. The ultrasound-guided method guarantees the most accurate placement of the needle tip, allowing direct visualization of the cervical level of the spine and associated structures, such as the carotid vessels, cervical muscles and associated fascial structures.
Therefore, the authors suggest that a sonography-guided procedure would be the most suitable method of SGB for patients with SSNHL. Adequate vasodilation can be achieved by precise blockade of the cervical sympathetic ganglia and gives rise to the therapeutic effect of SGB on SSNHL. Ultrasound-guided SGB could be an alternative salvage therapy for patients with refractory SSNHL.
A 36-year-old woman presented to our pain center complaining of incomplete recovery from hearing loss in the right ear. Her symptoms had started 9 days prior to her visit to our clinic, and the patient had been treated with high-dose oral steroid therapy with methylprednisolone 48 mg daily and intratympanic dexamethasone every other day for 7 days at a local ear, nose, and throat (ENT) clinic.
Her initial audiogram demonstrated that her right ear had an air conduction threshold of 45-65 dB and a bone conduction threshold of 80-50 dB, while the air and bone conduction thresholds of her left ear remained normal.
We performed three sessions of right-sided SGB at 2-week intervals under ultrasound guidance. After 2 sessions of SGB, the patient experienced subjective recovery from hearing loss, and complete recovery was confirmed by an audiogram showing complete resolution after the 3rd session of SGB.
Discussion
This case is the first report of SGB used as a salvage therapy for an SSNHL patient who was refractory to systematic and intratympanic steroid therapy. The pathogenesis of SSNHL is still not well defined, but oxidative stress has been proposed as a possible mechanism. The mechanism of SGB in SSNHL patients is speculated to be improvement of inner ear circulation, similar to other applications of nerve blocks in orofacial regions, for example, to treat anosmia or laryngopharyngeal reflux disease. The effect of SGB is mediated by sympathetic blockade of the cervical region. The stellate ganglion is located at the C7-T1 level, and the correct spread of the injectate depends on the correct placement of the needle tip between the prevertebral fascia and the longus coli muscle. The ultrasound-guided method guarantees the most accurate placement of the needle tip, allowing direct visualization of the cervical level of the spine and associated structures, such as the carotid vessels, cervical muscles and associated fascial structures.
Therefore, the authors suggest that a sonography-guided procedure would be the most suitable method of SGB for patients with SSNHL. Adequate vasodilation can be achieved by precise blockade of the cervical sympathetic ganglia and gives rise to the therapeutic effect of SGB on SSNHL. Ultrasound-guided SGB could be an alternative salvage therapy for patients with refractory SSNHL.
