ISSN: 1300 - 6525 E-ISSN: 2149 - 0880
kulak burun boğaz
ve baş boyun cerrahisi dergisi
http://dergi.kbb-bbc.org.tr
Kayıtlı İndeksler





ORIGINAL RESEARCH

Effect of Dexamethasone Administration to the Fenestra during Stapedotomy on Postoperative Dizziness
Stapes Cerrahisi Sırasında Fenestra Üzerine Deksametazon Uygulamasının Postoperatif Baş Dönmesi Üzerine Etkisi
Received Date : 03 Aug 2021
Accepted Date : 20 Oct 2021
Available Online : 02 Nov 2021
Doi: 10.24179/kbbbbc.2021-85624 - Makale Dili: EN
KBB ve BBC Dergisi. 2021;29(4):264-70
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: To evaluate the effect of dexamethasone administration to the fenestra during stapedotomy on early postoperative dizziness. Material and Methods: Of all 85 patients, who underwent stapedotomy for otosclerosis, were divided into 2 groups according to whether dexamethasone was administered immediately after fenestra was opened during surgery. In the dexamethasone group, 4 drops (0.8 mg/0.2 mL) of dexamethasone phosphate were administered to fenestra using a 21-gauge injector immediately after stapedotomy during the surgery. These 2 groups were compared in terms of the severity of postoperative dizziness and its effect on quality of life, hearing thresholds, length of stay in the hospital and drugs used for dizziness. Results: The postoperative air-bone gap was 14±6 decibel in both the dexamethasone and control groups. The severity of dizziness on the day of the surgery was 4.68/10 points (range, 2-9) and 5.24/10 points (range, 2-8) in the dexamethasone and control groups, respectively (p=0.048). On the day of discharge, the severity of dizziness was 3.1/10 points (range, 0-9) and 3.78/10 points (range, 1-6) in the dexamethasone and control groups, respectively (p=0.008). The postoperative use of metoclopramide HCl was 0.33±0.764 units and 0.87±1.07 units in the dexamethasone and control groups, respectively (p=0.003). Conclusion: The results suggest that dexamethasone administration to the fenestra during otosclerosis surgery may reduce the severity of dizziness and the frequency of antiemetic drug use in the early period after stapedotomy while it has no effect on the hearing thresholds and dizziness in the long term period.
ÖZET
Amaç: Stapedotomi sırasında fenestraya deksametazon uygulamasının erken postoperatif baş dönmesi üzerine etkisini değerlendirmek. Gereç ve Yöntemler: Otoskleroz nedeniyle stapedotomi uygulanan toplam 85 hasta, ameliyat sırasında fenestra açıldıktan hemen sonra deksametazon uygulanıp uygulanmamasına göre 2 gruba ayrıldı. Deksamatazon grubunda, 4 damla (0,8 mg/0,2 mL) deksamatazon fosfat operasyonda stapedotomi hemen sonrası fenestra üzerine 21-gauge enjektör ucundan damlatılmıştır. Bu 2 grup, ameliyat sonrası baş dönmesinin şiddeti ve yaşam kalitesine etkisi, işitme eşikleri, hastanede kalış süresi ve baş dönmesi için kullanılan ilaçlar açısından karşılaştırıldı. Bulgular: Ameliyat sonrası hava-kemik aralığı hem deksametazon hem de kontrol gruplarında 14±6 desibel idi. Ameliyat sonrası aynı gün, baş dönmesinin şiddeti deksametazon ve kontrol gruplarında sırasıyla 4,68/10 puan (dağılım 2-9) ve 5,24/10 puan (dağılım 2-8) idi (p=0,048). Taburculuk gününde, baş dönmesi şiddeti deksametazon ve kontrol gruplarında sırasıyla 3,1/10 puan (dağılım, 0-9) ve 3,78/10 puan (dağılım, 1-6) idi (p=0,008). Postoperatif metoklopramid HCl kullanımı deksametazon ve kontrol gruplarında sırasıyla 0,33±0,764 ünite ve 0,87±1,07 ünite idi (p=0,003). Sonuç: Sonuçlar otoskleroz cerrahisi sırasında fenestraya deksametazon uygulanmasının stapedotomi sonrası erken dönemde baş dönmesi şiddetini ve antiemetik ilaç kullanım sıklığını azaltabileceğini bunun yanında uzun dönemde işitme eşikleri ve baş dönmesi üzerinde herhangi bir etki oluşturmayacağını düşündürmektedir.
KAYNAKLAR
  1. Rudic M, Keogh I, Wagner R, Wilkinson E, Kiros N, Ferrary E, et al. The pathophysiology of otosclerosis: review of current research. Hear Res. 2015;330(Pt A):51-6. [Crossref] [PubMed] 
  2. Shea JJ. Thirty years of stapes surgery. J Laryngol Otol. 1988;102(1):14-9. [Crossref] [PubMed] 
  3. Wegner I, Kamalski DM, Tange RA, Vincent R, Stegeman I, van der Heijden GJ, et al. Laser versus conventional fenestration in stapedotomy for otosclerosis: a systematic review. Laryngoscope. 2014;124(7):1687-93. [Crossref] [PubMed] 
  4. Nadol JB, Schuknecht HF. Surgery of the Ear and Temporale Bone. New York: Raven Press; 1993. [Link] 
  5. Ozmen AO, Aksoy S, Ozmen S, Saraç S, Sennaroğlu L, Gürsel B. Balance after stapedotomy: analysis of balance with computerized dynamic posturography. Clin Otolaryngol. 2009;34(3):212-7. [Crossref] [PubMed] 
  6. Sakata E, Itoh A, Ohtsu K, Nakazawa H, Iwashita N. Pathology and treatment of cochlear tinnitus by blocking with 4% lidocaine and decadron infusion. Practica Otol (Jpn). 1982;75:2525-35. [Crossref] 
  7. Itoh A, Sakata E. Treatment of vestibular disorders. Acta Otolaryngol Suppl. 1991;481:617-23. [Crossref] [PubMed] 
  8. Yilmaz I, Yilmazer C, Erkan AN, Aslan SG, Ozluoglu LN. Intratympanic dexamethasone injection effects on transient-evoked otoacoustic emission. Am J Otolaryngol. 2005;26(2):113-7. [Crossref] [PubMed] 
  9. Boleas-Aguirre MS, Lin FR, Della Santina CC, Minor LB, Carey JP. Longitudinal results with intratympanic dexamethasone in the treatment of Ménière's disease. Otol Neurotol. 2008;29(1):33-8. [Crossref] [PubMed] [PMC] 
  10. Gardu-o-Anaya MA, Couthino De Toledo H, Hinojosa-González R, Pane-Pianese C, Ríos-Casta-eda LC. Dexamethasone inner ear perfusion by intratympanic injection in unilateral Ménière's disease: a two-year prospective, placebo-controlled, double-blind, randomized trial. Otolaryngol Head Neck Surg. 2005;133(2):285-94. [Crossref] [PubMed] 
  11. Herraiz C, Plaza G, Aparicio JM, Gallego I, Marcos S, Ruiz C. Transtympanic steroids for Ménière's disease. Otol Neurotol. 2010;31(1):162-7. [Crossref] [PubMed] 
  12. Canbal M, Cebeci S, Çamur Duyan G, Kurtaran H, Arslan İ. Baş dönmesi engellilik envanterinin Türkçe geçerlilik ve güvenilirlik çalışması [A study of reliability and validity for the Turkish version of dizziness handicap inventory]. Turk J Family Med Prim Care. 2016;10(1):19-24. [Crossref] 
  13. Morozova SV, Dobrotin VE, Kulakova LA, Kaspranskaia GR, Ovchinnikov IuM. [Vestibular disorders in patients with otosclerosis: prevalence, diagnostic and therapeutic options]. Vestn Otorinolaringol. 2009;2:20-2. [PubMed] 
  14. Vartanianand MS, Banashek-Meshchiarkova TV. [The incidence of vestibular disorders among the patients suffering from otosclerosis]. Vestn Otorinolaringol. 2013;2:23-6. [PubMed] 
  15. Shea JJ Jr, Ge X, Orchik DJ. Endolymphatic hydrops associated with otosclerosis. Am J Otol. 1994;15(3):348-57. [PubMed] 
  16. Birch L, Elbrønd O. Stapedectomy and vertigo. Clin Otolaryngol Allied Sci. 1985;10(4):217-23. [Crossref] [PubMed] 
  17. Mandalà M, Nuti D. Long-term follow-up of vestibular neuritis. Ann N Y Acad Sci. 2009;1164:427-9. [Crossref] [PubMed] 
  18. Jacobson GP, Calder JH. Self-perceived balance disability/handicap in the presence of bilateral peripheral vestibular system impairment. J Am Acad Audiol. 2000;11(2):76-83. [PubMed] 
  19. Ten Voorde M, van der Zaag-Loonen HJ, van Leeuwen RB. Dizziness impairs health-related quality of life. Qual Life Res. 2012;21(6):961-6. [Crossref] [PubMed] 
  20. de Vilhena D, Gambôa I, Duarte D, Lopes G. Vestibular disorders after stapedial surgery in patients with otosclerosis. Int J Otolaryngol. 2016;2016:6830648. [Crossref] [PubMed] [PMC] 
  21. Kujala J, Aalto H, Hirvonen TP. Video-oculography findings in patients with otosclerosis. Otol Neurotol. 2005;26(6):1134-7. [Crossref]  [PubMed] 
  22. Balkany TJ, Connell SS, Hodges AV, Payne SL, Telischi FF, Eshraghi AA, et al. Conservation of residual acoustic hearing after cochlear implantation. Otol Neurotol. 2006;27(8):1083-8. [Crossref] [PubMed] 
  23. Nadol JB Jr, Shiao JY, Burgess BJ, Ketten DR, Eddington DK, Gantz BJ, et al. Histopathology of cochlear implants in humans. Ann Otol Rhinol Laryngol. 2001;110(9):883-91. [Crossref] [PubMed] 
  24. Salt AN, Hartsock J, Plontke S, LeBel C, Piu F. Distribution of dexamethasone and preservation of inner ear function following intratympanic delivery of a gel-based formulation. Audiol Neurootol. 2011;16(5):323-35. [Crossref] [PubMed] [PMC] 
  25. James DP, Eastwood H, Richardson RT, O'Leary SJ. Effects of round window dexamethasone on residual hearing in a Guinea pig model of cochlear implantation. Audiol Neurootol. 2008;13(2):86-96. [Crossref] [PubMed] 
  26. Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, et al; American Academy of Otolaryngology-Head and Neck Surgery. Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg. 2012;146(3 Suppl):S1-35. [Crossref] [PubMed] 
  27. House HP, Hansen MR, Al Dakhail AA, House JW. Stapedectomy versus stapedotomy: comparison of results with long-term follow-up. Laryngoscope. 2002;112(11):2046-50. [Crossref] [PubMed] 
  28. Fisch U. Stapedotomy versus stapedectomy. Am J Otol. 1982;4(2):112-7. [PubMed] 
  29. Çelik Ç, Ceylan ME, Aliyeva A, Düzenli U, Dalgıç A. The effect of perioperative ı.v. corticosteroids on hearing outcome following stapedotomy. ENT Updates. 2018;8(2):82-7. [Crossref] 
  30. Székely L, Gáborján A, Dános K, Szalóki T, Fent Z, Tamás L, et al. Mid-term evaluation of perioperative i.v. corticosteroid treatment efficacy on overall and audiological outcome following CO2 laser stapedotomy: a retrospective study of 84 cases. Eur Arch Otorhinolaryngol. 2020;277(4):1031-8. [Crossref] [PubMed] [PMC] 
  31. Chang A, Eastwood H, Sly D, James D, Richardson R, O'Leary S. Factors influencing the efficacy of round window dexamethasone protection of residual hearing post-cochlear implant surgery. Hear Res. 2009;255(1-2):67-72. [Crossref]  [PubMed]