ORIGINAL RESEARCH
Is Corticosteroid Safe Enough for the Treatment of Sudden Hearing Loss and Bell’s Palsy in Diabetic and Hypertensive Patients?
Diyabetik ve Hipertansif Hastalarda Ani İşitme Kaybı ve Bell’s Palsi Tedavisinde Kortikosteroid Yeterince Güvenli midir?
Received Date : 06 Jan 2020
Accepted Date : 01 May 2020
Available Online : 08 May 2020
Kemal KESEROĞLUa, Başak YALÇINERa, Sibel ALİCURA TOKGÖZa, Bülent ÖCALa, Cem SAKAa, Güleser SAYLAMa
aUniversity of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Otorhinolaryngology, Ankara, TURKEY
Doi: 10.24179/kbbbbc.2020-73358 - Makale Dili: EN
KBB ve BBC Dergisi. 2020;28(2):117-23
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 investigate the side effects of systemic
corticosteroid (CS) treatment in the idiopathic sudden sensorineural
hearing loss (ISSHL) and Bell’s palsy patients. Material and Methods:
The patients were retrospectively evaluated for the major side effects
of systemic CS. The patients with systemic diseases (hypertension
and diabetes mellitus) were further investigated with respect to alterations
on antidiabetic or antihypertensive drug regimens. The categorization
was performed according to the dosage alterations of
antidiabetic or antihypertensive drugs and the patients were divided
into 3 groups: Group 1 (stable group), Group 2 (acute dysregulated
group) and Group 3 (chronic dysregulated group). Results: Among the
276 patients, there was only one major complication which was a femur
avascular necrosis during a mean follow up 4,5 months. In the diabetic
group, the acute and chronic drug alteration was statistically significantly
higher with respect to hypertensive group (p<0.001). HbA1c≥8%
(64 mmol/mol) caused a significant increase in Group 3 ratio (p<0.05).
Conclusion: The risk of major side effect of the systemic CS was extremely
low (<1%). Corticosteroids in patients with hypertension did
not alter the antihypertensive doses however, diabetic patients needed
drug alteration. HbA1c level<8% (64 mmol/mol) can be used as a
safety criterion for starting systemic CS therapy in the diabetic patients
with ISSHL and Bell’s palsy.
Keywords: Sudden hearing loss; Bell’s palsy; corticosteroids; side effects of drugs; glycosylated hemoglobin A1c
ÖZET
Amaç: Ani idiopatik sensörinöral işitme kaybı ve Bell’s palsi
hastalarında kortikosteroid tedavisinin yan etkilerini araştırmak. Gereç
ve Yöntemler: Hastalar sistemik steroid tedavisinin major yan etkileri
açısından retrospektif olarak değerlendirilmiştir. Sistemik hastalığı
(diabetes mellitus ve hipertansiyon) olan hastalar antidiyabetik veya
antihipertansif ilaç rejimlerindeki değişimlere göre ayrıca araştırılmıştır.
Kategorizasyon antidiyabetik ve antihipertansif ilaçlardaki doz
değişikliklerine göre yapılmış ve hastalar 3 grup altında toplanmıştır:
Grup 1 (stabil grup), Grup 2 (akut disregüle olan grup) ve Grup 3 (kronik
disregüle olan grup). Bulgular: 276 hasta arasında ortalama 4,5
aylık takip süresinde 1 tane majör komplikasyon görülmüştür: femurun
avasküler nekrozu. Diyabetik grupta hipertansif gruba göre, akut
ve kronik ilaç değişikliği istatistiksel olarak anlamlı yüksek olarak bulunmuştur
(p<0,001). HbA1c >%8 (64 mmol/mol) olması, Grup 3 oranında
anlamlı bir artışa neden olmuştur (p<0,05). Sonuç: Sistemik
kortikosteroide bağlı majör yan etki görülme riski oldukça düşük bulunmuştur
(<%1). Hipertansiyonu olan hastalarda kortikosteroid kullanımı
antihipertansif dozlarını değiştirmese de, diyabetik hastalar ilaç
değişimine ihtiyaç duymuşlardır. HbA1c <%8 (64 mmol/mol), ani
idiopatik sensörinöral işitme kaybı ve Bell’s palsi olan diyabetik hastalarda
kortikosteroid başlamak için bir güvenlik kriteri olarak kullanılabilir.
Anahtar Kelimeler: Ani işitme kaybı; Bell’s palsi; kortikosteroidler; ilaç yan etkisi; glikolize hemoglobin A1c
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