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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
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.
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.
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