gms | German Medical Science

80. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

20.05. - 24.05.2009, Rostock

Rheopheresis for idiopathic sudden hearing loss: results from a large prospective, multicenter, randomized, controlled clinical trial

Meeting Abstract

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Rostock, 20.-24.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09hno031

DOI: 10.3205/09hno031, URN: urn:nbn:de:0183-09hno0319

Veröffentlicht: 22. Juli 2009

© 2009 Mösges et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: Idiopathic sudden hearing loss (ISHL) has been suggested to precipitate as final common pathway of microcirculatory impairment of the inner ear associated with a variety of etiologies and characterized by a local hyperviscosity syndrome in cochlear vessels. Therefore, we investigated the effect of Rheopheresis, a method of therapeutic apheresis reducing plasma viscosity and improving microcirculation on hearing recovery.

Methods: Patients were randomly assigned to receive 2 Rheopheresis treatments, or treatment according to current German guidelines consisting either of i.v. corticosteroids (methylprednisolon 250 mg for 3 days and subsequent oral dosing with tapering to zero) or i.v. hemodilution (500 mL 6% hydroxyethyl starch + 600 mg pentoxifylline per day), each applied for 10 days. The primary outcome was absolute recovery of hearing as measured by pure tone audiometry 10 days after start of treatment. Secondary outcomes were recovery of hearing at day 42, improvement of speech audiometry, tinnitus and feeling of pressure and frequency of adverse events.

Results: In total, 240 ISHL patients were enrolled from otorhinolaryngological departments at hospitals and out patient clinics in Germany. Mean absolute recovery of hearing on day 10 within the intention-to-treat population (n = 193) was 23.95 dB (SD 15.05) in the Rheopheresis group, 24.29 dB (SD 15.48) in the control group. Equal efficacy of Rheopheresis and tested standard treatments was demonstrated (p = 0.00056). Single Rheopheresis led to a higher recovery of hearing after 48h in patients with high plasma viscosity (> 1.8 mPas s; p = 0.029) or high total protein (> 74 g/dL; p = 0.02). However, an overall good recovery of ISHL was observed, with none of the tested therapies being superior regarding the primary outcome.

Conclusion: Rheopheresis proved to be an effective treatment option within the ENT armamentarium for ISHL. 2 Rheopheresis treatments within 3 days lasting for about 2 hours each could be used to replace a 10-day infusion regimen, especially in patients who desire fast recovery from acute hearing loss. Also, this may be a second line treatment option for patients refractory to i.v. corticosteroids or hemodilution.


References

1.
Mösges R, Köberlein J, Erdtracht B, Klingel R; RHEO-ISHL Study Group.Quality of life in patients with idiopathic sudden hearing loss: comparison of different therapies using the Medical Outcome Short Form (36) Health Survey questionnaire. Otol Neurotol. 2008;769-75.
2.
Suckfüll M. Fibrinogen and LDL apheresis in treatment of sudden hearing loss: a randomised multicentre trial. Lancet 2002;360:1811-7.