Corticoids
Three investigations have evaluated the role of intratympanic
corticosteroids to prevent CiO (Marshak et al., 2014, Moreno et al.,
2022, Nasr et al., 2018). Two studies used dexamethasone and one
methylprednisolone. In a controlled trial, prior to each cisplatin
treatment session, intratympanic dexamethasone was injected 0.7 to 1.0
ml (10mg/ml) into randomly assigned ears. A significant attenuation in
the hearing loss at 6000 Hz (P<0.02) and decreased outer hair
dysfunction in the range of 4000 to 8000 Hz (P<0 .04) was
observed in the intervention group (Marshak et al., 2014). These
positive findings of intratympanic dexamethasone protecting the hearing
capacity were corroborated by a second randomized controlled phase IIIB
trial. Dexamethasone was administered via a passive diffusion device to
an ear and the contralateral ear was used as the control. Audiometric
analysis showed a higher hearing threshold in the study group than in
the control group with significant differences at frequencies of 500,
1000, and 6000 Hz (p < 0.05)(Moreno et al. 2022). Safety
outcomes for both trials reported slight pain and mild vertigo during
the application, otological infections, and permanent tympanic
perforation in 34.8% of the patients (Marshak et al., 2014, Moreno et
al., 2022). Lastly, 0.3ml (40mg/ml) of intratympanic methylprednisolone
was also assessed for CiO treatment in a prospective cohort of 20
patients with any type of cancer. Intratympanic corticosteroid
injections appeared to have minimal therapeutic effect diminishing
cisplatināinduced hearing loss at 6000 and 8000 Hz. The adverse effects
of this trial were not reported (Nasr et al., 2018).