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Table of Contents
Vol. 11, No. 6, 2006
Issue release date: October 2006
Section title: Original Paper
Audiol Neurotol 2006;11:357–365
(DOI:10.1159/000095897)

Local Perfusion of the Tumor Necrosis Factor α Blocker Infliximab to the Inner Ear Improves Autoimmune Neurosensory Hearing Loss

van Wijk F. · Staecker H. · Keithley E. · Lefebvre P.P.
aDepartment of Otorhinolaryngology, University of Liège, Liège, Belgium; bDepartment of Otolaryngology Head and Neck Surgery, University of Kansas, Kansas City, Mo., and cDepartment of Otolaryngology, San Diego, Calif., USA

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 2/13/2006
Accepted: 6/7/2006
Published online: 10/23/2006
Issue release date: October 2006

Number of Print Pages: 9
Number of Figures: 4
Number of Tables: 1

ISSN: 1420-3030 (Print)
eISSN: 1421-9700 (Online)

For additional information: http://www.karger.com/AUD

Abstract

Objective: To evaluate the effect of transtympanic administration of tumor necrosis factor α (TNF-α) blockers to patients suffering from autoimmune inner ear disease (AIED). Study Design: Nonrandomized, prospective pilot study. Setting: Tertiary referral center. Patients: 9 patients (4 men and 5 women; aged 51.22 ± 13.11 years) presenting with autoimmune sensorineural hearing loss who responded to oral steroid treatment. Two groups of patients were treated. Group A consisted of 5 patients with AIED who could not be tapered off steroids. Group B consisted of 4 patients who were treated with intratympanic anti-TNF-α antibody therapy alone after a relapse of hearing loss following discontinuation of steroids. Intervention: A Silverstein MicroWickTM local delivery system was placed in the round window niche and the patients were treated for 4 weeks with a weekly infusion of infliximab, a monoclonal antibody against TNF-α. Main Outcome Measure(s): Evaluation of hearing thresholds at 250–8000 Hz was performed before and after implantation of the Silverstein MicroWick and local delivery of the TNF-α blocker. Results: Local administration of the TNF-α blocker allowed methylprednisolone to be tapered off without loss of hearing function in 4/5 steroid-dependent patients. Four additional patients were treated only with anti-TNF-α perfusion to the round window membrane without concomitant systemic administration of methylprednisolone. In 3 of these 4 patients, the pure tone average improved to 22.6 ± 15.7 dB, resulting in hearing recovery comparable to treatment with systemic methylprednisolone. The 7 responding patients showed a significant reduction of recurrence of hearing loss to 0.028 ± 0.072 episodes per month over the 4.3 ± 2.4 months of the post-treatment period compared to 0.84 ± 0.4 recurrences per week seen in the pretreatment period. Conclusions: The results of this pilot trial demonstrate that in patients with AIED, transtympanic delivery of the TNF-α blocker infliximab once weekly for 4 weeks allowed steroids to be tapered off, resulted in hearing improvement and reduced disease relapses. These preliminary efficacy and safety results appear encouraging enough to warrant further follow-up and studies for better determination of the potential clinical utility of local administration of infliximab for autoimmune hearing loss.


  

Author Contacts

Philippe Lefebvre
Department of Otorhinolaryngology
CHU de Liège
BE–4000 Liège (Belgium)
Tel. +32 436 68891, Fax +32 436 67525, E-Mail pp.lefebvre@ulg.ac.be

  

Article Information

Received: February 13, 2006
Accepted after revision: June 7, 2006
Published online: September 21, 2006
Number of Print Pages : 9
Number of Figures : 4, Number of Tables : 1, Number of References : 32

  

Publication Details

Audiology and Neurotology (Basic Science and Clinical Research in the Auditory and Vestibulary Systems and Diseases of the Ear)

Vol. 11, No. 6, Year 2006 (Cover Date: October 2006)

Journal Editor: Harris, J.P. (San Diego, Calif.)
ISSN: 1420–3030 (print), 1421–9700 (Online)

For additional information: http://www.karger.com/AUD


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 2/13/2006
Accepted: 6/7/2006
Published online: 10/23/2006
Issue release date: October 2006

Number of Print Pages: 9
Number of Figures: 4
Number of Tables: 1

ISSN: 1420-3030 (Print)
eISSN: 1421-9700 (Online)

For additional information: http://www.karger.com/AUD


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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