Concurrent treatment with intratympanic dexamethasone improves facial nerve recovery in Ramsay Hunt syndrome

• Published in: Journal of the neurological sciences 2020-03, Vol.410, p.116678-116678, Article 116678
• Main Authors: Inagaki, Akira, Minakata, Toshiya, Katsumi, Sachiyo, Murakami, Shingo
• Format: Article
• Language: English
• Subjects: Antiviral therapy; Clinical trial; Dexamethasone - therapeutic use; Facial Nerve; Glucocorticoids - therapeutic use; Hearing Loss, Sensorineural; Herpes Zoster Oticus - drug therapy; Humans; Injection, Intratympanic; Intratympanic injection; Ramsay hunt syndrome; Steroid therapy; Systemic administration; Treatment Outcome
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2020.116678

To determine whether early intervention with intratympanic steroid injections, known as concurrent intratympanic steroid therapy (ITST), is an effective supplement to systemic steroid therapy for moderately-severe to severe Ramsay Hunt syndrome. Forty-six patients with Ramsay Hunt syndrome (House-Brackmann grade IV or higher) who received either concurrent ITST with standard systemic steroid therapy (ITST group, n = 12) or standard systemic therapy alone (control group, n = 34) with antivirals starting within 7 days of onset. Patients in the concurrent ITST group received the standard systemic dose of prednisolone (410 mg in total) and intratympanic dexamethasone (16.5 mg in total) over 10 consecutive days. Patients in the control group received systemic prednisolone at the standard dose or higher (average dose, 581 ± 25 mg). The recovery rate was higher in the concurrent ITST group than in the control group (93% vs 47%, P = .013). The adjusted odds ratio was 22.2 (95% confidence interval 1.32–373.58, P = .031). The recovery rate was higher after concurrent systemic and intratympanic steroid therapy than after standard systemic steroid therapy, regardless of whether the steroid used had lower or equivalent glucocorticoid potency. This finding suggests that concurrent intratympanic steroid therapy is a beneficial supplement in patients with Ramsay Hunt syndrome. •Patients with Ramsay Hunt syndrome often present with severe facial palsy.•Systemic steroid and antiviral therapy are the current standard-of-care.•Intratympanic injection allows high doses of steroids to reach the facial nerve.•This approach was tested in Ramsay Hunt syndrome to supplement standard-of-care.•Better facial outcomes were achieved regardless of low glucocorticoid potency.