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Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
Intra Tympanic Medications
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Intra Tympanic Medications

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This presentation describes the procedure intra tympanic medications

This presentation describes the procedure intra tympanic medications

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    • 1. Intra Tympanic Medications Dr. T. Balasubramanian M.S. D.L.O.
    • 2. Why ? <ul><li>Focused application </li></ul><ul><li>High drug levels where it is needed most </li></ul><ul><li>Use of smaller quantity of the drug </li></ul>
    • 3. Round window anatomy <ul><li>Round window is about 70 µ thick </li></ul><ul><li>Consists of 3 layers </li></ul><ul><li>Acts as a semi permeable membrane </li></ul><ul><li>Blood labyrinthine barrier </li></ul>
    • 4. What drugs can be used ? <ul><li>Gentamycin </li></ul><ul><li>Lignocaine </li></ul><ul><li>Steroids </li></ul><ul><li>Inner ear cells could be potential targets for gene therapy </li></ul><ul><li>Calpain inhibitors (leupeptin) </li></ul>
    • 5. Lignocaine as I.T. infusion <ul><li>Silences the hyper functional neuronal pathways which causes tinnitus </li></ul><ul><li>Causes intense vertigo and nausea </li></ul><ul><li>Effect does not last long hence abandoned </li></ul>
    • 6. Indications for intra tympanic steroids <ul><li>Idiopathic sudden s/n loss </li></ul><ul><li>Idiopathic rapidly progressive s/n loss </li></ul><ul><li>Otologic manifestations of systemic auto immune disease </li></ul>
    • 7. SSNHL <ul><li>New onset unilateral hearing loss developing within 72 hours </li></ul><ul><li>Patient feels a sudden pop with development of tinnitus </li></ul><ul><li>Hearing drops precipitously </li></ul><ul><li>Hearing fluctuations are common </li></ul><ul><li>Medical emergency </li></ul>
    • 8. Causes of SSNHL <ul><li>Traumatic </li></ul><ul><li>Immunologic </li></ul><ul><li>Toxic </li></ul><ul><li>Circulatory </li></ul><ul><li>Neurologic </li></ul><ul><li>Metabolic </li></ul><ul><li>Viral </li></ul>
    • 9. Pharmacology of steroids <ul><li>Genomic actions </li></ul><ul><li>Non genomic immediate actions </li></ul>
    • 10. Action of steroids in the ear <ul><li>Anti inflammatory action </li></ul><ul><li>Increases cochlear vascularity </li></ul><ul><li>Reduces degeneration of stria vascularis due to its anti oxidant effects </li></ul>
    • 11. What steroid to use ? <ul><li>? Methyl prednisolone </li></ul><ul><li>? Hydrocortisone </li></ul><ul><li>? Dexamethosone </li></ul>
    • 12. Why Methyl prednisolone ? <ul><li>Methyl prednisolone reached high concentration in the inner ear fluids </li></ul><ul><li>This high concentration is retained for a longer period of time. </li></ul><ul><li>The anti inflammatory potential of Methyl prednisolone was the best </li></ul>
    • 13. Mode of administration <ul><li>Through a middle ear catheter </li></ul><ul><li>Through a grommet </li></ul><ul><li>Continuous infusion pump </li></ul>
    • 14. Factors affecting the transfer of drug through round window <ul><li>Size of the particle </li></ul><ul><li>Charge </li></ul><ul><li>Presence of facilitating substances </li></ul><ul><li>Thickness of the round window membrane </li></ul><ul><li>Presence of inflammation in the round window membrane </li></ul>
    • 15. Facilitators <ul><li>Histamine </li></ul><ul><li>Prostaglandins </li></ul><ul><li>Leukotrienes </li></ul><ul><li>E.coli endotoxin </li></ul><ul><li>Staphylococcal exotoxin </li></ul><ul><li>Ethacrinic acid </li></ul>
    • 16. Aminoglycosides <ul><li>Gets preferentially concentrated in the endolymph </li></ul><ul><li>Damages type I cells preferentially in the ampullar area </li></ul><ul><li>Delivered using Silverstein micro wick technique through a grommet </li></ul>
    • 17. Silverstein Micro wick technique <ul><li>Made of polyvinyl acetate </li></ul><ul><li>Passed through a ventilation tube </li></ul><ul><li>The wick is 1mm in diameter and 9 mm long </li></ul><ul><li>Drugs can be self administered </li></ul><ul><li>Wick must be replaced once a month lest it is difficult to remove and becomes adherent to round window </li></ul>
    • 18. &nbsp;
    • 19. Complications of IT medications <ul><li>Persistent perforation </li></ul><ul><li>Mastoiditis </li></ul><ul><li>Deafness </li></ul>
    • 20. Role of reactive oxygen species <ul><li>Reactive oxygen species causes extensive damage to stria vascularis </li></ul><ul><li>They are extremely toxic to cellular and sub cellular structures </li></ul><ul><li>It is generated by noise trauma and also by aging </li></ul><ul><li>Aminoglycosides cause trauma to cochlea by releasing R.O.S. </li></ul>
    • 21. R.O.S. blockers <ul><li>Gluthathione </li></ul><ul><li>D. Methionine </li></ul><ul><li>Resveratrol </li></ul><ul><li>Oxygen </li></ul>
    • 22. Role of gene therapy <ul><li>Improves neuronal survival </li></ul><ul><li>Prevents oxidative stress </li></ul><ul><li>Regenerates auditory and vestibular hair cells </li></ul>
    • 23. Gene therapy <ul><li>Direct delivery of genes </li></ul><ul><li>Cochlea is suited because it is isolated from the remaining body by the blood labyrinth barrier </li></ul><ul><li>Perilymph permits virus to reach the cochlea hence genes can be transmitted using a virus or non virus vectors </li></ul>
    • 24. &nbsp;
    • 25. &nbsp;

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