Intra Tympanic Medications Dr. T. Balasubramanian M.S. D.L.O.
Why ? <ul><li>Focused application </li></ul><ul><li>High drug levels where it is needed most </li></ul><ul><li>Use of smal...
Round window anatomy <ul><li>Round window is about 70  µ thick </li></ul><ul><li>Consists of 3 layers </li></ul><ul><li>Ac...
What drugs can be used   ? <ul><li>Gentamycin </li></ul><ul><li>Lignocaine </li></ul><ul><li>Steroids </li></ul><ul><li>In...
Lignocaine as I.T. infusion <ul><li>Silences the hyper functional neuronal pathways which causes tinnitus </li></ul><ul><l...
Indications for intra tympanic steroids <ul><li>Idiopathic sudden s/n loss </li></ul><ul><li>Idiopathic rapidly progressiv...
SSNHL <ul><li>New onset unilateral hearing loss developing within 72 hours </li></ul><ul><li>Patient feels a sudden pop wi...
Causes of SSNHL <ul><li>Traumatic </li></ul><ul><li>Immunologic </li></ul><ul><li>Toxic </li></ul><ul><li>Circulatory </li...
Pharmacology of steroids <ul><li>Genomic actions </li></ul><ul><li>Non genomic immediate actions </li></ul>
Action of steroids in the ear <ul><li>Anti inflammatory action </li></ul><ul><li>Increases cochlear vascularity </li></ul>...
What steroid to use ? <ul><li>? Methyl prednisolone </li></ul><ul><li>? Hydrocortisone </li></ul><ul><li>? Dexamethosone <...
Why Methyl prednisolone ? <ul><li>Methyl prednisolone reached high concentration in the inner ear fluids </li></ul><ul><li...
Mode of administration <ul><li>Through a middle ear catheter </li></ul><ul><li>Through a grommet </li></ul><ul><li>Continu...
Factors affecting the transfer of drug through round window <ul><li>Size of the particle </li></ul><ul><li>Charge </li></u...
Facilitators <ul><li>Histamine </li></ul><ul><li>Prostaglandins </li></ul><ul><li>Leukotrienes </li></ul><ul><li>E.coli en...
Aminoglycosides <ul><li>Gets preferentially concentrated in the endolymph </li></ul><ul><li>Damages type I cells preferent...
Silverstein Micro wick technique <ul><li>Made of polyvinyl acetate </li></ul><ul><li>Passed through a ventilation tube </l...
 
Complications of IT medications <ul><li>Persistent perforation </li></ul><ul><li>Mastoiditis </li></ul><ul><li>Deafness </...
Role of reactive oxygen species <ul><li>Reactive oxygen species causes extensive damage to stria vascularis </li></ul><ul>...
R.O.S. blockers <ul><li>Gluthathione </li></ul><ul><li>D. Methionine </li></ul><ul><li>Resveratrol </li></ul><ul><li>Oxyge...
Role of gene therapy <ul><li>Improves neuronal survival </li></ul><ul><li>Prevents oxidative stress </li></ul><ul><li>Rege...
Gene therapy <ul><li>Direct delivery of genes </li></ul><ul><li>Cochlea is suited because it is isolated from the remainin...
 
 
Upcoming SlideShare
Loading in …5
×

Intra Tympanic Medications

2,166 views

Published on

This presentation describes the procedure intra tympanic medications

Published in: Health & Medicine, Technology
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,166
On SlideShare
0
From Embeds
0
Number of Embeds
8
Actions
Shares
0
Downloads
77
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide
  • Intra Tympanic Medications

    1. 1. Intra Tympanic Medications Dr. T. Balasubramanian M.S. D.L.O.
    2. 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. 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. 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. 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. 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. 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. 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. 9. Pharmacology of steroids <ul><li>Genomic actions </li></ul><ul><li>Non genomic immediate actions </li></ul>
    10. 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. 11. What steroid to use ? <ul><li>? Methyl prednisolone </li></ul><ul><li>? Hydrocortisone </li></ul><ul><li>? Dexamethosone </li></ul>
    12. 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. 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. 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. 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. 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. 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. 19. Complications of IT medications <ul><li>Persistent perforation </li></ul><ul><li>Mastoiditis </li></ul><ul><li>Deafness </li></ul>
    19. 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>
    20. 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>
    21. 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>
    22. 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>

    ×