Are Steroids the Best Treatment for AIED?

The dilemma in AIED in using intratympanic steroids is if you believe that the patient’s entire immune system is dysregulated, putting a few drops of steroid in their ear is really not treating the whole immune system-it’s treating one little place, the ear. If you believe the patient’s whole immune system is okay but there’s something wrong in the ear, then injecting the drug in the ear might have some logic. This is analogous to patients who are using systemic steroids for a condition such as rheumatoid arthritis, but occasionally need a steroid injection directly into a ‘hot’ joint.

Getting the evidence isn’t an easy task, Dr. Harris noted. AIED is rare, and getting enough patients to make a study powerful enough statistically is difficult. However, Dr. Harris does use intratympanic injections in patients who are clearly steroid-responsive, but who can no longer tolerate high-dose steroids.

We will try intratympanic injections of high-dose steroids into the middle ear to see if that will give these patients the same benefit that the oral steroids gave them, he said. If the patient responds, then the patients will be offered repeat injections.

However, the timing and regime for injections are a best guess. Studies still need to be done to sort out the effectiveness of intratympanic injections for steroid-responsive AIED, Dr. Harris said.

Overall, there isn’t much debate over oral steroids for some types of AIED. The efficacy of steroids in autoimmune deafness has been pretty well established, Dr. Harris said.

©2007 The Triological Society