The Comparison of the Effects of Anesthesia Methods Used in Intratympanic Injections on Pain in Patients Diagnosed With Sudden İdiopathic Hearing Loss
Abstract
Giriş ve Amaç: İdyopatik ani sensörinöral işitme kaybı (AİK) acil tanı ve tedavi gerektiren bir kulak hastalığıdır. İntratimpanik steroidlerin (İTS), AİK tedavisindeki etkinliğini göstermek için birçok çalışma yapılmıştır. İTS sonrasında sıklıkla ağrı, vertigo, otitis media ve zar perforasyonu gelişebilmektedir. İTS enjeksiyonu öncesi yapılan lokal anestezi metodunun ağrı azaltma üzerindeki etkilerinde birbirlerinden üstünlük olarak fark saptanmamıştır. Bu çalışmamızda, lokal anestezik krem, lidokain sprey, Vibrasyon Anestezi Cihazı ve serum fizyolojik damla kullanılarak İTS uygulanan hastalarda bu dört yöntemin ağrı düzeylerinin karşılaştırılması amaçlanmıştır. Materyal ve Metod: Çalışma için Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu'ndan etik izni alındı (Tarih: 17.06.2020, Karar No: 03). Çalışmaya 25/07/2020-25/08/2021 tarihleri arasında Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi Hastanesi KBB Kliniği'nde idyopatik ani işitme kaybı saptanan toplam 41 hasta dahil edildi. Bulgular: Çalışmamıza yaş ortalaması 40.7±15.4 yıl olan, 25 (%60.9)'i erkek ve 16 (%39.1)'sı kadın toplam 41 hasta alındı. Hastaların AİK gelişen kulaklarından 22 (%53.6)'si sol ve 19 (%46.4)'u sağ taraftı. Hastaların ilk 4 enjeksiyonları sırasında anestezi uygulama yöntemi daha önce random şekilde düzenlenen dağılıma uygun olarak yapıldı. Son enjeksiyon sırasında ise hastaların isteğine göre seçilen yöntem ile anestezi sağlanmaya çalışıldı. Hastaların 13 (%24.5)'ü vibrasyon anestezi cihazı yöntemini, 15 (%2.3)'i lokal anestezik kremi (EMLA krem), 10 (%18.4)'u lidokain enjeksiyonunu tercih eder iken SF damlasını isteyen 3 (%7) hasta vardı. İntratimpanik steroid (İTS) öncesi yapılan anestezi seçeneklerinin VAS (Vizüel analog skalası), NRS (Numerikal rating skala) ve VRS (Verbal rating skala) sonuçlarına etkisi değerlendirildi. Vibrasyon anestezi cihazı (VAC), lokal anestezik krem ve lidokain sprey kullanılan hastalarda 1., 2., ve 3. uygulamalar sırasında ortalama VAS, NRS ve VRS açısından farklılık saptanmadı. Bununla birlikte 4. enjeksiyon sırasında SF damla kullanılan gruptaki VAS ve NRS skorları VAC ve lokal anestezik krem kullanılan gruptan daha yüksek saptandı (sırasıyla; p=0.039 ve p=0.013). Hastaların 5. Enjeksiyonları sırasında analjezik olarak istedikleri yöntemlere göre VAS, NRS ve VRS skorları açısından anlamlı farklılık saptanmadı (p>0.05). Sonuç: Ani idyopatik işitme kaybı (AİK) tanılı hastalarda vibrasyon anestezi cihazı (VAC) ile yapılan anestezi uygulamasının sonuçları en az diğer lokal anestezi uygulamaları kadar iyi ağrı palyasyonu sağlamıştır. Aynı zamanda VAC uygulamasının diğer anestezik ajanlara göre avantajı yara iyileşmesini bozabilecek lokal anestezik ilaç kullanım ihtiyacını ortadan kaldırmıştır. Bunun yanında ilaç alerjisi olan hastalarda da VAC uygulaması ile anestezi sağlanması alternatif bir yöntem olarak düşünülebilir. Anahtar Kelimeler: Ani işitme kaybı, İntratimpanik steroid, Ağrı, VAC, Sensorinöral işitme kaybı
Aim and Objective: Idiopathic sudden sensoryneural hearing loss (ISSNHL) is an ear disease that requires urgent diagnosis and treatment. Many studies have been conducted to demonstrate the efficacy of intratympanic steroids (ITS) in the treatment of ISSNHL. Pain, vertigo, otitis media, and membrane perforation can often develop after ITS. There was no difference in the effects of the local anesthesia method applied before the ITS injection on pain reduction. In this study, it was aimed to compare the pain levels of these four methods in patients who underwent ITS using topical lidocaine spray, local anesthetic cream, vibration anesthesia device and saline drops (control). Materials and Method: Ethics approval was obtained for the study from the Van Yüzüncü Yıl University Medicine Faculty Clinical Researches Ethics Committee (Date: 17.06.2020, Decision No: 03). A total of 41 patients with idiopathic ISSNHL who applied to the ENT Clinic of Van Yüzüncü Yıl University Faculty of Medicine Hospital between 25/07/2020-25/08/2021. Results: A total of 41 patients, 25 (60.9%) male and 16 (39.1%) female, with a mean age of 40.7±15.4 years were included in our study. Of the patients' ears that developed ISSNHL, 22 (53.6%) were on the left and 19 (46.4%) were on the right. During the first 4 injections of the patients, the anesthesia method was applied in accordance with the previously randomly arranged distribution. During the last injection, anesthesia was tried to be provided with the method chosen according to the wishes of the patients. While 13 (24.5%) of the patients preferred the vibration anesthesia device method, 15 (2.3%) local anesthetic cream, 10 (18.4%) lidocaine injection, there were 3 (7%) patients who wanted saline drops (SF). The effects of anesthesia options before intratympanic steroid (ITS) on VAS (visual analog scale), NRS (numerical rating scale) and VRS (verbal rating scale) results were evaluated. There was no difference in the mean VAS, NRS and VRS during the 1st, 2nd, and 3rd applications in patients who used VAD, EMLA and Lidocaine Spray. However, the VAS and NRS scores in the group using SF drops during the 4th injection were higher than those in the group using VAD and local anesthetic cream (p=0.039 and p=0.013, respectively). No significant difference was found in terms of VAS, NRS and VRS scores according to the analgesic methods requested by the patients during their 5th injection (p>0.05). Conclusion: The results of anesthesia application with VAD (vibration anesthesia device) in patients with ISSNHL diagnosis provided pain palliation at least as well as other local anesthesia applications. At the same time, the advantage of VAD application over other anesthetic agents has eliminated the need to use local anesthetics that may impair wound healing. In addition, anesthesia with VAD application in patients with drug allergy can be considered as an alternative method. Keywords: Sudden hearing loss, Intratympanic steroid, Pain, VAD, Sensorineural hearing loss.
Aim and Objective: Idiopathic sudden sensoryneural hearing loss (ISSNHL) is an ear disease that requires urgent diagnosis and treatment. Many studies have been conducted to demonstrate the efficacy of intratympanic steroids (ITS) in the treatment of ISSNHL. Pain, vertigo, otitis media, and membrane perforation can often develop after ITS. There was no difference in the effects of the local anesthesia method applied before the ITS injection on pain reduction. In this study, it was aimed to compare the pain levels of these four methods in patients who underwent ITS using topical lidocaine spray, local anesthetic cream, vibration anesthesia device and saline drops (control). Materials and Method: Ethics approval was obtained for the study from the Van Yüzüncü Yıl University Medicine Faculty Clinical Researches Ethics Committee (Date: 17.06.2020, Decision No: 03). A total of 41 patients with idiopathic ISSNHL who applied to the ENT Clinic of Van Yüzüncü Yıl University Faculty of Medicine Hospital between 25/07/2020-25/08/2021. Results: A total of 41 patients, 25 (60.9%) male and 16 (39.1%) female, with a mean age of 40.7±15.4 years were included in our study. Of the patients' ears that developed ISSNHL, 22 (53.6%) were on the left and 19 (46.4%) were on the right. During the first 4 injections of the patients, the anesthesia method was applied in accordance with the previously randomly arranged distribution. During the last injection, anesthesia was tried to be provided with the method chosen according to the wishes of the patients. While 13 (24.5%) of the patients preferred the vibration anesthesia device method, 15 (2.3%) local anesthetic cream, 10 (18.4%) lidocaine injection, there were 3 (7%) patients who wanted saline drops (SF). The effects of anesthesia options before intratympanic steroid (ITS) on VAS (visual analog scale), NRS (numerical rating scale) and VRS (verbal rating scale) results were evaluated. There was no difference in the mean VAS, NRS and VRS during the 1st, 2nd, and 3rd applications in patients who used VAD, EMLA and Lidocaine Spray. However, the VAS and NRS scores in the group using SF drops during the 4th injection were higher than those in the group using VAD and local anesthetic cream (p=0.039 and p=0.013, respectively). No significant difference was found in terms of VAS, NRS and VRS scores according to the analgesic methods requested by the patients during their 5th injection (p>0.05). Conclusion: The results of anesthesia application with VAD (vibration anesthesia device) in patients with ISSNHL diagnosis provided pain palliation at least as well as other local anesthesia applications. At the same time, the advantage of VAD application over other anesthetic agents has eliminated the need to use local anesthetics that may impair wound healing. In addition, anesthesia with VAD application in patients with drug allergy can be considered as an alternative method. Keywords: Sudden hearing loss, Intratympanic steroid, Pain, VAD, Sensorineural hearing loss.
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Keywords
Kulak Burun ve Boğaz, Ağrı, Ağrı ölçümü, Kulak hastalıkları, Timpanik membran, İşitme, İşitme bozuklukları, İşitme kaybı-ani, İşitme kaybı-sensori nöral, Otorhinolaryngology (Ear-Nose-Throat), Pain, Pain measurement, Ear diseases, Tympanic membrane, Hearing, Hearing disorders, Hearing loss-sudden, Hearing loss-sensorineural
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