Emerging treatments
Tumour necrosis factor-alpha inhibitors
Tumour necrosis factor (TNF)-alpha is a pro-inflammatory cytokine that increases the production of prostaglandins, thromboxanes, and leukotrienes by activating phospholipase A2. These autacoids are typically released by neutrophils, platelets, and endothelial cells. Data from an animal study suggest that TNF-alpha is involved in meningitis-induced hearing loss and cochlear injury and is therefore a possible target for future therapies in patients with labyrinthitis secondary to meningitis.[44]
Superoxide dismutase
Oxygen free radicals induced by the complement cascade play a critical role in the development of hearing loss and labyrinthitis ossificans associated with meningitis. Hearing preservation and prevention of labyrinthitis ossificans with intrathecal superoxide dismutase has been demonstrated in an animal model.[45]
Intra-tympanic corticosteroids
Traditionally corticosteroids have been given orally, but reports suggest that intra-labyrinthine concentrations can be improved by intra-tympanic injections of the drugs. This mode of therapy is still under investigation.[46]
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