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Case Report

Int J Pain 2022; 13(2): 99-102

Published online December 31, 2022 https://doi.org/10.56718/ijp.22-007

Copyright © The Korean Association for the Study of Pain.

Successful Hearing Recovery after Stellate Ganglion Block in a Patient Who Failed to Respond to Systematic and Intratympanic Steroid Injection: A New Approach to Salvage Therapy for Sudden Sensorineural Hearing Loss

Jiyoung Kim1, Jae-Hyun Seo2, Chang Jae Kim3, Hojun Ro1, Lib Kim1, Hyunjoon Lee1, Hue Jung Park1

1Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 2Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 3Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Sudden sensorineural hearing loss (SSNHL) is a common otolaryngologic emergency. In natural history of SSNHL, spontaneous resolutions have been reported in 32-65% in previous studies. However, hearing loss as a sequelae may remain for some patients, which is devastating. Therefore, when first-line therapy fails to SSNHL patients, necessity of salvage therapy could be emphasized. 36-year-old woman presented to our clinic. The patient has not responded to oral and intratympanic steroid therapy. Her initial audiogram revealed the patient is experiencing sensorineural hearing loss. We performed stellate ganglion block (SGB) under ultrasound. After two sessions of SGB, the patient experienced subjective recovery of SSNHL and recovery of audiogram. SGB could be attempted to the refractory SSNHL patients who failed to recover spontaneously or responded by primary therapy such as intratympanic or systemic steroids.

Keywordshearing loss, nerve block, stellate ganglion, sympathetic nerve block

Sudden sensorineural hearing loss (SSNHL) is a common emergency in otolaryngological clinics [1]. Although spontaneous resolution has been reported to occur in 32% to 65% of cases [2-4], clinicians suspect based on their experience that these numbers might be overestimated [5]. Systemic steroid remains mainstay of treatment [6], with recovery rate reported as 61% in a hallmark study [7], and intratympanic steroid is often used as primary, or combination, or salvage therapy, with varying recovery rate [8-10]. Moreover, if treatments fail and hearing loss remains as a sequalae, SSNHL may cause significant depression and loss of quality of life [10]. While systemic and intratympanic administration of steroids has been proposed as the mainstay of treatment for patients without spontaneous resolution, the only approved option as a salvage is hyperbaric oxygen therapy (HBOT), which is expensive and less accessible to the patients [5]. Therefore, diversifying the available measures for salvage therapy in SSNHL patients who are refractory to steroids would be meaningful for individuals who are on the verge of complete hearing loss. In this case, we present a case of successful hearing recovery after stellate ganglion block (SGB) in an SSNHL patient who failed to respond to systemic steroid therapy and subsequent intratympanic steroid therapy. This is the first report of SGB used as a salvage therapy for refractory SSNHL.

A 36-years-old woman presented to our pain center complaining of incomplete recovery from hearing loss in the right ear. Her symptoms had started 9 days prior to her visit to our clinic, and the patient had been treated with high-dose oral steroid therapy with methylprednisolone 48 mg daily and intratympanic dexamethasone every other day for 7 days at a local ear, nose, and throat (ENT) clinic.

Her initial audiogram demonstrated that her right ear had an air conduction threshold of 45-65 dB and a bone conduction threshold of 80-50 dB, while the air and bone conduction thresholds of her left ear remained normal (Fig. 1A).

Figure 1.The patient’s audiogram. (A) Initial audiogram from other hospital with increased hearing threshold in both bone and air conduction at right ear indicating SSNHL. (B) The patient’s audiogram after 3 sessions of SGB with decreased hearing threshold indicating complete recovery. Means of thresholds at 6 frequencies are lower than 25 dB. (C) The patient’s audiogram 4 weeks after completion of SGB. Hearing threshold remained in normal range. O: Right ear air conduction; X: Left ear air condoction; [: Right ear bone conduction masked; ]: Left ear bone conduction masked; Δ: Right ear air conduction masked.

We performed three sessions of right-sided SGB at 2-week intervals under ultrasound guidance (Fig. 2). We injected 5ml of 0.4 % lidocaine at prevertebral fascia at 7th level of spine. After 2 sessions of SGB, the patient experienced subjective recovery from hearing loss, and complete recovery was confirmed by an audiogram showing complete resolution after the 3rd session of SGB. Both the air and bone conduction thresholds were less than 15 db (Fig. 1B,C). This case report is approved by Institutional Review Board The Catholic University of Korea, Seoul St. Mary’s Hospital (IRB no : KC22ZISI0727), and written and informed consent was obtained from the patient.

Figure 2.Performing ultrasound guided right-sided stellate ganglion block. (A) Needle placed at between carotid artery and longus colli muscle. (B) After injecting local anesthetics, injectate is spread in between prevertebral fascia. SCM: Sternocleidomastoid muscle; CA: carotid artery; LC: longus colli muscle; TP: transverse process. Internal jugular vein is collapsed by pressure on ultrasound transducer.

This case is the first report of SGB used as a salvage therapy for an SSNHL patient who was refractory to systematic and intratympanic steroid therapy. Although the effect of SGB on SSNHL as part of a combination therapy is well researched [11-13], the effectiveness of SGB as a salvage therapy has not yet been investigated. In a previous study, improve of SSNHL after SGB was associated with early onset of treatment [11].

HBOT is an established salvage therapy for SSNHL [5]. However, possible complications, such as pulmonary and middle ear barotrauma and oxygen toxicity, and out of accessibility to centers applying HBOT are limitations of this treatment [14]. SGB could be an alternative salvage therapy method for SSNHL patients who are not eligible for HBOT.

The pathogenesis of SSNHL is still not well defined, but oxidative stress has been proposed as a possible mechanism [15]. The mechanism of SGB in SSNHL patients is speculated to be improvement of inner ear circulation [12], similar to other applications of nerve blocks in orofacial regions, for example, to treat anosmia or laryngopharyngeal reflux disease [16,17]. The effect of SGB is mediated by sympathetic blockade of the cervical region. Therefore, SGB must be performed correctly in order to treat SSNHL effectively. The stellate ganglion is located at the C7-T1 level, and the correct spread of the injectate depends on the correct placement of the needle tip between the prevertebral fascia and the longus colli muscle [18]. Ever since SGB has been performed for hearing loss patients [11-12,19], and the amount of anesthetics researchers used for SGB varied, from 3-5 ml to 7 ml. In this study, the author used 5ml of lidocaine. The correct placement of needle in the prevertebral fascia lets clinician to minimize the volume of injectate. The methodology for SGB has evolved from landmark-based to fluoroscopy-based to ultrasound-based methods. The ultrasound-guided method guarantees the most accurate placement of the needle tip, allowing direct visualization of the cervical level of the spine and associated structures, such as the carotid vessels, cervical muscles and associated fascial structures.

Therefore, the authors suggest that a sonography-guided procedure would be the most suitable method of SGB for patients with SSNHL. Adequate vasodilation can be achieved by precise blockade of the cervical sympathetic ganglia and gives rise to the therapeutic effect of SGB on SSNHL. Ultrasound-guided SGB could be an alternative salvage therapy for patients with refractory SSNHL. Currently, the authors are conducting a prospective study of SGB as a salvage therapy for SSNHL.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.

No potential conflict of interest relevant to this article was reported.

  1. Kuhn M, Heman-Ackah SE, Shaikh JA, Roehm PC: Sudden sensorineural hearing loss: a review of diagnosis, treatment, and prognosis. Trends Amplif 2011; 15: 91-105.
    Pubmed KoreaMed CrossRef
  2. Byl FM Jr: Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope 1984; 94: 647-61.
    Pubmed CrossRef
  3. Mattox DE, Simmons FB: Natural history of sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol 1977; 86: 463-80.
    Pubmed CrossRef
  4. Nosrati-Zarenoe R, Arlinger S, Hultcrantz E: Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database. Acta Otolaryngol 2007; 127: 1168-75.
    Pubmed CrossRef
  5. Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, et al: Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg 2019; 161: S1-45.
    Pubmed CrossRef
  6. Marx M, Younes E, Chandrasekhar SS, Ito J, Plontke S, O'Leary S, et al: International consensus (ICON) on treatment of sudden sensorineural hearing loss. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135: S23-8.
    Pubmed CrossRef
  7. Wilson WR, Byl FM, Laird N: The Efficacy of steroids in the treatment of idiopathic sudden hearing loss: a double-blind clinical study. Archives of Otolaryngology 1980; 106: 772-6.
    Pubmed CrossRef
  8. Rauch SD, Halpin CF, Antonelli PJ, Babu S, Carey JP, Gantz BJ, et al: Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial. Jama 2011; 305: 2071-9.
    Pubmed CrossRef
  9. Dispenza F, Amodio E, De Stefano A, Gallina S, Marchese D, Mathur N, et al: Treatment of sudden sensorineural hearing loss with transtympanic injection of steroids as single therapy: a randomized clinical study. European Archives of Oto-Rhino-Laryngology 2011; 268: 1273-8.
    Pubmed CrossRef
  10. Lee JB, Choi SJ, Park K, Park HY, Choo OS, Choung YH: The efficiency of intratympanic dexamethasone injection as a sequential treatment after initial systemic steroid therapy for sudden sensorineural hearing loss. European Archives of Oto-Rhino-Laryngology 2011; 268: 833-9.
    Pubmed CrossRef
  11. Haug O, Draper WL, Haug SA: Stellate ganglion blocks for idiopathic sensorineural hearing loss. Arch Otolaryngol 1976; 102: 5-8.
    Pubmed CrossRef
  12. Takinami Y: Evaluation of effectiveness of stellate ganglion block (SGB) treatment of sudden hearing loss. Acta Otolaryngol 2012; 132: 33-8.
    Pubmed CrossRef
  13. Park KH, Lee CK, Lee JD, Park MK, Lee BD: Combination therapy with systemic steroids, an antiviral agent, anticoagulants, and stellate ganglion block for treatment of sudden sensorineural hearing loss. Korean J Audiol 2012; 16: 71-4.
    Pubmed KoreaMed CrossRef
  14. Yildiz S, Uzun G, Kiralp MZ: Hyperbaric oxygen therapy in chronic pain management. Curr Pain Headache Rep 2006; 10: 95-100.
    Pubmed CrossRef
  15. Elias TGA, Monsanto RDC, do Amaral JB, Oyama LM, Maza PK, Penido NO: Evaluation of Oxidative-Stress Pathway and Recovery of Sudden Sensorineural Hearing Loss. Int Arch Otorhinolaryngol 2021; 25: E428-32.
    Pubmed KoreaMed CrossRef
  16. Moon HS, Chon JY, Lee SH, Ju YM, Sung CH: Long-term results of stellate ganglion block in patients with olfactory dysfunction. Korean J Pain 2013; 26: 57-61.
    Pubmed KoreaMed CrossRef
  17. Chung JW, Chun HJ, Lee MS, Ahn KR, Kim CS, Kang KS, et al: Effect of stellate ganglion block on laryngopharyngeal reflux disease. Korean J Anesthesiol 2013; 64: 439-42.
    Pubmed KoreaMed CrossRef
  18. Narouze S: Ultrasound-guided stellate ganglion block: safety and efficacy. Curr Pain Headache Rep 2014; 18: 424.
    Pubmed CrossRef
  19. Hilger JA: Vasomotor labyrinthine ischemia. Ann Otol Rhinol Laryngol 1950; 59: 1102-16.
    Pubmed CrossRef

Article

Case Report

Int J Pain 2022; 13(2): 99-102

Published online December 31, 2022 https://doi.org/10.56718/ijp.22-007

Copyright © The Korean Association for the Study of Pain.

Successful Hearing Recovery after Stellate Ganglion Block in a Patient Who Failed to Respond to Systematic and Intratympanic Steroid Injection: A New Approach to Salvage Therapy for Sudden Sensorineural Hearing Loss

Jiyoung Kim1, Jae-Hyun Seo2, Chang Jae Kim3, Hojun Ro1, Lib Kim1, Hyunjoon Lee1, Hue Jung Park1

1Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 2Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 3Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Sudden sensorineural hearing loss (SSNHL) is a common otolaryngologic emergency. In natural history of SSNHL, spontaneous resolutions have been reported in 32-65% in previous studies. However, hearing loss as a sequelae may remain for some patients, which is devastating. Therefore, when first-line therapy fails to SSNHL patients, necessity of salvage therapy could be emphasized. 36-year-old woman presented to our clinic. The patient has not responded to oral and intratympanic steroid therapy. Her initial audiogram revealed the patient is experiencing sensorineural hearing loss. We performed stellate ganglion block (SGB) under ultrasound. After two sessions of SGB, the patient experienced subjective recovery of SSNHL and recovery of audiogram. SGB could be attempted to the refractory SSNHL patients who failed to recover spontaneously or responded by primary therapy such as intratympanic or systemic steroids.

Keywords: hearing loss, nerve block, stellate ganglion, sympathetic nerve block

INTRODUCTION

Sudden sensorineural hearing loss (SSNHL) is a common emergency in otolaryngological clinics [1]. Although spontaneous resolution has been reported to occur in 32% to 65% of cases [2-4], clinicians suspect based on their experience that these numbers might be overestimated [5]. Systemic steroid remains mainstay of treatment [6], with recovery rate reported as 61% in a hallmark study [7], and intratympanic steroid is often used as primary, or combination, or salvage therapy, with varying recovery rate [8-10]. Moreover, if treatments fail and hearing loss remains as a sequalae, SSNHL may cause significant depression and loss of quality of life [10]. While systemic and intratympanic administration of steroids has been proposed as the mainstay of treatment for patients without spontaneous resolution, the only approved option as a salvage is hyperbaric oxygen therapy (HBOT), which is expensive and less accessible to the patients [5]. Therefore, diversifying the available measures for salvage therapy in SSNHL patients who are refractory to steroids would be meaningful for individuals who are on the verge of complete hearing loss. In this case, we present a case of successful hearing recovery after stellate ganglion block (SGB) in an SSNHL patient who failed to respond to systemic steroid therapy and subsequent intratympanic steroid therapy. This is the first report of SGB used as a salvage therapy for refractory SSNHL.

CASE REPORT

A 36-years-old woman presented to our pain center complaining of incomplete recovery from hearing loss in the right ear. Her symptoms had started 9 days prior to her visit to our clinic, and the patient had been treated with high-dose oral steroid therapy with methylprednisolone 48 mg daily and intratympanic dexamethasone every other day for 7 days at a local ear, nose, and throat (ENT) clinic.

Her initial audiogram demonstrated that her right ear had an air conduction threshold of 45-65 dB and a bone conduction threshold of 80-50 dB, while the air and bone conduction thresholds of her left ear remained normal (Fig. 1A).

Figure 1. The patient’s audiogram. (A) Initial audiogram from other hospital with increased hearing threshold in both bone and air conduction at right ear indicating SSNHL. (B) The patient’s audiogram after 3 sessions of SGB with decreased hearing threshold indicating complete recovery. Means of thresholds at 6 frequencies are lower than 25 dB. (C) The patient’s audiogram 4 weeks after completion of SGB. Hearing threshold remained in normal range. O: Right ear air conduction; X: Left ear air condoction; [: Right ear bone conduction masked; ]: Left ear bone conduction masked; Δ: Right ear air conduction masked.

We performed three sessions of right-sided SGB at 2-week intervals under ultrasound guidance (Fig. 2). We injected 5ml of 0.4 % lidocaine at prevertebral fascia at 7th level of spine. After 2 sessions of SGB, the patient experienced subjective recovery from hearing loss, and complete recovery was confirmed by an audiogram showing complete resolution after the 3rd session of SGB. Both the air and bone conduction thresholds were less than 15 db (Fig. 1B,C). This case report is approved by Institutional Review Board The Catholic University of Korea, Seoul St. Mary’s Hospital (IRB no : KC22ZISI0727), and written and informed consent was obtained from the patient.

Figure 2. Performing ultrasound guided right-sided stellate ganglion block. (A) Needle placed at between carotid artery and longus colli muscle. (B) After injecting local anesthetics, injectate is spread in between prevertebral fascia. SCM: Sternocleidomastoid muscle; CA: carotid artery; LC: longus colli muscle; TP: transverse process. Internal jugular vein is collapsed by pressure on ultrasound transducer.

DISCUSSION

This case is the first report of SGB used as a salvage therapy for an SSNHL patient who was refractory to systematic and intratympanic steroid therapy. Although the effect of SGB on SSNHL as part of a combination therapy is well researched [11-13], the effectiveness of SGB as a salvage therapy has not yet been investigated. In a previous study, improve of SSNHL after SGB was associated with early onset of treatment [11].

HBOT is an established salvage therapy for SSNHL [5]. However, possible complications, such as pulmonary and middle ear barotrauma and oxygen toxicity, and out of accessibility to centers applying HBOT are limitations of this treatment [14]. SGB could be an alternative salvage therapy method for SSNHL patients who are not eligible for HBOT.

The pathogenesis of SSNHL is still not well defined, but oxidative stress has been proposed as a possible mechanism [15]. The mechanism of SGB in SSNHL patients is speculated to be improvement of inner ear circulation [12], similar to other applications of nerve blocks in orofacial regions, for example, to treat anosmia or laryngopharyngeal reflux disease [16,17]. The effect of SGB is mediated by sympathetic blockade of the cervical region. Therefore, SGB must be performed correctly in order to treat SSNHL effectively. The stellate ganglion is located at the C7-T1 level, and the correct spread of the injectate depends on the correct placement of the needle tip between the prevertebral fascia and the longus colli muscle [18]. Ever since SGB has been performed for hearing loss patients [11-12,19], and the amount of anesthetics researchers used for SGB varied, from 3-5 ml to 7 ml. In this study, the author used 5ml of lidocaine. The correct placement of needle in the prevertebral fascia lets clinician to minimize the volume of injectate. The methodology for SGB has evolved from landmark-based to fluoroscopy-based to ultrasound-based methods. The ultrasound-guided method guarantees the most accurate placement of the needle tip, allowing direct visualization of the cervical level of the spine and associated structures, such as the carotid vessels, cervical muscles and associated fascial structures.

Therefore, the authors suggest that a sonography-guided procedure would be the most suitable method of SGB for patients with SSNHL. Adequate vasodilation can be achieved by precise blockade of the cervical sympathetic ganglia and gives rise to the therapeutic effect of SGB on SSNHL. Ultrasound-guided SGB could be an alternative salvage therapy for patients with refractory SSNHL. Currently, the authors are conducting a prospective study of SGB as a salvage therapy for SSNHL.

ACKNOWLEDGEMENTS

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Fig 1.

Figure 1.The patient’s audiogram. (A) Initial audiogram from other hospital with increased hearing threshold in both bone and air conduction at right ear indicating SSNHL. (B) The patient’s audiogram after 3 sessions of SGB with decreased hearing threshold indicating complete recovery. Means of thresholds at 6 frequencies are lower than 25 dB. (C) The patient’s audiogram 4 weeks after completion of SGB. Hearing threshold remained in normal range. O: Right ear air conduction; X: Left ear air condoction; [: Right ear bone conduction masked; ]: Left ear bone conduction masked; Δ: Right ear air conduction masked.
International Journal of Pain 2022; 13: 99-102https://doi.org/10.56718/ijp.22-007

Fig 2.

Figure 2.Performing ultrasound guided right-sided stellate ganglion block. (A) Needle placed at between carotid artery and longus colli muscle. (B) After injecting local anesthetics, injectate is spread in between prevertebral fascia. SCM: Sternocleidomastoid muscle; CA: carotid artery; LC: longus colli muscle; TP: transverse process. Internal jugular vein is collapsed by pressure on ultrasound transducer.
International Journal of Pain 2022; 13: 99-102https://doi.org/10.56718/ijp.22-007

References

  1. Kuhn M, Heman-Ackah SE, Shaikh JA, Roehm PC: Sudden sensorineural hearing loss: a review of diagnosis, treatment, and prognosis. Trends Amplif 2011; 15: 91-105.
    Pubmed KoreaMed CrossRef
  2. Byl FM Jr: Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope 1984; 94: 647-61.
    Pubmed CrossRef
  3. Mattox DE, Simmons FB: Natural history of sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol 1977; 86: 463-80.
    Pubmed CrossRef
  4. Nosrati-Zarenoe R, Arlinger S, Hultcrantz E: Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database. Acta Otolaryngol 2007; 127: 1168-75.
    Pubmed CrossRef
  5. Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, et al: Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg 2019; 161: S1-45.
    Pubmed CrossRef
  6. Marx M, Younes E, Chandrasekhar SS, Ito J, Plontke S, O'Leary S, et al: International consensus (ICON) on treatment of sudden sensorineural hearing loss. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135: S23-8.
    Pubmed CrossRef
  7. Wilson WR, Byl FM, Laird N: The Efficacy of steroids in the treatment of idiopathic sudden hearing loss: a double-blind clinical study. Archives of Otolaryngology 1980; 106: 772-6.
    Pubmed CrossRef
  8. Rauch SD, Halpin CF, Antonelli PJ, Babu S, Carey JP, Gantz BJ, et al: Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial. Jama 2011; 305: 2071-9.
    Pubmed CrossRef
  9. Dispenza F, Amodio E, De Stefano A, Gallina S, Marchese D, Mathur N, et al: Treatment of sudden sensorineural hearing loss with transtympanic injection of steroids as single therapy: a randomized clinical study. European Archives of Oto-Rhino-Laryngology 2011; 268: 1273-8.
    Pubmed CrossRef
  10. Lee JB, Choi SJ, Park K, Park HY, Choo OS, Choung YH: The efficiency of intratympanic dexamethasone injection as a sequential treatment after initial systemic steroid therapy for sudden sensorineural hearing loss. European Archives of Oto-Rhino-Laryngology 2011; 268: 833-9.
    Pubmed CrossRef
  11. Haug O, Draper WL, Haug SA: Stellate ganglion blocks for idiopathic sensorineural hearing loss. Arch Otolaryngol 1976; 102: 5-8.
    Pubmed CrossRef
  12. Takinami Y: Evaluation of effectiveness of stellate ganglion block (SGB) treatment of sudden hearing loss. Acta Otolaryngol 2012; 132: 33-8.
    Pubmed CrossRef
  13. Park KH, Lee CK, Lee JD, Park MK, Lee BD: Combination therapy with systemic steroids, an antiviral agent, anticoagulants, and stellate ganglion block for treatment of sudden sensorineural hearing loss. Korean J Audiol 2012; 16: 71-4.
    Pubmed KoreaMed CrossRef
  14. Yildiz S, Uzun G, Kiralp MZ: Hyperbaric oxygen therapy in chronic pain management. Curr Pain Headache Rep 2006; 10: 95-100.
    Pubmed CrossRef
  15. Elias TGA, Monsanto RDC, do Amaral JB, Oyama LM, Maza PK, Penido NO: Evaluation of Oxidative-Stress Pathway and Recovery of Sudden Sensorineural Hearing Loss. Int Arch Otorhinolaryngol 2021; 25: E428-32.
    Pubmed KoreaMed CrossRef
  16. Moon HS, Chon JY, Lee SH, Ju YM, Sung CH: Long-term results of stellate ganglion block in patients with olfactory dysfunction. Korean J Pain 2013; 26: 57-61.
    Pubmed KoreaMed CrossRef
  17. Chung JW, Chun HJ, Lee MS, Ahn KR, Kim CS, Kang KS, et al: Effect of stellate ganglion block on laryngopharyngeal reflux disease. Korean J Anesthesiol 2013; 64: 439-42.
    Pubmed KoreaMed CrossRef
  18. Narouze S: Ultrasound-guided stellate ganglion block: safety and efficacy. Curr Pain Headache Rep 2014; 18: 424.
    Pubmed CrossRef
  19. Hilger JA: Vasomotor labyrinthine ischemia. Ann Otol Rhinol Laryngol 1950; 59: 1102-16.
    Pubmed CrossRef
The Korean Association for the Study of Pain

Vol.14 No.2
December 2023

pISSN 2233-4793
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