Pneumatic external counterpulsation (PECP): A new treatment option for therapy-resistant inner ear disorders?

Background: The established therapeutic principle for sudden deafness and t innitus is based on the stimulation of the inner ear perfusion by infusion therapy using vase-active or hemodilutive agents. Concerning a mechanically induced increase of the inner ear's blood supply, the new technique of Pne umatic External Counterpulsation (PECP) was performed. This technique had a lready been used successfully in patients suffering from coronary heart dis ease. Due to an EGG-guided pneumatic compression of the lower extremities d uring diastole an increase of arterial perfusion of the extracranial supply ing brain vessels can be obtained by PECP-treatment. Patients and Methods: PECP was used in 33 patients (22 males, 11 females) between 19 and 76 years of age suffering from persisting acute hearing disorders and/or tinnitus a fter adequate infusion therapy. 3 patients revealed mild complications duri ng PECP-treatment (e.g. thoracic pain) which seemed to be related to the th erapeutic regime and disappeared completely after cessation of PECP. 30 pat ients underwent PECP-treatment on 5 following days for 1 hour. This standar dized hourly treatment regime was extended to 10 days in 12 patients. Thera peutic effects were determined by color-coded duplexsonography and pure ton e audiometry eventually masking the audiogram. Results: During treatment an increase of 19% flow volume in the internal carotid arteries and of 11% in the vertebral arteries was evaluated using color-coded duplexsonography. I n 47% of cases (n = 14) decrease of tinnitus intensity and/or tinnitus appe arance with an average of 16 dB was perceived after the end of the treatmen t series. Hearing threshold increased in 28% of cases (n = 7) with an avera ge threshold shift of 19 dB after PECP-treatment. All patients were examine d by pure tone audiometry during the follow-up after 4, 8 and 12 weeks as w ell as after 6 and 12 months. In all cases the audiometric benefit lasted t hroughout the follow-up 1 year, after treatment. Conclusions: The determina tion of a positive correlation between vascular flow increase in the extrac ranial brain-supplying vessels during PECP-treatment and the encouraging th erapeutic results obtained by audiometry seem to make this new and promisin g therapeutic option effective, practicable and easy to handle. These preli minary results of the PECP technique should be validated in further studies featuring larger numbers of patients suffering from therapy-resistant inne r ear disorders.