Пути проникновения глюкокортикостероидов из барабанной полости к структурам внутреннего уха

Блинова М.Л., Голованов А.Е., Исаченко В.С. Пути проникновения глюкокортикостероидов из барабанной полости к структурам внутреннего уха. Consilium Medicum. 2022;24(9):626–631.
DOI: 10.26442/20751753.2022.9.201907

© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.

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Blinova ML, Golovanov AE, Isachenko VS. Ways of penetration of glucocorticosteroids from the tympanic cavity to the structures of the inner ear: A review. Consilium Medicum. 2022;24(9):626–631.
DOI: 10.26442/20751753.2022.9.201907

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Аннотация

На сегодняшний день в отечественной и зарубежной литературе появляется все больше сообщений об успешном применении глюкокортикостероидов для лечения патологии внутреннего уха путем местного – интратимпанального введения. Разрабатывается множество способов доставки лекарственных средств к структурам внутреннего уха. Как известно, системное введение глюкокортикостероидов имеет ряд противопоказаний и большое количество побочных эффектов за счет широкого спектра действия. Экзогенные глюкокортикоиды нарушают естественный баланс гипоталамо-гипофизарно-надпочечниковой системы, вмешиваясь в систему регуляции отрицательной обратной связи, для полного восстановления которого впоследствии требуется длительное время. Интратимпанальный способ введения глюкокортикостероидов позволяет обойти указанные нежелательные эффекты и в то же время оказать желаемое терапевтическое действие на вестибулярные и кохлеарные структуры внутреннего уха. В отношении действия, оказываемого на структуры внутреннего уха, интратимпанальное применение глюкокортикостероидов оказалось более эффективным по сравнению с системным, что связано с наличием гематоперилимфатического барьера, сравниваемого по своей проницаемости с гематоэнцефалическим. Более того, при системном введении для достижения достаточной концентрации препарата в жидкостях внутреннего уха требуются большие дозы стероидов. На сегодняшний день остается достаточно много вопросов в отношении путей, по которым лекарственный препарат проникает к структурам внутреннего уха, принципов распространения препарата внутри кохлеарных жидкостей, а также анатомических препятствий, с которыми можно столкнуться на пути к достижению желаемого терапевтического эффекта. Целью статьи является освещение актуальных на сегодняшний день достижений в области исследований, посвященных путям проникновения лекарственных препаратов, в частности глюкокортикостероидов, к структурам внутреннего уха из барабанной полости.

Ключевые слова: интратимпанальное введение глюкокортикостероидов, мембрана круглого окна, структуры овального окна, внутреннее ухо

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To date, in domestic and foreign literature, there are more and more reports of the successful use of glucocorticosteroids for the treatment of pathology of the inner ear by local – intratympanic administration. Many methods are being developed to deliver drugs to the structures of the inner ear. As you know, the systemic administration of glucocorticosteroids has a number of contraindications and a large number of side effects, due to a wide spectrum of action. Exogenous glucocorticoids disrupt the natural balance of the hypothalamic-pituitary-adrenal system, interfering with the negative feedback regulation system, which requires a long time to fully restore. The intratympanic method of administering glucocorticosteroids makes it possible to bypass the above undesirable effects and at the same time provide the desired therapeutic effect on the vestibular and cochlear structures of the inner ear. With regard to the effect on the structures of the inner ear, intratympanic use of glucocorticosteroids turned out to be more effective than the systemic one, which is associated with the presence of a hematoperilymphatic barrier, comparable in its permeability to the blood-brain barrier. Moreover, when administered systemically, large doses of steroids are required to achieve a sufficient concentration of the drug in the fluids of the inner ear. To date, many questions remain regarding the routes by which the drug penetrates to the structures of the inner ear, the principles of distribution of the drug within the cochlear fluids, as well as the anatomical obstacles that may be encountered on the way to achieving the desired therapeutic effect. The purpose of this article is to highlight the current achievements in the field of research on the routes of penetration of drugs, in particular glucocorticosteroids, to the structures of the inner ear from the tympanic cavity.

Keywords: intratympanic administration of glucocorticosteroids, round window membrane, foramen ovale structures, inner ear

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Авторы

М.Л. Блинова*1, А.Е. Голованов2, В.С. Исаченко1

1 ФГБУ «Санкт-Петербургский научно-исследовательский институт уха, горла, носа и речи» Минздрава России, Санкт-Петербург, Россия;
2 ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России, Санкт-Петербург, Россия
*m.blinova@niilor.ru

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Marina L. Blinova*1, Andrei E. Golovanov2, Vadim S. Isachenko1

1 Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg, Russia;
2 Kirov Military Medical Academy, Saint Petersburg, Russia
*m.blinova@niilor.ru

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