Solid drug implants for intracochlear delivery of therapeutics for the treatment of otic disorders

Abstract

The present invention provides for pharmaceutical preparations, devices, systems and methods for the treatment of otic diseases and conditions. In various embodiments, the preparations, devices, systems and methods enable sustained drug release for the treatment or prevention of hearing loss, infections, and other pathological conditions of cochlea and inner ear.

Description

FIELD OF THE INVENTION[0001]This invention relates to the fields of pharmaceuticals, drug delivery devices, methods for sustained drug release, and methods for treatment of hearing loss, infections, and other pathological conditions of cochlea and inner ear.BACKGROUND OF THE INVENTION[0002]All publications herein are incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference. The following description includes information that may be useful in understanding the present invention. It is not an admission that any of the information provided herein is prior art or relevant to the presently claimed invention, or that any publication specifically or implicitly referenced is prior art.1. Sensorineural Hearing Loss[0003]Sensorineural hearing loss (SNHL) is a major medical problem with over 32 million Americans affected by hearing loss. The most common form of hearing loss i...

AI Technical Summary

Benefits of technology

[0045]In another aspect, the present invention provides a method for preventing or reducing ototoxicity in a patient undergoing treatment with a loop diuretic agent.

[0046]In yet a further aspect, the present invention provides a method for preventing or reducing ototoxicity in a patient undergoing treatment with quinine or quinidine for conditions in which such compounds are indicated.

[0047]In another aspect, the present invention provides a method for preventing or reducing ototoxicity in a patient exposed to noise for a time and at an intensity sufficient to result in ototoxicity.

[0048]The invention provides sustained-release devices, adapted for insertion into the cochlea, for administration of ototoprotective agents, as well as a method of reducing the ototoxic effect of a chemotherapeutic agent upon a subject which comprises inserting into an inner ear cavity of the subject a sustained-release device of the invention. In particular embodiments, the inner ear cavity is the cochlea.

Problems solved by technology

Sensorineural hearing loss (SNHL) is a major medical problem with over 32 million Americans affected by hearing loss.

Causes of hearing loss include loud noise, aging, infections, and ototoxic chemicals.

Damage to the peripheral auditory system is responsible for a majority of such hearing deficits.

Unfortunately, salicylates have ototoxic side effects.

They often lead to tinnitus (“ringing in the ears”) and temporary hearing loss, and if used at high doses for a prolonged time, hearing impairment can become persistent and irreversible (J. A. Brien, 1993, Drug Safety 9:143-148).

The toxic effects of these drugs on auditory cells and spiral ganglion neurons are often the limiting factor in their therapeutic usefulness.

However, the aminoglycosides are known to exhibit serious ototoxicity, especially at higher (and more effective) doses.

The most effective and frequently used loop diuretics (such as ethacrynic acid, furosemide, and bumetanide) are known to cause ototoxicity.

Hearing loss associated with loop diuretics is frequently, but not always, reversible.

Generally, cisplatin ototoxicity is irreversible, its onset insidious, and the hearing loss may progress after discontinuation of the protocol.

Thus, although an increasing number of cancer patients are surviving modern regimens of chemotherapy, they frequently suffer from cisplatin-induced hearing loss.

Cisplatin damages both the auditory and vestibular systems.

Both an intense sound presented to the ear for a short period of time and a less intense sound that is presented for a longer time period can produce equal damage to the inner ear.

However, a non-occupational form of NIHL, called socioacusis, may result from gunfire, loud music (via concerts or headphones), open vehicles such as motorcycles, snowmobiles or tractors, and power tools to name just a few.

Although the hearing damage is often symmetrical, i.e., both ears are affected, there are cases, such as hearing loss due to frequent target shooting, which result in asymmetric hearing loss.

Upon exposure to impulse noise, such as an explosive blast, a patient may suffer significant tympanic membrane and middle ear damage.

Acute and chronic inflammation can lead to hair cell and spiral ganglion neuron death and can permanently impair hearing.

Some patients will have attacks of dizziness separated by long periods of time.

Currently, there is no FDA-approved drug product for treatment or prevention of Meniere's disease.

The pitfalls of intratympanic gentamicin include inconsistent efficacy and hearing loss.

Both of these problems may be attributable to inconsistent and variable dosing regimens.

Bacteria and viruses migrate from the naso-pharynx to the normally air-filled middle ear via the Eustachian tube, and can cause the Eustachian tube to become blocked, preventing ventilation and drainage of the middle ear.

Fluid then accumulates behind the eardrum, causing pain and inflammation.

Otitis media is the most common cause of hearing loss among children.

Although otitis media is readily treated with antibiotics and is ordinarily not serious, frequent and / or untreated otitis media may permanently damage a child's hearing.

Fluid remaining in the middle ear can cause repeated bouts of acute otitis media, and if the condition becomes chronic it may result in frequent recurrences of acute infections.

In the more severe forms of otitis media, purulent exudate, toxins and endogenous anti-microbial enzymes accumulate in the middle ear, which can cause irreparable damage to sensory-neural and sound conducting structures.

Damage to the eardrum, the bones of the ear, or the auditory nerves caused by such infections can cause permanent hearing loss.

Hearing loss may also result from impairment, damage or destruction of inner ear cochlear hair cells, as damaging substances in the middle ear space gain access to the inner ear via diffusion through the round window membrane.

However, the pharmacological profile of (D)-methionine makes it difficult to administer it to patients.

Another difficulty in preventing ototoxicity, especially when due to aminoglycoside antibiotics, is that the damage occurs over a period of time that extends well beyond the time during which the ototoxic agent is administered.

For instance, the ototoxicity of aminoglycosides has limited the applications of this very important group of antibiotics, and the ototoxicity of cisplatin adds a further burden to those already facing a life-threatening disease.

Systemic administration of such drugs is associated with severe side-effects, however, and the therapeutic effect is short-lived without repeated administration of the drugs.

Systemic administration of antibiotics to combat or prevent middle ear infection generally involves a prolonged lag time to achieve therapeutic levels within the ear, requires high initial doses in order to achieve such levels, and in some cases may require administration over a very long period of time.

These drawbacks complicate the ability to obtain and maintain therapeutic levels, and systemic toxicities may preclude the prophylactic use of some antibiotics altogether.

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