Combined Intratympanic and Systemic Use of Steroids for Idiopathic Sudden Sensorineural Hearing Loss

Arslan, Necmi; Oğuz, Haldun; Demirci, Münir; Şafak, Mustafa Asım; İslam, Ahmet; Kaytez, Selda Kargn; Samim, Erdal

doi:10.1097/mao.0b013e318206fdfa

Cited by 66 publications

(59 citation statements)

References 28 publications

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“…It has been reported that the likelihood of hearing recovery after simultaneous therapy is higher than that of either therapy alone [Arslan et al, 2011;Battaglia et al, 2008Battaglia et al, , 2014. However, other reports show no superiority of simultaneous therapy over systemic therapy alone or IT steroid alone [Ahn et al, 2008;Lim et al, 2013].…”

Section: Discussionmentioning

confidence: 78%

“…Intratympanic (IT) steroid injection for SSNHL is considered the treatment of choice for SSNHL patients with contraindications for oral steroids or as salvage after oral steroids [Ho et al, 2004;Kim et al, 2012;Lee et al, 2011;Stachler et al, 2012]. However, the efficacy of simultaneous (oral and IT steroids at the same time) treatment is not clear [Ahn et al, 2008;Arslan et al, 2011;Park et al, 2011], and simultaneous treatment did not confer an additional hearing gain or an earlier recovery rate compared to sequential (oral and salvage IT steroid) treatment in recent prospective studies [Lim et al, 2013;Park et al, 2011].…”

Section: Introductionmentioning

confidence: 99%

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Simultaneous versus Sequential Intratympanic Steroid Treatment for Severe-to-Profound Sudden Sensorineural Hearing Loss

et al. 2016

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Objectives: Severe-to-profound sudden sensorineural hearing loss (SSNHL) has a poor prognosis. We aimed to compare the efficacy of simultaneous and sequential oral and intratympanic steroids for this condition. Methods: Fifty patients with severe-to-profound SSNHL (>70 dB HL) were included from 7 centers. The simultaneous group (27 patients) received oral and intratympanic steroid injections for 2 weeks. The sequential group (23 patients) was treated with oral steroids for 2 weeks and intratympanic steroids for the subsequent 2 weeks. Pure-tone averages (PTA) and word discrimination scores (WDS) were compared before treatment and 2 weeks and 1 and 2 months after treatment. Treatment outcomes according to the modified American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria were also analyzed. Results: The improvement in PTA and WDS at the 2-week follow-up was 23 ± 21 dB HL and 20 ± 39% in the simultaneous group and 31 ± 29 dB HL and 37 ± 42% in the sequential group; this was not statistically significant. Complete or partial recovery at the 2-week follow-up was observed in 26% of the simultaneous group and 30% of the sequential group; this was also not significant. The improvement in PTA and WDS at the 2-month follow-up was 40 ± 20 dB HL and 37 ± 35% in the simultaneous group and 41 ± 25 dB HL and 48 ± 41% in the sequential group; this was not statistically significant. Complete or partial recovery at the 2-month follow-up was observed in 33% of the simultaneous group and 35% of the sequential group; this was also not significant. Seven patients in the sequential group did not need intratympanic steroid injections for sufficient improvement after oral steroids alone. Conclusions: Simultaneous oral/intratympanic steroid treatment yielded a recovery similar to that produced by sequential treatment. Because the addition of intratympanic steroids can be decided upon based on the improvement after an oral steroid, the sequential regimen can be recommended to avoid unnecessary intratympanic injections.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Simultaneous versus Sequential Intratympanic Steroid Treatment for Severe-to-Profound Sudden Sensorineural Hearing Loss

et al. 2016

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“…Of the two studies [22,23] comparing systemic, ITSI and combination therapy, one found that combination therapy was superior to systemic treatment alone (87.5 vs 44.4 %). As for the four remaining studies, three [24][25][26] found that combination therapy was superior to systemic therapy and one [27] favored ITSI over placebo.…”

Section: Resultsmentioning

confidence: 98%

Intratympanic corticosteroids injections: a systematic review of literature

Lavigne

Saliba

2015

Eur Arch Otorhinolaryngol

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The objective of the study was to determine the evidence of intratympanic steroids injections (ITSI) for efficacy in the management of the following inner ear diseases: Ménière's disease, tinnitus, noise-induced hearing loss (NIHL) and idiopathic sudden sensorineural hearing loss (ISSNHL). The data sources were literature review from 1946 to December 2014, PubMed and Medline. A systematic review of the existing literature was performed. Databases were searched for all human prospective randomized clinical trials using ITSI in at least one treatment group. The authors identified 29 prospective randomized clinical trials investigating the benefits of an intratympanic delivery of steroids. Six articles on Ménière's disease were identified, of which one favored ITSI over placebo in vertigo control. Of the five randomized clinical trials on tinnitus therapy, one study found better tinnitus control with ITSI. The only available trial on NIHL showed significant hearing recovery with combination therapy (ITSI and oral steroids therapy). Seventeen studies were identified on ISSNHL, of which 10 investigated ITSI as a first-line therapy and 7 as a salvage therapy. Studies analysis found benefits in hearing recovery in both settings. Due to heterogeneity in treatment protocols and follow-up, a meta-analysis was not performed. Given the low adverse effects rates of ITSI therapy and good patient tolerability, local delivery should be considered as an interesting adjunct to the therapy of the ISSNHL and NIHL. Only one article over six where ITSI therapy offers potential benefits to patients with Ménière's disease in the control of tinnitus and vertigo was found. ITSI does not seem to be effective in the treatment of tinnitus.

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“…In the literature review, it is seen that there are some recent studies defending that combined intratympanic and systemic steroid treatments can be used as a safe and efficient initial therapy for SSNHL patients (27,28). Gündoğan et al (29) emphasized that combined intratympanic and oral treatment was superior to only steroid therapy.…”

Section: Discussionmentioning

confidence: 99%

Can Intratympanic Steroid Be Initial Therapy for Sudden Sensorineural Hearing Loss?

Ocak¹,

Beton²,

Kesici³

et al. 2014

Turk Arch Otolaryngol

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Objective: To evaluate the efficacy of intratympanic steroid treatment with concurrent systemic steroids as an initial therapy for sudden sensorineural hearing loss (SSNHL). Methods:Patients who were diagnosed as idiopathic SSNHL and received no therapy were included in the study. Patients were divided into control and study groups. Patients in the study group received concurrent intratympanic steroid treatment with systemic steroid therapy. Patients in the control group received standard systemic steroid treatment alone. The duration of time before the treatment was evaluated for all the patients. Pure tone audiometry (PTA) was performed for all the patients in the pre-treatment and post-treatment period in order to record the responses for both in terms of the individual frequencies and the pure tone average. Results:Twenty nine patients (16 female and 13 male) with a mean age of 43.6 years were enrolled in the study.There was 15 patients in the study group and 14 patients in the control group. The mean duration of time for the initial therapy was 4 days for the control group and 6.5 days for the study group (p=0.125). The mean recovery in PTA for the control group was 10.29±4.10 decibel (dB) (0-15) while it was 19.40±18.84 dB (3-68) for the study group (p=0.003). Conclusion:At the end of treatment, significantly better hearing results were obtained for the patients in the study group when compared to the control group both for PTA and all the frequencies individually. We suggest that concurrent intratympanic steroids with systemic steroid therapy gives better hearing results than the standard systemic therapy alone.

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Combined Intratympanic and Systemic Use of Steroids for Idiopathic Sudden Sensorineural Hearing Loss

Abstract: The results of this study suggest that adding intratympanic methylprednisolone to systemic therapy increases the probability of hearing recovery in ISSHL patients.

Cited by 66 publications

References 28 publications

Simultaneous versus Sequential Intratympanic Steroid Treatment for Severe-to-Profound Sudden Sensorineural Hearing Loss

Simultaneous versus Sequential Intratympanic Steroid Treatment for Severe-to-Profound Sudden Sensorineural Hearing Loss

Intratympanic corticosteroids injections: a systematic review of literature

Can Intratympanic Steroid Be Initial Therapy for Sudden Sensorineural Hearing Loss?

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