Comparison of Intratympanic, Systemic, and Combined Steroid Therapies for Sudden Sensorineural Hearing Loss in Patients with Diabetes Mellitus

Abstract

IntroductionSudden sensorineural hearing loss (SSNHL) is an otologic emergency. SSNHL is commonly defined as hearing loss of greater than 30 dB involving at least three consecutive frequencies and occurring within a 3-day period. 1) There are many hypotheses regarding the etiology of SSNHL, including those implicating viral infection, vascular compromise, and immune-mediated responses. 2) Patients diagnosed with-Background and Objectives We investigated whether the intratympanic steroid injections might be an effective initial treatment for sudden sensorineural hearing loss (SSNHL) in patients with diabetes mellitus (DM). Subjects and Method We assessed a total of 167 patients with DM and SSNHL who visited a tertiary referral otolaryngology department between January 2010 and April 2018. Fortytwo patients with DM and SSNHL received intratympanic steroid injections; 48 patients with DM and SSNHL received systemic steroid treatment; and 77 patients with DM and SSNHL received a combination of systemic and intratympanic treatment. Initial and post treatment hearing levels and fasting blood sugar (FBS) were assessed, and correlations between hearing gain and the duration of DM, HbA1c, FBS were investigated. Results After steroid treatment, hearing levels were 38.87±25.35 dB in the intratympanic injection group, 41.09±28.49 dB in the systemic steroid treatment group, and 47.81±27.12 dB in the combined treatment group. Final hearing levels and hearing gain in the three groups did not differ significantly. FBS after treatment in the systemic steroid treatment and combined steroid treatment group worsened relative to the intratympanic injection group (202.00±9.40 mg/dL to 326.63±7.85 mg/dL). FBS, duration of DM, and HbA1c levels did not affect the hearing gain in patients with DM and SSNHL. Conclusion Intratympanic steroid injections are comparable to the systemic steroid treatment modality for SSNHL in patients with DM. Thus, intratympanic steroid injections may serve as an effective initial treatment modality for SSNHL in patients with DM. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Clinical Features and Hearing Outcomes of Sudden Sensorineural Hearing Loss in Diabetic Patients

“…With associated microangiopathy or inflammatory processes, diabetes mellitus (DM) could be a risk factor for SSNHL [ 5 ]. Additionally, microvascular problems in diabetic patients can affect the delivery and efficacy of systemic steroid in the cochlea [ 6 , 7 ]. Also, the use of systemic steroids can worsen glycemic control in diabetic patients.…”