Effectiveness of Systemic High-Dose Dexamethasone Therapy for Idiopathic Sudden Sensorineural Hearing Loss

Abstract

Objective: To evaluate the effectiveness of systemic high-dose dexamethasone therapy for sudden sensorineural hearing loss in comparison to the previous treatment regimen at our clinic with systemic prednisone 100 mg daily for 7 days analyzed in a previous study. Methods: We conducted a retrospective review of an electronic patient data base of 79 patients with idiopathic sudden sensorineural hearing loss. The standard treatment was orally applied dexamethasone (1st to 3rd day: 40 mg daily, 4th to 6th day: 10 mg daily) in an ambulant setting. The primary endpoint was change in hearing threshold from the initial audiogram to an audiogram at least 4 weeks later. Factors that were analyzed included patient's age, interval between onset of symptoms and start of treatment, presence or absence of dizziness and tinnitus, the audiogram pattern, severity of hearing loss and hearing in the opposite ear. Hearing gain was expressed either as absolute or relative hearing gain. Functionally relevant recovery of hearing was defined as the final pure-tone average (PTA) of 30 dB or less (or the same as the PTA of the opposite ear ± 10 dB). Furthermore, we calculated the percentage of patients with complete, partial and no recovery as defined in the recently published Clinical Practice Guideline of the American Academy of Otolaryngology - Head and Neck Surgery Foundation. We then compared our results with the previous treatment regimen carried out at our clinic. Results: The average initial PTA hearing loss in the affected ear compared to baseline PTA of the unaffected ear was 51.5 ± 20.9 dB (mean ± SD). The mean absolute hearing gain was 44.4 ± 18.1 dB. The mean relative hearing gain was 86 ± 19%. Of the total, 87% had functionally relevant recovery of hearing. All of our patients showed partial (24%) or complete recovery (76%). No difference in recovery rate could be detected between patients with start of therapy within 24 h and patients with beginning of therapy within 7 days. We found a correlation between the severity of hearing loss and functionally relevant recovery. A mild hearing loss was noted in 34% of patients, with an average relative hearing gain of 89% and a functionally relevant recovery in 96% of them; the 9% of patients with initial deafness showed a mean relative hearing gain of 69% and a functionally relevant recovery in 43%. The audiogram pattern with low- or high-frequency hearing loss showed the best recovery rate; the poorest recovery rate was found in patients with initial deafness. Con-clusion: Application of high-dose orally applied dexamethasone seems to improve the recovery outcomes in comparison to prednisone 100 mg p.o. for 7 days.

Prognostic impact of standard laboratory values on outcome in patients with sudden sensorineural hearing loss

“…More severe initial hearing loss has higher probability of improvement in some studies but in other studies a lower probability [2,5,15]. In contrast to others, in present study vertigo or impaired hearing on the contralateral ear had no negative prognostic influence [2,5,3]. The reason why vertigo had no influence in the present study might be that patients with acute vestibular deficits elicited by caloric testing were strictly excluded.…”

“…SSNHL has an estimated incidence between 160 and 400 per 100,000 persons per year, i.e. much higher than assumed in older studies [2,3]. The causes of SSNHL are speculative and probably multifactorial [4].…”

Predictors of hearing recovery in patients with severe sudden sensorineural hearing loss

“…There was a clear trend towards improved outcome in patients receiving high-dose steroids, but, no significant relationship. The question if steroids or the dose of the administered steroids have important influence on hearing recovery remains controversial [21–23, 29, 44, 55–57]. …”

Comparison - effectiveness of oral steroid versus intratympanic Dexamethasone for sudden onset sensorineural hearing loss

“…Audiological examination includes a pure tone audiogram and a tympanogram. MRI scan of the brain preferably with gadolinium enhancement will exclude the presence of a CP angle tumour [1,2] .…”