Idiopathic Sudden Sensorineural Hearing Loss: Average Time Elapsed Before Presentation to the Otolaryngologist and Effectiveness of Oral and/or Intratympanic Steroids in Late Presentations

Abstract

ObjectivesTo determine how long after symptom onset that the average patient with an idiopathic sudden sensorineural hearing loss (ISSNHL) presents to the otolaryngology clinic. In late presentations, to determine the time to presentation cutoff after which intervention may not be effective. To evaluate the effectiveness of oral steroids versus a combination of oral and intratympanic steroid therapy in late presentations of ISSNHL. Methods and proceduresSixty-four patients met inclusion criteria after chart review of 2,037 patients seen at Metro Health Hospital from 2006 to 2016 for sensorineural hearing loss. All sixty-four patients were used to calculate the average time to presentation, but only 40 were included to evaluate treatment efficacy because 24 were lost to follow-up or declined treatment. Audiograms were analyzed for baseline status and response to treatment. Therapy was either oral steroids or intratympanic (IT) steroids. Thirty-nine of the 40 treated patients received oral steroid therapy. Eighteen of these 39 patients received both oral and IT steroids. One patient received IT steroids only. ResultsFor all 64 patients in the study, the average time to presentation was 55 days, ranging from one day to 240 days. Data for 32 of the 40 treated patients were analyzed. These patients were further divided into smaller groups: Group 1 (N = 11) - treatment within seven days of symptom onset, Group 2 (N = 17) - time to treatment greater than seven days but less than 90 days of symptom onset, and Group 3 (N = 4) - greater than 90 days of symptom onset. In Group 2, there was a significant improvement in pure tone average (P-value: 0.005). Forty-seven percent of patients in this group had objective treatment response utilizing Wilson’s criteria. Two patients had a complete recovery and six had a partial recovery. Hearing gains ranged from 10 dB (decibels) to 23 dB. Sixty-three percent of patients with objective improvement also had subjective improvement. In Group 3, none of the patients met Wilson’s criteria for recovery. There was no statistically significant difference in response between patients treated with oral steroids only versus a combination of oral and IT steroids.ConclusionPatients with ISSNHL present to an otolaryngologist on average 55 days after symptom onset. There is statistically and clinically significant response to treatment in late presenters. Improvement can be seen up to three months from symptom onset. Oral steroid therapy is effective. IT steroid therapy may have an added benefit.

Research progress in refractory sudden hearing loss: steroid therapy

“…38 However, Wang et al 39 found that there was a therapeutic value in administering steroids to patients with an SSNHL duration of onset greater than 3 months, especially in those with mild or moderate hearing loss. Similarly, a recent study 40 showed a hearing improvement in patients with SSNHL after 3 months from symptom onset. Additionally, after a 10-day course of systemic steroid therapy and a long-term follow-up of more than 3 months, Yeo et al 41 found that 35.54%, 8.26%, and 1.65% of patients with SSNHL recovered within 1 month, 1-3 months, and >3 months, respectively, while a previous case report described a complete spontaneous recovery of hearing at approximately 9 months after the onset of SSNHL.…”

Intratympanic Dexamethasone in Sudden Sensorineural Hearing Loss

“…According to the authors, the most likely explanation for the success of combination therapy as compared with oral steroids or intratympanic dexamethasone alone is that a maximal dose of corticosteroids is delivered to the damaged inner ear which not only receives systemic prednisolone via labyrinthine blood vessels that remain patent but also receives dexamethasone via diffusion through the round window thus preventing or delaying the initiation of hair cell apoptosis. Anyah et al [28] reported that there is a statistically and clinically significant response to treatment (oral steroids ? It dexa) in late presenters; hearing improvement was observed even in patients whose treatment was started up to three months from symptom onset.…”

Intratympanic vs Systemic Corticosteroids in First-line Treatment of Idiopathic Sudden Sensorineural Hearing Loss

“…Finally, we do not consider the different PTA at baseline a limitation of significance, as we allocated studies accordingly to mean PTA at baseline and performed our analyses based on the stratification according to Goodman criteria. 32 We observed that follow-up in the included studies ranged from 17 days to 3 months. We cannot adjust for the inherent heterogeneity of varying follow-up and this must be considered a limitation for arriving at concise recommendations.…”