Intratympanic Dexamethasone for Sudden Sensorineural Hearing Loss After Failure of Systemic Therapy

Abstract

Difficulty in proving efficacy of a single modality is present in all studies on SNHL secondary to multiple treatment protocols, variable rates of recovery, and a high rate of spontaneous recovery. Forty percent of patients showed some improvement in SDS or PTA after treatment failure. When criteria of 20-dB PTA or 20% is considered to define improvement, the recovery rate was 27.5%. Modest improvement is seen with the current protocol of a single intratympanic steroid injection of 24 mg/mL dexamethasone in patients who failed systemic therapy. Dramatic hearing recovery in treatment failures was rarely encountered. No patient showed significant benefit from intratympanic steroids after 36 days when using this protocol for idiopathic sudden SNHL. If patients injected after 6 weeks are excluded from the study, the improvement rate increases from 26.9% to 39.3%. Earlier intratympanic injection had a significant impact on hearing recovery, although with any therapeutic intervention for sudden SNHL, early success may be attributed to natural history. If we further exclude seven patients treated with intratympanic steroids within 2 weeks of the onset of symptoms (i.e., study only those patients treated with intratympanic dexamethasone between 2 and 6 weeks after onset of symptoms), still, 26% improved by 20 dB or 20% SDS. The recovery rates after initial systemic failure are higher than would be expected in this treatment failure group given our control group (9.1%) and literature review. These findings indicate a positive effect from steroid perfusion in this patient population.

Sudden Sensorineural Hearing Loss: Results of intratympanic steroids as salvage treatment

“…A hearing improvement in patients with SSHL who failed to recover with primary systemic therapy was reported by several authors [16][17][18][19][20]. Also in our study the rate of recovery after salvage therapy was good and similar to already mentioned reports.…”

Comparison of Contrast Effect on the Cochlear Perilymph after Intratympanic and Intravenous Gadolinium Injection

“…These patients were evaluated for clinically severe vertigo or hearing loss and underwent intratympanic gadolinium injection for simulation of intratympanic injection therapy with gentamicin to control severe vertigo or with steroids to treat SNHL. [18][19][20][21] On the other hand, the 22 IV-method patients (9 men, 13…”

Recovery of Hearing in Cisplatin-Induced Ototoxicity in the Guinea Pig with Intratympanic Dexamethasone

“…Various reports on the effect of intratympanic steroid injection in sudden hearing loss have been published [14,[17][18][19].…”

“…Intratympanic steroids are increasingly used in the treatment of inner ear disorders, especially in patients with sudden sensorineural hearing loss and endolymphatic hydrops [13,14]. Dexamethasone was previosly investigated as a protective agent in cisplatin-induced ototoxicity [15,16].…”