Intratympanic Steroid Treatment for Idiopathic Sudden Sensorineural Hearing Loss after Failure of Intravenous Therapy

Abstract

Purpose. The aim of this study is the investigation of the effectiveness of intratympanic steroids therapy (IST) in patients with idiopathic sudden sensorineural hearing loss (ISSHL) who had not responded to intravenous treatment, evaluating the overall hearing recovery and comparing the results with different variables. Materials and Methods. Our study consisted of 55 patients with refractory ISSHL who, at the end of 10 days of therapy with intravenous steroids, had puretone 4-frequency average (PTA) of worse than 30 dB. The patients received 0.5 mL of methylprednisolone by direct intratympanic injection. The procedure was carried out up to 7 times within a 20-days period. Statistical analysis was carried out. Results. Overall 29 patients (52.7%) showed improvement in PTA, 24 (43.8%) had no change in hearing, and 2 (3.5%) worsened. There was a significant statistical correlation between hearing recovery and time to onset of symptoms, severity of hearing loss and frequency of hearing loss. Conclusions. IST is an effective and safe therapy in sudden sensorineural hearing loss cases that are refractory to standard treatment. The earlier IST, the hearing losses less than 90 dB and the involvement of the low frequencies seem to influence positively the hearing recovery.

Management of sudden sensorineural hearing loss: a prospective study of 30 patients

“…14 On the contrary, in the study performed by Ahn et al, overall rate of hearing improvement was 73.3% (44/60 patients) in the intratympanic injection of steroids group, which was not significantly higher than the 70.0% rate (42/60 patients) in the control group.…”

“…14 Patients with severe losses greater than 90 dB had a poorer recovery (7.2%) compared with losses less than 90 dB (35.6%)…”

“…14 For the group that responded to intratympanic injection of steroid with a "complete recovery", the median was 12 days; for the group that responded to intratympanic injection of steroid with a "partial or slight recovery", the median was 23 days; for the group that did not respond, the mean was 34 days.…”

Neuroplasticity-targeted Intervention for Idiopathic Sudden Sensorineural Hearing Loss: A New Therapeutic Direction

“…Nonetheless, over the past three decades, a tapering course of corticosteroids (including prednisone, methylprednisolone, solumedrol, and dexamethasone) has been widely adopted as the principal treatment for idiopathic SSNHL [1]. The success rate of this treatment strategy is reported to be between 50 and 80% [7,13,14]. However, recent systematic reviews of randomized controlled trials determined that the use of corticosteroids in SSNHL treatment is an issue of some controversy; i.e., these findings are based on conflicting results from multiple studies [1,9,[15][16][17], and other treatment options have not been validated by sufficiently rigorous randomized trials [1].…”

“…Furthermore, all of the patients in these studies also underwent steroid treatment (which is the current first-line treatment); therefore, functional recovery cannot be attributed solely to sound therapy. At present, steroid therapy has a success rate of approximately 50% to 80% [14]. Furthermore, the large number of patients that undergo spontaneous recovery (32% to 65%) makes it very difficult to determine the degree to which acoustic stimulation actually improves hearing function [3,6,9].…”