Intratympanic Steroid Use for Sudden Sensorineural Hearing Loss: Current Otolaryngology Practice

Abstract

Objective: To investigate the current practice of intratympanic steroid (ITS) injection for sudden sensorineural hearing loss (SSNHL) in the United Kingdom and link the data with data from the United States and continental Europe. Methods: A survey of 21 questions was distributed to members of the British Society of Otology using an online survey platform via ENT UK. Data obtained from UK otolaryngologists (n = 171) were integrated with previously published data from other countries, including the United States (n = 63) and continental Europe (n = 908). Results: In the United Kingdom, 62% of responding otolaryngologists use ITS injection for SSNHL, while 38% do not. Of those using ITS, 59% use it as first-line treatment, either using it in conjunction with oral steroids (51%) or using it as monotherapy (8%). Of those that use ITS, a majority (83%) use it as salvage therapy when primary treatment with systemic steroids has failed, and similar results are found in the continental Europe and US surveys. The most commonly used preparation is dexamethasone. Responses to questions regarding treatment regimes used are enlightening and show considerable variation in the treatment regimes used within and between countries. Conclusions: There is a wide variation in practice with regards to ITS for SSNHL hearing loss in the United Kingdom, United States, and continental Europe. In the absence of protocols or definitive guidance from published literature, knowledge of contemporary practice may help guide or encourage reevaluation of clinical practice and will help guide the design of future clinical trials.

Demographic and Socioeconomic Disparities in Life Expectancy With Hearing Impairment in the United States

“…First, hearing impairment may result from transient physical exposures, such as noise exposure causing "temporary" threshold shifts in hearing (Kujawa & Liberman, 2009). Removing wax buildup can improve hearing (Fishman & Cullen, 2018) and intratympanic steroid injections can treat sudden sensorineural hearing loss (Lechner et al, 2019). Second, hearing impairment may have social explanations.…”

“…Hearing impairment in older adults is primarily progressive in nature, but it can temporarily result from ear infections, strokes, noise exposure, etc. (Fishman & Cullen, 2018;Kujawa & Liberman, 2009;Lechner et al, 2019). Importantly, individuals' perceptions of their hearing impairment may change over time and impact their perceived quality of life (Kamil et al, 2015).…”

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

“…However, published protocols differ in the kind of steroid used, drug concentration and applied volume, number of injections and intervals between injections, total duration of treatment and starting time after the onset of ISSNHL. It becomes difficult to compare the results and subsequently to find clear recommendations for primary or secondary IT steroid treatment [5,6,10,11].…”

Steroid Administration Approach for Idiopathic Sudden Sensorineural Hearing Loss: A National Survey in China

“…This provides an interesting comparison to the current uptake of 49.1% in practice in Germany and Austria, 25 100% in the United States 26 and 66.67% in the UK. 27 The results, which reflect local practice, can apply to other settings where practice patterns are different.…”