Optimal timing of salvage intratympanic steroids in idiopathic sudden sensorineural hearing loss

Abstract

Background Salvage intratympanic steroids (ITS) works in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) after failure of initial therapy, but optimal timing of administration is unknown. Methods Two hundred and seventy patients with ISSNHL were included. Among them, 180 were treated with ITS and standard medical treatment (SMT) and the other 90 received SMT along. The hearing threshold before and after salvage treatment were compared. The relationship between the salvage starting time and hearing recovery was analyzed. Results The hearing of ITS group improved more than that of the SMT group in all frequency bands. The effect of both strategies decreases with the delay of the starting time. ITS can improve hearing even if being administrated 5 weeks after onset while SMT failed after 3 weeks. Conclusion Patients with profound ISSNHL can obtain extra hearing recovery from salvage ITS. The earlier salvage starts, the greater the patient benefits.

Primary versus salvage intratympanic steroid treatment for idiopathic sudden sensorineural hearing loss

“…However, we found no standard protocol for IT steroid treatment in the literature 13,14 . Considerable differences among countries in clinical practices for IT steroid treatment for ISSNHL were noted 15 …”

“…13,14 Considerable differences among countries in clinical practices for IT steroid treatment for ISSNHL were noted. 15 There is limited data available regarding the efficacy of IT steroid as a salvage therapy for patients who do not respond adequately to systemic steroid treatment. IT steroid injection is administered as either primary or salvage treatment at the discretion of clinicians.…”

“…13 , 14 Considerable differences among countries in clinical practices for IT steroid treatment for ISSNHL were noted. 15 …”

Clinical efficacy of intratympanic steroid injection for treating idiopathic sudden sensorineural hearing loss

“…1,3,4 Although various studies have demonstrated the efficacy of ITSI in prospective, randomized, and placebo-controlled trials, 5,6 the complete hearing recovery rate for ISSNHL is low, ranging from 5% to 55%. 7 Thus, researchers are increasingly exploring methods for improving the outcome of ITSI. The AAO-HNS guideline recommends the initiation of treatment within 2 weeks of symptom onset; 1 however, timely treatment is often not provided because of delays in the diagnosis of ISSNHL.…”