Simultaneous versus Sequential Intratympanic Steroid Treatment for Severe-to-Profound Sudden Sensorineural Hearing Loss

Abstract

Objectives: Severe-to-profound sudden sensorineural hearing loss (SSNHL) has a poor prognosis. We aimed to compare the efficacy of simultaneous and sequential oral and intratympanic steroids for this condition. Methods: Fifty patients with severe-to-profound SSNHL (>70 dB HL) were included from 7 centers. The simultaneous group (27 patients) received oral and intratympanic steroid injections for 2 weeks. The sequential group (23 patients) was treated with oral steroids for 2 weeks and intratympanic steroids for the subsequent 2 weeks. Pure-tone averages (PTA) and word discrimination scores (WDS) were compared before treatment and 2 weeks and 1 and 2 months after treatment. Treatment outcomes according to the modified American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria were also analyzed. Results: The improvement in PTA and WDS at the 2-week follow-up was 23 ± 21 dB HL and 20 ± 39% in the simultaneous group and 31 ± 29 dB HL and 37 ± 42% in the sequential group; this was not statistically significant. Complete or partial recovery at the 2-week follow-up was observed in 26% of the simultaneous group and 30% of the sequential group; this was also not significant. The improvement in PTA and WDS at the 2-month follow-up was 40 ± 20 dB HL and 37 ± 35% in the simultaneous group and 41 ± 25 dB HL and 48 ± 41% in the sequential group; this was not statistically significant. Complete or partial recovery at the 2-month follow-up was observed in 33% of the simultaneous group and 35% of the sequential group; this was also not significant. Seven patients in the sequential group did not need intratympanic steroid injections for sufficient improvement after oral steroids alone. Conclusions: Simultaneous oral/intratympanic steroid treatment yielded a recovery similar to that produced by sequential treatment. Because the addition of intratympanic steroids can be decided upon based on the improvement after an oral steroid, the sequential regimen can be recommended to avoid unnecessary intratympanic injections.

Comparison of Two Different Treatment Protocols Using Systemic and Intratympanic Steroids with and without Hyperbaric Oxygen Therapy in Patients with Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss: A Randomized Controlled Trial

“…We assessed the hearing improvement at 3 months after treatment according to the modified recommendations of outcome assessment in the "Clinical Practice Guideline: Sudden Hearing Loss" published by the American Academy of OtolaryngologyHead and Neck Surgery (AAO-HNS) in 2012 to determine treatment success [Stachler et al, 2012;Yoo et al, 2016]. According to the modifications of the "Clinical Practice Guideline: Sudden Hearing loss," unless the asymmetry of hearing is unknown or suspected, the PTA of the contralateral ear was used as the criterion for recovery.…”

Tympanic Membrane Perforation After Intratympanic Steroid Injection: A Systematic Review and Meta‐analysis

“…After assessing the remaining 99 full-text articles, 41 studies were excluded for the following reasons: foreign language (n = 3), case reports (n = 3), review or meta-analysis (n = 10), and no mention of complications (n = 25). Finally, 58 studies 1-5,9-61 were included in the systemic review and meta-analysis including 25 randomized controlled trials, 10 prospective studies, and 22 retrospective case-controlled studies ( Table 1 ). A total of 2824 patients served as participants in the meta-analysis wherein 2567 received ITSI via TC (54 articles) and 257 received ITSI via VT (4 articles).…”

Clinical Analysis of Intratympanic Injection of Dexamethasone for Treating Sudden Deafness

“… 14 Glucocorticoid receptors are widely distributed in the inner ear. 10 In addition, dexamethasone treatment affects the protein resynthesis in the inner ear. However, oral or intravenous glucocorticoids may produce many adverse effects, and the use of glucocorticoids is limited for patients with diabetes, severe hypertension, and gastric ulcers.…”

“…The sudden deafness was evaluated according to the criteria of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). 10 Patients diagnosed with sudden deafness for the first time and who had not received any related treatment before admission (duration ≤7 days) were included. Patients with surgical contraindications and autoimmune diseases or patients who had any other signs or symptoms of diabetes or hypertension were excluded from this study.…”