Standardization of Outcome Measures for Intratympanic Steroid Treatment for Idiopathic Sudden Sensorineural Hearing Loss

Abstract

Objective: To identify variability in reported hearing outcomes for intratympanic (IT) steroid treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) by comparing outcomes using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline with other published criteria. Study Design: Retrospective chart review. Setting: Tertiary otology practice. Patients: Patients with ISSNHL treated with IT steroid between April 2003 and December 2020. Interventions: IT steroid injection and audiometric evaluation. Main Outcome Measures: 1) Rates of full, partial, or no recovery using the AAO-HNS guideline versus other reported criteria, and 2) correlation analyses of demographic and clinical variables with response to IT steroid. Results: Using AAO-HNS reporting criteria, full recovery of the pure-tone average was noted in 25.68% of patients. Applying eight other published outcomes criteria to this patient cohort classified full recovery in 14.87 to 40.54% of patients. Similarly, AAO-HNS criteria classified "no recovery" in 51.35% of our patients, whereas applying the other reported criteria showed an average rate of 62.16% no recovery and as high as 82.43% of patients without recovery. Younger age ( p = 0.003; effect size, 0.924) and IT injection within a week of onset ( p < 0.001; effect size, 1.099) positively correlated with full recovery. There was no impact of prior or concurrent oral steroids, or number of steroid injections on outcome. Conclusion: Great variability exists in the literature for assessment of IT steroid outcomes in ISSNHL. Standard reporting of outcomes as per the AAO-HNS SSNHL guideline is recommended to consistently characterize IT steroid efficacy and allow comparison across studies.

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

“…14 The literature findings on the therapeutic effect of ITSIs are inconsistent; various definitions of hearing recovery have been proposed, and various demographics have been examined. 15 Koltsidopoulos et al 8 reported significant hearing recovery in 31 (67.39%) of 46 patients who underwent ITSI treatment. Siegel 11 used the final pure-tone audiometry (PTA) of the affected ear as a measure of recovery.…”

“…The results for delayed treatment group were comparable with previous studies: Haynes et al 19 reported 15.79% of cases improved hearing after the delayed salvage ITSIs (time to injection >1 month), using the criteria of 20-dB gain in PTA. As the primary but delayed ITSIs treatment and using AAO-HNS reporting criteria, Osafo et al 15 published the recovery rate after ITSIs was slightly more than 20%. Our results, with a larger sample size, offer more robust evidence for this matter.…”

“…Specifically, because hearing recovery was defined as a mean hearing level gain of ≥10 dB, the patients with severe initial hearing loss were more likely to meet the applied criteria. Furthermore, most studies that reported profound hearing loss as a poor prognostic factor have discussed hearing thresholds as a categorical variable; 3,8,11,15,16 by contrast, our study analyzed continuous variables. Although diabetes was revealed to be a protective factor in our univariate analysis, it was nonsignificant in our multivariate analysis.…”

“…Third, even though it is widely used, the absolute change in hearing threshold of just 10 dB may be excessively low for assessing recovery, and this standard could have led to an overestimation of the efficacy of IT steroids. 15 Fourth, all the patients were given 0.4 to 0.6 mL of intratympanic dexamethasone that was injected three to four times; thus, whether the dose and frequency of ITSIs influence their efficacy is unclear. These topics should be addressed in future studies.…”

Comparison of Intratympanic Steroid and Hyperbaric Oxygen Salvage Therapy Hearing Outcomes in Idiopathic Sudden Sensorineural Hearing Loss: A Retrospective Study

“…ITS provides a higher concentration of steroids in perilymph compared with systemic steroid therapy (Xenellis et al 2006). American Academy of Otolaryngology-Head and Neck Surgery has clinical practice guidelines that recommend the use of ITS as salvage therapy in cases of incomplete recovery 2 to 6 weeks after symptom onset (Xenellis et al 2006; Osafo et al 2022). HBO therapy is thought to increase oxygen tension in the blood and inner ear.…”