Sudden Sensorineural Hearing Loss: Results of intratympanic steroids as salvage treatment

Abstract

Objective: The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone to treat sudden sensorineural hearing loss as salvage therapy. Materials and methods: A prospective study was conducted on patients affected by idiopathic sudden hearing loss who were treated before with some systemic therapy, but without recovery of the hearing The patients able to undergo the study, but who refused salvage treatment were considered as control group. A solution of Dexamethasone 4 mg/ml was then injected through the posterior-inferior quadrant filling completely the middle ear.The follow-up in the following 6 months included an audiogram every month. Results: The number of patients treated with salvage therapy was 36. The patients who refused treatment were further 10. The salvage treatment was done with a mean delay of 24.3 days from the onset of symptoms. Mean hearing threshold after the onset of sudden hearing loss at PTA was 66.5 dB. After the failed treatment the mean PTA was 59.6 dB. The mean PTA after the intratympanic steroid administration was 46.8 dB, with a mean improvement of 12.8 dB. No hearing change was noted in the 10 patients who refused salvage therapy. The patients that assumed systemic steroid as first therapy showed a better PTA threshold after the salvage intratympanic treatment (p < 0.01). A significant difference (p < 0.05) of hearing recovery was evidenced between non-smoker patients and those with smoking habit. Conclusions: Our data showed that a salvage treatment with intratympanic dexamethasone should be suggested to all patients who failed the first systemic treatment. The systemic steroid therapy done before the salvage treatment seems to exert a protective role for the inner ear, as shown by our series. On the contrary the smoke habit is a negative prognostic factor in the hearing recovery.

A Clinical Study on Intratympanic Methyl Prednisolone as Primary and Rescue Therapies Versus Oral Prednisolone in the Treatment of Ssnhl: A Study on 90 Patients

“…It occurs in 5-15 persons in 100,000 every year. The incidence is approximately the same as Meniere's syndrome and Bell's palsy (20)(21)(22)(23)(24)(25) per 100,000). Tinnitus and imbalance is present in about half of these patients.…”

“…21 Plaza G et al in their nonrandomized control study found that in refractory cases to standard treatment with intra venous steroids, intra tympanic steroids are having statistical significant benefit, without any adverse effects. 22 Dispenza F et al in their prospective study found that intra tympanic administration of steroids act as a salvage method to recover hearing loss in patients who are earlier treated with Oral or Intravenous steroids. The earlier treatment with steroids seems to have a protective role in these patients treated with salvage treatment.…”

Evaluation of Adjuvant Intratympanic Dexamethasone Administration in the Treatment of Sudden Sensorineural Hearing Loss

“…[3] , Plaza et al [13] and Dispenza et al [14] , reported that in cases that are unresponsive to SS-only treatment, ITS applied as salvage treatment is effective.…”

Sudden Hearing Loss

“…[10][11][12][13][14][15] As for etiology, several mechanisms, either isolated or combined, are believed to damage the cochlea, thus provoking SHL (infective, vascular, immunological, membranous breakage theory, and other factors), although the exact cause of most cases remains unknown.…”

“…In fact, in literature, several treatment protocols have been proposed, including vasodilators to improve hematic flow, corticosteroids for their antinflammatory immunomodulating and antiedema effects, hyperbaric oxygen therapy for cochlear vasodilatations, anticoagulants to reduce hematic viscosity, antiaggregating drugs, osmotic diuretics to reduce endolymphatic pressure, antivirals (when a viral origin is suspected, in particular the herpes virus), or rest in bed. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Finally, there is no consensus about which factors can have a prognostic value for hearing recovery.…”