The Short- and Long-Term Outcome of Intratympanic Steroid Therapy as a Salvage Treatment for Acute Low-Tone Sensorineural Hearing Loss without Episodes of Vertigo

Abstract

Objectives: To evaluate the hearing outcomes of intratympanic steroid (ITS) treatment for patients with acute low-tone sensorineural hearing loss (ALHL) after failure of initial therapy and to investigate the recurrence and progression to definite Ménière's disease (MD) during a long-term follow-up. Methods: We retrospectively reviewed the medical records of 90 patients with refractory ALHL who were followed up for at least 1 year between January 2000 and April 2014. Patients who responded poorly to initial medical treatment received intratympanic dexamethasone injections (ITS group) or isosorbide administration for 4 weeks (diuretic group) as salvage treatment options according to their choice of management. The control group did not receive ITS or the diuretic, due to their refusal of both medical treatments. The hearing outcomes were evaluated 1 month, 1 year and 5 years after the completion of the second-line therapy, and the rates of recurrence and progression to MD were measured during a follow-up period of at least 1 year. Results: Twenty-seven patients in the ITS group, 39 patients in the diuretic group and 24 patients in the control group were enrolled. Of these, 12 patients in the ITS group, 15 patients in the diuretic group and 12 patients in the control group were followed up for over 5 years. We found that the recovery rates and the audiometric functional values after 1 month and 1 year in the ITS group were significantly higher than those in the diuretic and control groups. However, there were no significant differences in the recovery rates or the audiometric functional values after 5 years, or in the rates of recurrence and progression to MD between the groups. Conclusions: Salvage ITS therapy can provide a relatively good short-term hearing outcome for ALHL patients who have persistent hearing loss despite conventional treatment. However, both recurrence and progression to MD after treatment were observed in some patients during the long-term follow-up.

Idiopathic sudden sensorineural hearing loss and acute low-tone sensorineural hearing loss: a comparison of the results of a nationwide epidemiological survey in Japan

“…Corticosteroids are a commonly used treatment for SSNHL in Japan [2,14]. Recently, intratympanic steroid administration has been used for some cases [15][16][17]. In our study, most idiopathic SSNHL patients received systemic steroids as a primary treatment, whereas a combination of systemic steroids and diuretic agents was mainly used for ALHL patients.…”

Optimal First-Line Therapy for Acute Low-Tone Sensorineural Hearing Loss

“…Partially consistent with our finding, a comparative study with a larger sample size reported no difference in treatment outcome between low dose steroids, high dose steroids, low dose steroids plus diuretics, and ITS plus diuretics [18]. In contrast, ITS as a salvage treatment after 2 weeks of combined steroid-diuretic treatment yields better outcome than observation or continuous diuretics treatment alone for 1-year follow-up, though final treatment outcome after 5 years was not different, irrespective of treatment strategies [19]. We did not find any beneficial effect of concurrent use of ITS; however, there is some scope to adopt ITS as a salvage treatment.…”

Intratympanic corticosteroid as salvage therapy in treatment of idiopathic sudden sensorineural hearing loss: A systematic review and meta-analysis

“…This is a limitation that hinders the interpretation and comparison of treatments used for ISSHL, including the effect of ITC as salvage treatment. Thus, the results concerning recovery in this review may generally reflect an increase in the number of Salvage corticosteroid may improve the gain in PTA (dB) Difference: MD 7.39 higher (CI 95% 0.55 higher -14.22 higher) 1 Ahn 2008, Clary 2011, Covelli 2018, Erdur 2014, Moon 2011, Morita 2016 Inconsistency: Serious. The magnitude of statistical heterogeneity was high, with I ^2: 84%.…”

“…These studies were obtained in full and read for final eligibility. Eleven studies were finally included, which comprised of four randomized controlled trials (Lee et al, 2011;Li et al, 2011;Wu et al, 2011;Xenellis et al, 2006) and seven observational studies (Ahn et al, 2008;Amarillo et al, 2019;Clary et al, 2011;Covelli et al, 2018;Erdur et al, 2014;Moon et al, 2011;Morita et al, 2016). A flowchart showing the selection of studies can be seen in Figure 1 and an overview of the included studies is found in Table 1.…”

“…The objective of this systematic review was to provide an overview and quality assessment of the current evidence regarding ITC as salvage treatment for ISSNHL. Following a systematic search for literature, we identified four randomized controlled trials (Lee et al, 2011;Li et al, 2011;Wu et al, 2011;Xenellis et al, 2006) and seven observational studies (Ahn et al, 2008;Amarillo et al, 2019;Covelli et al, 2018;Erdur et al, 2014;Clary et al, 2011;Moon et al, 2011;Morita et al, 2016) that matched our inclusion criteria. The meta-analysis of both the randomized controlled trials and observational studies showed a statistically significant increase in the number of patients obtaining recovery in favor of ITC as salvage treatment for patients with ISSNHL.ITC treatment for Meniere's disease, autoimmune inner ear disease, and ISSNHL was pioneered over 25 years ago (Silverstein et al, 1996).…”