Intratympanic and systemic steroids for sudden hearing loss.

OBJECTIVE

To investigate the therapeutic efficacy of intratympanic dexamethasone combined with systemic prednisolone in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

STUDY DESIGN

Prospective, quasirandomized, multicenter clinical trial.

SETTING

One university hospital and 2 affiliated hospitals.

PATIENTS

A total of 92 eligible patients with ISSNHL were allocated into 2 groups. Patients in the control group were treated with systemic prednisolone alone. Patients of the combined treatment group received additionally 3 intratympanic dexamethasone injections within 5 days.

MAIN OUTCOME MEASURES

The main outcome measures used were the differences between pretreatment and posttreatment pure-tone audiometry averages (PTAs) and speech discrimination scores (SDSs). Successful treatment was defined as a greater than 10 dB improvement in PTA and 15% in SDS. The final assessment of hearing was performed 3 months after completion of treatment.

RESULTS

Significant hearing recovery was observed in 31 (67.39%) of 46 cases, and in 24 (52.17%) of 46 control patients. Patients receiving combination therapy had a median improvement in PTA of 23.12 dB and a median increase in SDS of 32%. In the control group, the median hearing gain was 16.87 dB and 18%, respectively. The differences between the 2 groups were not statistically significant (p = 0.10 and p = 0.13). However, after performing a post hoc analysis by excluding individuals with profound hearing loss (PTA, >90 dB), the combined treatment group showed significant improvement compared with the control group (p = 0.04). No serious complications or adverse reactions were reported.

CONCLUSION

The addition of intratympanic steroids to the conventional systemic steroid therapy may provide a safe and potentially effective therapeutic option in patients with mild-to-severe ISSNHL.