Against the odds: idiopathic sudden sensorineural hearing loss-results from delayed treatment

A 79-yr-old male was evaluated by the authors 4-6 wk following a rapid decline in perceived hearing in the right ear. Initial treatment with self-administered external ear canal irrigations and topical antibiotic prescribed by the patient's primary care physician resulted in no apparent improvement. The initial hearing evaluation revealed a mild-to-severe sloping sensorineural loss above 1000 Hz in the left ear and a moderately severe to severe sensorineural loss with a "flat" configuration in the right ear. There was normal word recognition in the left ear, with no measurable word recognition in the right ear. Initial treatment with oral steroids suggested some subjective improvement, and an intratympanic dexamethasone injection was performed. A repeat audiogram obtained approximately 1 mo postinjection showed significant improvement in pure tone thresholds and significant improvement in the word recognition score in the right ear. One week later a second intratympanic injection was completed, again, with follow-up in 1 mo. This case report reviews treatment options for idiopathic sudden sensorineural hearing loss (ISSNHL), including usual time lines for treatment and expected outcomes and the specific treatments and evaluation results for this patient for whom delayed treatment was unusually effective.