Intratympanic and systemic steroids for sudden hearing loss

Area of Science:

• Otolaryngology
• Neurology
• Pharmacology

Background:

• Idiopathic sudden sensorineural hearing loss (ISSNHL) is a common otologic emergency.
• Prompt treatment is crucial for hearing recovery.
• Systemic corticosteroids are the standard therapy, but efficacy can be limited.

Purpose of the Study:

• To evaluate the therapeutic effectiveness of adding intratympanic dexamethasone to systemic prednisolone for ISSNHL.
• To compare hearing outcomes between combined therapy and systemic therapy alone.

Main Methods:

• A prospective, quasirandomized, multicenter clinical trial involving 92 patients with ISSNHL.
• Patients received either systemic prednisolone alone (control) or systemic prednisolone plus three intratympanic dexamethasone injections.
• Hearing outcomes were assessed by pure-tone audiometry averages (PTAs) and speech discrimination scores (SDSs) three months post-treatment.

Main Results:

• The combined therapy group showed a higher rate of hearing recovery (67.39%) compared to the control group (52.17%).
• Median PTA improvement was 23.12 dB and SDS increase was 32% in the combined group, versus 16.87 dB and 18% in the control group.
• Post hoc analysis excluding profound hearing loss cases revealed a statistically significant improvement with combined therapy (p=0.04). No serious adverse events were reported.

Conclusions:

• Intratympanic dexamethasone combined with systemic prednisolone is a safe therapeutic option for ISSNHL.
• This combination therapy may enhance hearing recovery, particularly in patients with mild-to-severe hearing loss.
• Further research may confirm its role in standard ISSNHL treatment protocols.