Effectiveness of intratympanic dexamethasone for refractory sudden sensorineural hearing loss

The purpose of this study was to investigate the effectiveness of intratympanic steroids in patients with idiopathic sudden sensorineural hearing loss who did not respond to initial systemic steroid therapy. This retrospective study involved 51 patients, who did not respond to systemic steroids as a first-line treatment. Initial systemic steroid therapy consisted of administration of methylprednisolon intravenously (250 mg) at the first day and followed by orally (1 mg/kg) tapering for 14 days. Twenty-one patients accepted intratympanic treatment, and the remaining 30 patients who refused intratympanic treatment were evaluated as the control group. Steroids (dexamethasone drops, 1 mg/mL) were administered through a ventilation tube. Hearing was assessed immediately before treatment and 2 months after treatment. Recovery of hearing was defined as an improvement of >20 dB in the pure tone average. We tested 250, 500, 1,000, 2,000, 4,000, and 8,000 Hz frequencies for the pure tone audiometric evaluation. Statistically Student's t test, Mann-Whitney U test, Chi-squared and Fisher's exact tests were used. The pure tone average improved in 47.6% of the intratympanic group and in 10% of the control group (p = 0.002), with pure tone average improvements of 19.9 ± 16.5 and 4.76 ± 9.6 dB in the intratympanic and control groups, respectively. When the hearing threshold at each frequency was analyzed, improvements at all frequencies were significantly greater in the intratympanic steroid group when compared with the control group (p < 0.01). Intratympanic steroid administration is an effective therapy for sudden sensorineural hearing loss in patients, who are refractory to primary systemic steroid therapy.