Intratympanic corticosteroids for sudden sensorineural hearing loss.

Area of Science:

• Otolaryngology
• Audiology
• Pharmacology

Background:

• Idiopathic sudden sensorineural hearing loss (ISSNHL) is a common condition of unknown cause.
• Systemic corticosteroids are a standard treatment, but their efficacy is debated.
• Intratympanic corticosteroid injections are increasingly used for ISSNHL.

Purpose of the Study:

• To evaluate the effectiveness of intratympanic corticosteroids for treating ISSNHL.
• To compare intratympanic corticosteroids with systemic corticosteroids and placebo/no treatment.
• To assess various outcomes including hearing threshold changes and adverse effects.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Included 30 studies with 2133 participants comparing intratympanic corticosteroids (primary or secondary therapy) with other treatments.
• Primary outcome was hearing threshold change; secondary outcomes included hearing improvement rates and adverse events.

Main Results:

• As primary therapy, intratympanic corticosteroids showed little to no improvement in hearing compared to systemic corticosteroids, with increased risk of ear pain and dizziness.
• Combined intratympanic and systemic therapy may offer a small benefit over systemic therapy alone, but evidence is uncertain.
• As secondary therapy, intratympanic corticosteroids showed low-certainty evidence of improved hearing outcomes compared to no treatment/placebo, with potential adverse effects.

Conclusions:

• Evidence for intratympanic corticosteroids in ISSNHL is mostly low or very low certainty.
• Intratympanic therapy may be beneficial as secondary treatment but offers limited advantages as primary therapy.
• Adverse effects of both intratympanic (perforation, pain, dizziness) and systemic (e.g., glucose issues) treatments should be considered.