Intratympanic Steroid Regimen for Prevention of Cisplatin-Induced Hearing Loss: A Systematic Review

Cisplatin exhibits a steep dose-response relationship, wherein its therapeutic efficacy increases significantly with higher doses. This dose escalation, however, is limited by severe adverse effects, notably ototoxicity, which can lead to permanent and disabling hearing loss. The objective of this review was to evaluate the potential efficacy of intratympanic steroid administration (ITD) in preventing cisplatin-induced hearing loss (CiHL).

A systematic literature search was conducted using PubMed, Cochrane Library, and Scopus databases for evidence-based research articles published between January 2004 and July 2023. The search strategy focused on intratympanic steroids for cisplatin-related ototoxicity. Two independent reviewers performed the search, screening, and study selection according to predefined Population, Intervention, Comparison, Outcome, Study design (PICOS) criteria. Only randomized controlled trials (RCTs) involving patients receiving cisplatin and treated with an intratympanic steroid regimen were included. The review process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

The initial database and manual searches identified 383 records. Following title and abstract screening, 42 articles underwent full-text review. After applying the eligibility criteria, 38 studies were excluded, resulting in four RCTs for qualitative synthesis. Risk of bias (RoB) assessment revealed a high-risk concerning allocation concealment in all four studies. Additionally, a substantial risk of detection bias was present in three RCTs. According to the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework, the overall quality of evidence was rated as high in one study, moderate in two, and low in one.

This review did not confirm a consistent otoprotective benefit of intratympanic steroid administration against CiHL. None of the included studies demonstrated high-quality evidence for a significant protective effect. The available RCTs report inconsistent outcomes and collectively fail to establish a definitive therapeutic advantage for ITD in this context. These discrepancies may be attributable to methodological variations across studies, including differences in steroid dosage, concentration, timing of administration relative to cisplatin therapy, and patient populations. Further rigorously designed RCTs with standardized protocols are warranted to definitively assess the potential role of ITD in mitigating cisplatin ototoxicity.