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Efficacy of Intratympanic versus Systemic Corticosteroids in Sudden Sensorineural Hearing Loss: A Systematic Review
Mateo Andrés Leal Capacho1, Laura Tatiana León Suárez2, Merly Lilian Figueroa Márquez3
1Department of Medicine, University of Pamplona, Cúcuta, Colombia.
Introduction:
Sudden sensorineural hearing loss (SSNHL) is an otologic emergency that typically requires prompt treatment with corticosteroids, administered either systemically or intratympanically. The optimal route for initial therapy remains uncertain due to heterogeneity in efficacy and safety profiles.
Materials And Methods:
We conducted a systematic review of randomized controlled trials (RCTs) published between 2011 and 2025, comparing intratympanic and systemic corticosteroids as primary treatment for SSNHL in adults. Following PRISMA 2020 and Cochrane Handbook guidelines, we screened studies without language restrictions. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the RoB 2.0 tool. Outcomes were synthesized narratively, focusing on changes in pure-tone average (PTA), complete/functional recovery, speech discrimination, and safety. Trials with combination/salvage strategies, adjuncts, or formulation comparisons were synthesized separately.
Results:
Seventeen RCTs were included. Efficacy results were heterogeneous; however, most studies indicated that intratympanic corticosteroids are at least as effective as systemic therapy. In severe hearing loss, intratympanic treatment achieved higher success rates (up to 70.6%) and greater PTA improvement compared to systemic administration. Adverse events differed by route: systemic corticosteroids were associated with metabolic disturbances, while intratympanic therapy caused localized, self-limiting events. Overall, 47.1% of studies had high risk of bias, and 52.9% showed some concerns.
Conclusion:
Intratympanic corticosteroids appear to be a non-inferior alternative to systemic steroids for initial SSNHL treatment, with potential advantages in cases of severe hearing loss or systemic contraindications. Nonetheless, methodological limitations across studies warrant cautious interpretation. Future high-quality trials should address efficacy, functional recovery, and safety more rigorously.
