Modified intratympanic treatment for idiopathic sudden sensorineural hearing loss

European Archives of Oto-Rhino-Laryngology (Oct 2009) 

Kara E, Cetik F, Tarkan O, Sürmelioglu O

Steroids are the only proven drugs in the treatment for idiopathic sudden sensorineural hearing loss. In the recent studies, it has been suggested that, steroids delivered through the intratympanic route obtained higher perilymph levels, resulting in better hearing outcomes. 

The purpose of this study is to compare the hearing outcomes of the two routes of steroid treatment: intratympanic route and systemic route. 

In this prospective study, 60 consecutive patients with idiopathic sensorineural hearing loss treated between January 2005 and September 2008 were enrolled: 29 were in the intratympanic steroid group (ITSG) and 31 were in the systemic steroid group (SSG). In the ITSG, 5 intratympanic injections of dexamethasone were performed with the dose of 4 mg/ml, consecutively. Oral methylprednisolone was given at the dose of 1 mg/kg, tapered every 2 days and stopped at 10 days, in the SSG. The pure tone averages (PTA), speech discrimination scores (SDS) and the percentage of the patients who made an improvement more than 10 dB were analyzed on the tenth day and 2 months after the treatment statistically. The improvement in PTA on tenth day and second month after treatment was 31.38 and 37.55 dB, in the ITSG and 19.35 and 20.68 dB in the SSG, respectively. The improvement in SDS in the same time period was 35.24 and 37.52% in the ITSG and 20.13 and 19.61% in the SSG, respectively. Also, 25 of the 29 patients (86.2%) in the ITSG and 16 of the 31 patients (51.6%) in the SSG made an improvement more than 10 dB on PTA in the second month control.

Intratympanic steroids gave better hearing results than systemic steroids with no systemic side effects. Studies with more sample sizes will identify the best steroid for injection, application time, frequency and dose.

Clinical efficacy of initial intratympanic steroid treatment on sudden sensorineural hearing loss with diabetes

Otolaryngology - Head and Neck Surgery 141 (5), 572-8 (Nov 2009)  Han CS, Park JR, Boo SH, Jo JM, Park KW, Lee WY, Ahn JG, Kang MK, Park BG, Lee H 

OBJECTIVE: The purpose of this study is to compare the efficacy of intratympanic steroid injection (ITSI) with that of systemic steroids as an initial treatment of sudden sensorineural hearing loss (SNHL) with diabetes. STUDY DESIGN: Prospective, nonrandomized multicenter clinical trial. SETTING: Multicenter study in Busan and Masan, South Korea. SUBJECTS AND METHODS: A total of 114 sudden SNHL patients who were diagnosed with diabetes were divided into peroral (PO) group (n = 48), intravenous (IV) group (n = 32), and intratympanic (IT) group (n = 34). In the PO group, prednisolone was used orally for 10 days, per schedule. In the IV group, prednisolone was administered intravenously for seven days, followed by oral administration of tapered doses for another several days. In the IT group, dexamethasone was injected into the tympanic cavity four times within a two-week period. Hearing outcome was assessed before and after the treatment. RESULTS: All groups showed significant improvement with criteria of 15 dB (P<0.05). However, there was no significant difference in hearing gain and recovery rate among groups (P>0.05). Systemic steroid treatment was stopped for two patients in the IV group and for one in the PO group due to uncontrolled hyperglycemia. However, in the IT group, there were no patients who failed to control their blood sugar level. 

CONCLUSION: ITSI is as effective as systemic steroid treatment for sudden SNHL patients with diabetes and it can avoid undesirable side effects. Therefore, we consider ITSI to be a more reasonable alternative as an initial treatment for sudden SNHL patients with diabetes.