Elsevier

American Journal of Otolaryngology

Volume 34, Issue 4, July–August 2013, Pages 296-300
American Journal of Otolaryngology

Original contribution
Sudden Sensorineural Hearing Loss: Results of intratympanic steroids as salvage treatment,☆☆

https://doi.org/10.1016/j.amjoto.2012.12.010Get rights and content

Abstract

Objective

The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone to treat sudden sensorineural hearing loss as salvage therapy.

Materials and methods

A prospective study was conducted on patients affected by idiopathic sudden hearing loss who were treated before with some systemic therapy, but without recovery of the hearing The patients able to undergo the study, but who refused salvage treatment were considered as control group. A solution of Dexamethasone 4 mg/ml was then injected through the posterior–inferior quadrant filling completely the middle ear. The follow-up in the following 6 months included an audiogram every month.

Results

The number of patients treated with salvage therapy was 36. The patients who refused treatment were further 10. The salvage treatment was done with a mean delay of 24.3 days from the onset of symptoms. Mean hearing threshold after the onset of sudden hearing loss at PTA was 66.5 dB. After the failed treatment the mean PTA was 59.6 dB. The mean PTA after the intratympanic steroid administration was 46.8 dB, with a mean improvement of 12.8 dB. No hearing change was noted in the 10 patients who refused salvage therapy. The patients that assumed systemic steroid as first therapy showed a better PTA threshold after the salvage intratympanic treatment (p < 0.01). A significant difference (p < 0.05) of hearing recovery was evidenced between non-smoker patients and those with smoking habit.

Conclusions

Our data showed that a salvage treatment with intratympanic dexamethasone should be suggested to all patients who failed the first systemic treatment. The systemic steroid therapy done before the salvage treatment seems to exert a protective role for the inner ear, as shown by our series. On the contrary the smoke habit is a negative prognostic factor in the hearing recovery.

Introduction

The loss of hearing of at least 30 dB over at least 3 contiguous frequencies occurring within 3 days or less is known as Sudden Sensorineural Hearing Loss (SSHL). In more than 90% of patients, the true cause of the hearing loss is not discovered, constituting an idiopathic disease. The estimated incidence of such disease is 5 to 20 cases per 100,000 annually [1]. However the exact incidence is underestimated, because many patients who recover early (within first few days) are unlikely to seek medical care [2]. The rate of spontaneous recovery is approximately between 32% and 70% which encourage some otologists not to treat SSHL patients [3].

The lack of consensus in the management of SSHL is due to difficulty in finding the true etiology of the deafness. Numerous treatments have been described: steroids, antiviral drugs, osmotic diuretics, anticoagulants, vasodilators, hyperbaric oxygen, carbogen; most therapies showed some benefits in restoring hearing notwithstanding the lack of robustness of the data.

The most widely employed drugs in the management of SSHL are steroids that are administered as a single agent or associated with other drugs. Several placebo-controlled trials reported encouraging results in terms of recovering of hearing loss [4], [5], although other authors discussed such efficacy in the treatment of SSHL [1], [3], [6], [7].

Although the treatment is started within a reasonable time after onset of the hearing loss, the result is not always achieved and about 30%–40% of patients have no benefits after systemic treatment.

The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone (ITD) to treat SSHL patients as salvage therapy after other treatments.

Section snippets

Materials and methods

A prospective study was conducted on patients affected by idiopathic SSHL who were treated before with some systemic therapy, but without recovery of the hearing (less than 10 dB of PTA threshold recovery). The patients included were referred to our departments from January 2011 to December 2011. The inclusion criteria were: an SSHL of at least 30 dB across 3 contiguous frequencies over a period of 3 days and a previous systemic treatment that gave no recovery of hearing. The patients with the

Results

The number of patients treated with salvage therapy was 36, of which 20 patients were female. The patients who refused treatment were further 10. The mean age of the whole series was 49.4 years. The salvage treatment was performed with a mean delay of 24.3 days from the onset of symptoms and about 2 days from the end of the first therapy done (Table 1).

Hearing threshold after the onset of sudden hearing loss at PTA was 66.5 dB (range 25–100 dB; SD ± 17.1 dB). After the failed treatment administered

Discussion

The use of intratympanic steroid is a known procedure. Itoh and Sakata first reported its use in 1991 in treatment of patients with Meniere's disease [8]. The first use of intratympanic therapy in SSHL was described by Silverstein in 1996 [9].

The rationale supporting the ITD administration is the round window membrane permeability to the drugs. Elevated perilymphatic concentration of steroids can be achieved after transtympanic administration, higher than after systemic administration [10], [11]

Conclusions

Our data showed that a salvage treatment with intratympanic dexamethasone should be suggested to all patients who failed the first systemic treatment. The unchanged hearing of the group of patients who refused salvage therapy is indicative of some important action of the steroids into the cochlear recovery process. The systemic steroid therapy done before the salvage treatment seems to exert a protective role for the inner ear, as shown by our series. On the contrary the smoking habit is a

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      ISP or ISI are often recommended for refractory SSNHL [7,9–14,19–24]. Although the most used method of steroid delivery into the middle ear is ISI [7,13,14,20–24], ISP may provide better hearing recovery compared to ISI [9,10]. However, the effective rate of ISP (34.0%) in the present study was slightly lower than that of ISI reported by Kordiš et al. (40.7%) and Song et al. (37.5%) [24,25].

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