Objective The aim of this study was to compare the effectiveness of intratympanic (IT) steroid therapy and combined intravenous-cum-intratympanic (IVIT) steroid therapy in the management of sudden sensorineural hearing loss (SSNHL). Study Design This was a nonrandomized clinical trial. Setting Tertiary referral center. Patients Forty-four patients, who presented to the outpatient department or the emergency room and those who fulfilled the inclusion criteria, were enrolled in this study. The patients were put into two groups: Group IT—that received intratympanic steroid therapy alone and Group IVIT—that received intratympanic as well as intravenous steroid therapies. Intervention Therapeutic—in the form of IVIT steroid therapy. Main Outcome Measure Impact of the steroid therapy in patients with SSNHL was measured objectively with the help of pure tone audiometry (PTA). The improvement in hearing was assessed in terms of decibels gained after the intervention in both the groups. Results The mean improvement in PTA after 3 months in Group IT was 19.78 (±18.918) dB, whereas the mean improvement after 3 months in Group IVIT was 22.29 (±16.147) dB, statistically showing no significant difference between the groups. Conclusion The authors recommend the use of IT steroid therapy alone in the management of SSNHL.

The sinus of Valsalva presents the initial segment of the aorta from where the coronary vessels arise. Sinus of Valsalva aneurysms (SOVAs) present as progressive dilatation of the aortic sinus. SOVA arises both from the congenital and acquired weakness of the elastic lamina of the aortic media. Though most of the SOVAs are asymptomatic and diagnosed on screening for other pathologies, patients can present with symptoms of arrhythmia, aortic insufficiency, aorto-cardiac fistulas, and, in a few cases, with rupture. We describe a patient who presented with recurrent syncope and was found to have a 6 cm dilated SOVA with an ectatic ascending aorta. Further assessment revealed a left anterior fascicular block, aortic regurgitation, and mitral regurgitation. On further assessment, no other cause of syncope was found. There was no family history of aneurysm or sudden cardiac death. The patient was eventually discharged with outpatient follow-up with cardiothoracic surgery. In patients presenting with asymptomatic SOVA, a dilatation with a maximum diameter of 6.0 cm requires stringent monitoring and should be considered for surgery.