A Clinical Study on Intratympanic Methyl Prednisolone as Primary and Rescue Therapies Versus Oral Prednisolone in the Treatment of Ssnhl: A Study on 90 Patients

Abstract

INTRODUCTION:Sudden Hearing Loss is a real emergency requiring a fixed protocol in every hospital to help the patient recover his lost hearing ability. Diagnostic tools including pure tone and speech audiometry, Hematological tests and MRI scan will guide the physician to identify the etiology of deafness to a certain extent, but in majority of the patients it is difficult. Oral steroid therapy with Prednisolone or Methyl Prednisolone over a period of 19 days is the most common choice. It also seems to be the best treatment option. Recently intratympanic steroids have become an attractive choice either as a primary therapy or as an adjuvant therapy, in patients showing no or little improvement with oral steroids. It is also useful in patients in whom steroids are contraindicated. OBJECTIVE: To observe and analyze the result of improvement in hearing following Intratympanic steroids used as a primary treatment and rescue therapy versus results in the patients on oral steroids alone taken as a control group; To evolve a treatment protocol in the management of SSNHL in our Hospital. MATERIALS AND METHODS: In this prospective study 90 patients are divided into three groups and the effect of Oral Prednisolone therapy on improving hearing is compared with primary and rescue therapy with Intratympanic steroid injections. Pre and post therapy audiograms of pure tone (PTA) and speech audiometry (SRT) of the three groups are analyzed to formulate a meaningful solution. RESULTS: Intratympanic steroids as a primary therapy showed effective recovery of hearing, observed by reduction in PTA of more than 15dB and improved SRT scoring of more than 15%. This study showed statistical significance when compared with systemic steroids therapy and failed systemic steroid therapy (less than expected P value <0.05) Intratympanic injections as a rescue therapy also showed recovery of hearing with fall in PTA to <15dB and improved SRT scoring >15%. CONCLUSIONS: Four injections of Steroids into the middle ear used as primary or rescue therapies, improved hearing thresholds as recorded on pure tone average and speech discrimination. The additional advantage of avoiding systemic side effects is established once again in this study.