Are intra-tympanically administered steroids effective in patients with sudden deafness? Implications for current clinical practice

Abstract

Over 60 years since its first report, sudden sensorineural hearing loss (SSNHL) still represents an ill-explained condition, with potentially devastating effects for the quality of life of previously well patients. The present study critically reviewed the available evidence regarding the efficacy of intra-tympanic steroid administration in the treatment of SSNHL. Factors affecting that efficacy were also explored. The literature was systematically reviewed in Medline and other database sources until July 2011, and analyzed through critical analysis of pooled data. The study selection included multi-center prospective randomized control trials, prospective randomized comparative, prospective comparative and prospective studies, retrospective comparative and retrospective studies. The total number of analyzed studies was 43. Intra-tympanic steroids appear to be effective as primary (strength of recommendation A), or salvage treatment (strength of recommendation B) in SSNHL. It is difficult to draw definite conclusions regarding the efficacy of combination therapy. The identification of a time window for effective treatment in the former two approaches yields a grade C strength of recommendation. Primary intra-tympanic treatment is the most effective modality in terms of complete hearing recovery (34.4% cure rate). There is not enough evidence to attribute treatment failures to impaired permeability of the round window membrane. Most complications of intra-tympanic treatment are minor, temporary, and conservatively managed. Intra-tympanic steroids can theoretically provide a more organ-specific treatment in patients with SSNHL. The observation that they seem effective both as primary and salvage treatment modalities with a very low complication rate may have serious implications for current clinical practice.

Controversies in the management of sudden sensorineural hearing loss: an evidence‐based review

“…A randomised trial involving 250 patients showed no difference in outcomes between oral and IT steroid therapy . Two high‐quality RCTs showed no improvement over systemic steroids although two lower quality RCTs showed superior results . .…”

“…The same aforementioned regimen for primary IT steroid therapy may be appropriate after failure of initial treatment and should ideally be administered within 1–4 weeks of SSNHL onset although some studies show benefit irrespective of onset‐to‐treatment interval …”

Hearing Changes After Intratympanically Applied Steroids for Primary Therapy of Sudden Hearing Loss: A Meta-analysis Using Mathematical Simulations of Drug Delivery Protocols

“…Following the wide acceptance of intratympanic applications of gentamicin for the treatment of Menière’s disease, intratympanically applied glucocorticosteroids (“steroids”) have become commonly-applied drugs for the therapy of patients with either Menière’s disease or idiopathic sudden sensorineural hearing loss (ISSHL) (1–4). Drug application protocols and the choice of steroid vary considerably between studies.…”

Evidencia y recomendación. ¿Es eficaz el corticoide intratimpánico como tratamiento de la sordera súbita?

“…Las estrategias de manejo varían, lo que refleja la incertidumbre de la eficacia del tratamiento y la tasa significativa de la recuperación espontánea [2]. En algunas revisiones se ha puesto de manifiesto que el tratamiento con corticoide intratimpánico (CIT) es eficaz como primera línea de tratamiento pero que se precisan ensayos prospectivos aleatorizados para demostrar su superioridad frente al tratamiento con corticoide sistémico (CS) [3]. Parece que el tratamiento médico debe incluir terapia con (CS) (prednisona, metilprednisolona o deflazacort) en pauta descendente durante un mes (generalmente vía oral [2]) y tratamiento con CIT como rescate (metilprednisolona o dexametasona) junto al tratamiento oral en caso de recuperación parcial (<15 dB) [1], en pacientes que no mejoran con 10 días de glucocorticoides orales o para los que hay contraindicación para su uso (en cuyo caso el tratamiento con CIT está indicado como primera opción de tratamiento) [2].…”