Daily Short-Term Intratympanic Dexamethasone Treatment Alone as an Initial or Salvage Treatment for Idiopathic Sudden Sensorineural Hearing Loss

Abstract

Objective: Intratympanic (IT) steroid therapy has been proposed as an alternative treatment option for patients with idiopathic sudden sensorineural hearing loss (ISSNHL). However, the number and frequency of IT treatments and drug delivery methods remain to be determined. The purpose of this study was to evaluate the efficacy of daily short-term IT dexamethasone (DEX) treatment alone in ISSNHL patients using laser-assisted myringotomy (LAM) for the drug delivery route as an initial and/or salvage treatment. Study Design: Retrospective study. Setting: University hospital. Patients: Seventy-six ISSNHL patients receiving IT DEX. Patients with low-tone hearing loss, unilateral or bilateral fluctuating hearing loss or contralateral hearing loss were excluded. Intervention: DEX (4 mg/ml) was injected through a perforation made by LAM. IT DEX administration was performed on 8 sequential days. Main Outcome Measures: Pre- and postprocedure hearing levels. The average hearing level was determined by 5 frequencies (250, 500, 1000, 2000 and 4000 Hz). Results: Nineteen out of 76 patients fit the criteria for initial treatment in the study (group I), while 24 patients, who had failed systemic therapy, received salvage treatment (group S). The mean age of the patients in groups I and S was 56.2 years with a range from 31 to 73 years of age and 46.0 years with a range from 11 to 76 years of age, respectively. The mean number of days from onset of symptoms to IT therapy in groups I and S was 4.8 days with a range of 1–23 days and 15.3 days with a range of 6–28 days, respectively. In group I, 18 of the 19 patients (95%) showed improvement of more than 10 dB in the pure-tone audiogram, with a mean improvement of 40 dB. Twelve patients (63%) recovered completely and 16 patients (84%) demonstrated successful results with an improvement of more than 30 dB. In group S, 14 of the 24 patients (58%) showed improvement of more than 10 dB with a mean improvement of 16 dB. Two (8%) of the 7 patients (29%) with successful results recovered completely. Conclusions: Daily short-term IT DEX administration using LAM for ISSNHL patients without concurrent therapy showed a high response rate and high cure rate and proved to be an alternative therapeutic option to high-dose systemic steroids as a first- and/or second-line treatment.

Randomized Prospective Trial of Hyperbaric Oxygen Therapy and Intratympanic Steroid Injection as Salvage Treatment of Sudden Sensorineural Hearing Loss

“…However, the literature is still inconsistent regarding the dose, concentration, drug selection, frequency of administration, or the total number of in-jections (6,8). However, the literature is still inconsistent regarding the dose, concentration, drug selection, frequency of administration, or the total number of in-jections (6,8).…”

The Efficacy of Concurrent or Sequential Intravenous and Intratympanic Steroid for Idiopathic Sudden Sensorineural Hearing Loss

“…IT steroid therapy delivers steroid to the cochlea via the round window membrane, providing a high concentration in the cochlea with little systemic steroid effects [Gao and Liu, 2016]. The benefit of IT steroid treatment has been demonstrated in several earlier studies, showing effectiveness in treating patients as primary and salvage therapy [Filipo et al, 2010;Kakehata et al, 2011;Rauch et al, 2011;Wu et al, 2011]. IT steroid therapy has been used as a primary therapy or a salvage treatment after systemic steroid treatment has failed [O'Connell et al, 2016].…”

Round Window Niche Drilling with Intratympanic Steroid Is a Salvage Therapy of Sudden Hearing Loss

“…Therefore, the problem how to improve the delivery efficiency of steroids arose. Under this circumstance, intratympanic steroid therapy was introduced and had been proven to be effective for the treatment of ISSNHL [Kakehata et al, 2011;Lavigne et al, 2016;Spear and Schwartz, 2011]. However, still a part of patients never recovered hearing.…”