Intratympanic Methylprednisolone versus Dexamethasone for the Primary Treatment of Idiopathic Sudden Sensorineural Hearing Loss

Tarkan, Özgür; Dagkiran, Muhammed; Sürmelioğlu, Özgür; Özdemir, Süleyman; Tuncer, Ülkü; Doğrusöz, Murat; Çetik, Fikret; Kıroğlu, Mete

doi:10.5152/iao.2018.4871

Cited by 13 publications

(12 citation statements)

References 18 publications

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“…Liebau et al conclude, that solely the degree of initial hearing loss correlates with post-therapeutic improvement while treatment delay does not play a significant role [5,6]. The benefit of IT triamcinolone in our cohort is in the range of 12 and 100% as reported by others [1,3,4,7]. However, the comparability of studies is limited due to the wide variety of treatment protocols.…”

Section: Discussionsupporting

confidence: 43%

“…Multiple non-randomized, randomized and even placebocontrolled studies on the benefit of IT glucocorticoids in the primary and secondary treatment of ISSNHL exist [1][2][3][4][5][6][7][8][9]. Due to the large variances in indication criteria, treatment protocols and the drugs used, no definite recommendations can be drawn and significant hearing improvements can still be questioned.…”

Section: Discussionmentioning

confidence: 99%

“…The first had no benefit from prior systemic steroid treatment (secondary therapy, group A) and the second who presented for primary IT treatment due to contraindications (primary treatment, group B). In comparison to other publications, our subgroups are small as our sampling period was limited to one year [1,3,7]. The reason is, that we had been routinely performing CBCT scanning of the temporal bone before IT triamcinolone application since 2018.…”

Section: Discussionmentioning

confidence: 99%

“…Intratympanic (IT) application of glucocorticosteroids for the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) was introduced into clinical routine not only as a secondary treatment option after failure of systemic steroid treatment but also as a primary therapy in patients with contraindications to systemic treatment [1][2][3][4][5][6][7]. Motivation is found in blinded, placebo-controlled studies, which show significant benefits of IT steroids in comparison to intratympanic normal saline injections [8,9] and in multiple other randomized and non-randomized studies.…”

Section: Introductionmentioning

confidence: 99%

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Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Roßberg

Goetz

Timm

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose To evaluate temporal bone cone-beam CT in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) being treated with primary and secondary intratympanic (IT) triamcinolone and to possibly correlate these results to the clinical outcome. Methods Retrospective analysis of patients treated with IT triamcinolone for ISSNHL at our department in 2018. Pre-and post-therapeutic audiologic examinations included four-tone average (FTA) at 0.5, 1, 2 and 3 kHz. Using a clinical questionnaire, pre-therapeutic CBCT scans were re-evaluated looking at items, which might interfere with adequate drug diffusion into the inner ear (e.g. bony overhangs or secondary membranes at the round or oval window). Results Thirty-one patients were included. Twenty-four (77%; group A) had experienced ineffective systemic steroid therapy before and seven (23%; group B) received primary IT injections. Four group A-patients (21%) and two group B-patients (33%) showed a post-therapeutic FTA improvement of more than 15 dB HL. Bony overhangs at the round window niche (RWN) were present in seven cases (26%), a secondary membrane at the RWN in four (15%) and soft tissue in eight (30%) cases, respectively. Conclusion Most patients present radiological findings in CBCT imaging, which might interfere with drug diffusion through the RW membrane. Interestingly, soft or bony tissue obstructing the RWN or the OWN was found in 50% of patients, who showed improvement of hearing. We conclude that radiologic 'tiny' findings are either clinically irrelevant or improvement in hearing is independent from intratympanic drug delivery.

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Roßberg

Goetz

Timm

et al. 2020

Eur Arch Otorhinolaryngol

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“…Their results suggested that both dexamethasone and methylprednisolone have good therapeutic efficacy for treatment of SSNHL. However, while methylprednisolone is a GC with medium effect, dexamethasone has long-term effects [ 14 , 15 ]. Therefore, for the treatment of SSNHL, methylprednisolone is more commonly used because it is safer than dexamethasone for systemic administration [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Differential Levels of Endoplasmic Reticulum Stress in Peripheral Blood Mononuclear Cells from Patients with Sudden Sensorineural Hearing Loss

Zhi-biao

Fei

et al. 2020

Med Sci Monit

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Intratympanic vs Systemic Corticosteroids in First-line Treatment of Idiopathic Sudden Sensorineural Hearing Loss

Mirian

Ovesen

2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCETo our knowledge, evidence-based recommendations on the intratympanic vs systemic administration of corticosteroids for the treatment of idiopathic sudden sensorineural hearing loss remain unestablished, and contradictory conclusions have been reported in previous meta-analyses.OBJECTIVE To compare recovery from idiopathic sudden sensorineural hearing loss based on systemic, intratympanic, or a combined treatment with corticosteroids as first-line treatment.DATA SOURCES We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We searched PubMed, Embase, OvidSP, CINAHL, and Cochrane Library from January 1, 1966, to July 1, 2018. This study was registered in the International Prospective Register of Systematic Reviews (CRD42018109314). STUDY SELECTIONWe included randomized studies. Included studies must have excluded identifiable causes. Corticosteroids must have been administered solitarily. We excluded studies that did not define hearing loss as a minimum 30 dB within 72 hours. DATA EXTRACTION AND SYNTHESISWe identified 170 titles, of which 56 (32.9%) were eligible for full-text screening. We independently extracted data. We applied a fixed-effects model to investigate our objectives. MAIN OUTCOMES AND MEASUREWe aimed to (1) estimate the difference in mean pure tone average (PTA) gain in decibels from intratympanic treatment vs systemic treatment and (2) investigate odds ratios for recovery between the different treatment groups. RESULTSWe included 7 eligible studies. A total of 710 patients were allocated to receive either intratympanic treatment (IT group, 235 [33%]), systemic treatment (ST group; 325 [46%]) or combined intratympanic and systemic treatment (CB group; 150 [21%]). The PTA was measured by taking the mean of 4 frequencies: 4 studies measured at 500, 1000, 2000, and 3000 Hz and 3 studies measured at 500, 1000, 2000, and 4000 Hz. The ST group had a 2.01-dB higher PTA gain (95% CI, −5.61 dB to 1.59 dB; P = .96; I 2 = 0%) compared with the IT group and the odds for achieving complete recovery was not significantly different at an odds ratio of 0.94 (95% CI, 0.61 to 1.44; P = .19; I 2 = 34.5%). For the CB group vs the ST group, the odds ratio was 1.11 (95% CI, 0.68 to 1.82; P = .75; I 2 = 0%). The analysis of the CB group vs IT group comprised only 2 studies.CONCLUSIONS AND RELEVANCE This study does not suggest that corticosteroid delivered intratympanically is more beneficial than systemic treatment in the case of moderate to severe idiopathic sudden sensorineural hearing loss. There were no indications that combined treatment was associated with improved hearing outcomes compared with either systemic or intratympanic treatment.

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Intratympanic Methylprednisolone versus Dexamethasone for the Primary Treatment of Idiopathic Sudden Sensorineural Hearing Loss

Cited by 13 publications

References 18 publications

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

Differential Levels of Endoplasmic Reticulum Stress in Peripheral Blood Mononuclear Cells from Patients with Sudden Sensorineural Hearing Loss

Intratympanic vs Systemic Corticosteroids in First-line Treatment of Idiopathic Sudden Sensorineural Hearing Loss

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