Intratympanic steroids as a salvage treatment for sudden sensorineural hearing loss? A meta-analysis

Abstract

Sudden sensorineural hearing loss is typically treated with systemic steroids. The aim of this meta-analysis was to evaluate the efficacy of salvage intratympanic steroid treatment in patients who have initial treatment failure with systemic steroids. A MEDLINE literature search was performed, supported by searches of Web of Science, Biosis, and Science Direct. Articles of all languages were included. Selection of relevant publications was conducted independently by three authors. Only randomized controlled trials were considered. In one arm of the studies, the patients received salvage intratympanic steroids. In the other arm, patients did not receive further treatment. The standard difference in mean (SDM) amount of improvement in hearing threshold between patients who did and did not receive salvage intratympanic steroids was calculated. From an initial 184 studies found via the search strategy, 5 studies met inclusion criteria and were included. There was a statistically significant greater reduction in hearing threshold on pure-tone audiometry in patients who received salvage intratympanic steroids than in those who did not (SDM = -0.401, p = 0.005). Subgroup analysis showed that administration by intratympanic injection (SDM = -0.375, p = 0.013) rather than a round window catheter (SDM = -0.629, p = 0.160) yielded significant improvement in outcome. The usage of dexamethasone yielded better outcomes (SDM = -0.379, p = 0.039) than the use of methylprednisolone (SDM = -0.459, p = 0.187). No serious side effect of treatment was reported. In patients who have failed initial treatment with systemic steroids, additional treatment with salvage intratympanic dexamethasone injections demonstrate a statistically significant reduction in the hearing thresholds as compared to controls.

Middle‐ear dexamethasone delivery via ultrasound microbubbles attenuates noise‐induced hearing loss

“…IT DEX administration causes a dose‐dependent preservation of retrocochlear auditory neurons in an NIHL mouse model . Glucocorticoids can be used as a primary initial treatment or as a salvage therapy for SSNHL, but the clinical therapeutic outcomes of IT steroid treatments are associated with the application timing, dosage, and administration protocol . Regardless, the key factor is delivery of a sufficient DEX concentration to the perilymph.…”

Acquired Hearing Loss in Children

“…The efficacy of intratympanic steroids, therefore, remains unclear. [76][77][78] Other therapies mentioned in the literature, including hyperbaric oxygen, volume expanders, vasodilators, herbal remedies, anticoagulants, and zinc, have not been studied in a rigorous fashion in any age group for sudden SNHL. Huang and Sataloff 79 reported on 7 children with autoimmune inner ear disease (AIED), with both systemic steroids and cytotoxic medications having some efficacy.…”

The Role of High Dose Intratympanic Dexamethasone as Salvage Therapy for Idiopathic Sudden Sensorineural Hearing Loss

“…The highest concentration and longest duration in the endolymph and perilymph was noticed after IT administration of MET compared to DEX and hydrocortisone, but resulted in increased pain and burning sensation in the ear and the throat [14] . A meta-analysis of Ng et al [16] showed better outcomes using DEX compared to MET. The concentration used in treatment is often associated with availability and approval of each country or medical center and ranged from 4 mg/mL to 24 mg/mL for DEX.…”