Oral versus Short-Term Intratympanic Prednisolone Therapy for Idiopathic Sudden Hearing Loss

Abstract

Objectives: To assess the therapeutic effectiveness of an intratympanic (IT) steroid protocol compared to a systemic steroid protocol. Methods: A total of 265 consecutive patients presenting unilateral idiopathic sudden sensorineural hearing loss were divided into 2 groups. One group comprised 131 patients enrolled between May 2009 and May 2010, and the other consisted of 134 patients enrolled between June 2010 and June 2011; a total of 48 patients were excluded among the 2 groups. The first group received oral prednisone for 8 days in tapering doses; the second group had IT prednisolone at a dose of 62.5 mg/ml once a day for 3 consecutive days. Audiological examinations were performed at study entry and 30 days after the beginning of therapy. Mean pure tone audiometry (PTA) of both groups and hearing outcomes following the criteria of Furuhashi et al. [Clin Otolaryngol 2002;27:458-463] and Siegel [Otolaryngol Clin North Am 1975;8:467-473] were investigated. Results: The strong efficacy of steroid therapy was evident in both groups, observing both PTA and hearing threshold improvement. The evaluation of the hearing outcomes shows a significantly better result for the short-term IT protocol; this result is ascribable to two types of audiometric curves: down- and up-sloping. Conclusion: The results show a significant efficacy of both steroid therapeutic approaches. There was no significant difference in PTA improvement between the 2 study groups; the short-term IT protocol led to better results in the evaluation of the hearing outcomes (following the criteria of Siegel and Furuhashi et al.) for up- and down-sloping audiometric curves.

Does age influence the success of intra-tympanic steroid treatment in idiopathic sudden deafness?

“…A previous study reported that a high-dose IT steroid administration for 3 consecutive days within 15 days from the onset of the ISSNHL would lead to a therapeutic success rate of 79.4% [8]. These results have recently been confirmed on a larger sample when IT prednisolone was administered as first line therapy, with a success rate of 73.6% [5]. Correspondence The present study aimed to evaluate the possible relationships between the therapeutic success of IT prednisolone therapy and the age of the patients with ISSNHL, also considering the role played by additional factors, such as time lapse between the onset of ISSNHL and the beginning of treatment (named 'delay'), gender, and pre-treatment hearing levels.…”

“…In the clinical practice, three main intra-tympanic (IT) steroid protocols are used applied in ISSNHL: IT steroids alone, combined IT and systemic steroids and salvage IT treatment after failure with systemic steroids [2][3][4][5].…”

Advances in nano-based inner ear delivery systems for the treatment of sensorineural hearing loss

“…A pioneering study by Wilson et al demonstrated that oral corticosteroids could effectively reverse SHL with a recovery rate of 61%, as compared with a placebo recovery rate of 32% [2]. Additional studies have since demonstrated SHL recovery rates of 57–66% with oral corticosteroid use [3,4]. More long-term courses of oral corticosteroids are used in the treatment of AIED, which presents as progressive bilateral asymmetric sensorineural hearing loss (SNHL) occurring over weeks to months, with possible vestibular deficit [5–7].…”

The Role of Preoperative Steroids for Hearing Preservation Cochlear Implantation: Results of a Randomized Controlled Trial

“…In other types of inner pathologies, such as sudden sensorineural hearing loss, the evidence for the benefit of oral steroids has been equivocal [Wei et al, 2013]. When compared to transtympanic steroids for sudden hearing loss, oral steroids were found to be less beneficial [Filipo et al, 2014]. Perhaps alternative routes for systemic drug delivery such as intravenous or intramuscular routes should be studied.…”