Intratympanic versus systemic steroid improves sudden hearing loss

By Sally Robertson, B.Sc.Feb 12 2013

Intratympanic treatment with the steroid dexamethasone should be considered as a salvage therapy for patients who have not responded to systemic treatment for sudden sensorineural hearing loss (SSHL), suggest study findings.

"We agree with the last recommendation of the American Academy in the field of SSHL that considers the salvage intratympanic steroids as a recommended therapy," say Francesco Dispenza (U.O. Otorinolaringoiatria, Agrigento, Italy) and colleagues.

The treatment was effective at improving hearing among 36 individuals with SSHL who had not recovered their hearing (pure-tone average [PTA] recovery of 10 dB or more) after a previous systemic treatment, report the researchers. By contrast, no recovery of hearing was observed among 10 individuals with a failed first treatment who refused the salvage therapy.

In the first instance, most patients had been treated with systemic steroids (n=41), with 24 also receiving intravenous osmotic diuretics, and four receiving osmotic diuretics alone.

As reported in the American Journal of Otolaryngology, the PTA hearing threshold after the onset of SSHL was 66.5 dB, which improved to 59.6 dB after first treatment.

However, 6 months after administration of intratympanic dexamethasone 4 mg/mL, PTA was further reduced to 46.8 dB, a mean improvement from first treatment of 12.8 dB, say Dispenza et al.

On the other hand, no hearing change was noted in the 10 patients who refused salvage therapy, a finding that "is indicative of some important action of the steroids into the cochlear recovery process," say Dispenza and team.

The researchers also found that all patients treated with steroids as a first therapy had a significantly better response to salvage therapy, compared with those who received diuretics alone, at mean reductions in PTA of 13.6 dB versus 6.3 dB.

In addition, there was a significantly greater improvement in hearing among patients who did not smoke, compared with smokers, with respective mean PTA reductions of 15.9 dB versus 3.3 dB.

"This study linked the failure of intratympanic salvage therapy to tobacco smoking, and these data should be kept in mind when planning some salvage therapy in patients who smoke cigarettes during treatment," writes the team.

The researchers conclude that, although the number of patients included was relatively low, "the results of the present study confirm the efficacy of [intratympanic steroids] as a salvage therapy."

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