Concurrent treatment with intratympanic dexamethasone improves facial nerve recovery in Ramsay Hunt syndrome

Abstract

ObjectiveTo determine whether early intervention with intratympanic steroid injections, known as concurrent intratympanic steroid therapy (ITST), is an effective supplement to systemic steroid therapy for moderately-severe to severe Ramsay Hunt syndrome. MethodsForty-six patients with Ramsay Hunt syndrome (House-Brackmann grade IV or higher) who received either concurrent ITST with standard systemic steroid therapy (ITST group, n = 12) or standard systemic therapy alone (control group, n = 34) with antivirals starting within 7 days of onset. Patients in the concurrent ITST group received the standard systemic dose of prednisolone (410 mg in total) and intratympanic dexamethasone (16.5 mg in total) over 10 consecutive days. Patients in the control group received systemic prednisolone at the standard dose or higher (average dose, 581 ± 25 mg). ResultsThe recovery rate was higher in the concurrent ITST group than in the control group (93% vs 47%, P = .013). The adjusted odds ratio was 22.2 (95% confidence interval 1.32–373.58, P = .031). ConclusionsThe recovery rate was higher after concurrent systemic and intratympanic steroid therapy than after standard systemic steroid therapy, regardless of whether the steroid used had lower or equivalent glucocorticoid potency. This finding suggests that concurrent intratympanic steroid therapy is a beneficial supplement in patients with Ramsay Hunt syndrome.