Corticothérapie intratympanique de rattrapage pour les surdités brusques sévères ou profondes

Abstract

Intratympanic corticosteroids (IT) have been proposed to treat idiopathic sensorineural hearing loss (SNHL). The aim of this study was to evaluate the results of intratympanic steroids as a salvage treatment for severe SNHL in a control group study. A regimen of three IT steroids was offered to patients who failed a 7-days intravenous steroid treatment. Eighty-four patients underwent IT salvage treatment (IT GROUP). Their outcomes were compared with those of 255 control patients with severe SNHL who received the same intravenous steroid regimen without salvage IT steroid therapy (CONTROL GROUP). Types of SNHL were classified into five subgroups according to their audiogram patterns. The initial pure tone averages (PTA) were 77 ± 29 dB and 78 ± 35 dB in the IT GROUP and the CONTROL GROUP, respectively (p = 0.68). Fifty-six percent of the patients in the IT GROUP had a hearing improvement of > 15 dB after one month. The average hearing improvements after one month were 26.5 ± 28 dB and 27.9 ± 24 dB in the IT GROUP and the CONTROL GROUP, respectively (p = 0.67). However, for patients with a type E audiogram pattern (total deafness), there was a substantial hearing gain. Although intratympanic steroids failed to show a global auditory benefit as a salvage treatment for the whole population of patients with severe SNHL, our data suggest that a salvage treatment with intratympanic dexamethasone may be offered to patients with total deafness for whom the first systemic treatment has failed.