Hearing outcomes of daily intratympanic dexamethasone alone as a primary treatment modality for ISSHL

Abstract

Objective Intratympanic (IT) dexamethasone offers a good method for avoiding systemic side effects in patients with sudden idiopathic sensorineural hearing loss (ISSHL). However, in most studies, IT was used as a salvage treatment for patients whose hearing failed to improve with the initial systemic treatment, or as an addition to conventional oral steroid protocols. Therefore, we investigated the outcomes of IT steroid administration as a primary treatment modality for ISSHL. Study Design Randomized controlled study. Setting Tertiary referral center. Subjects and Methods Two treatment methods, IT dexamethasone or oral prednisolone, were randomly assigned to 63 participants. A group of 32 patients (IT group) with ISSHL received IT dexamethasone once a day for eight days. A separate group of 31 patients (oral group), received oral prednisolone, also for eight days. We compared the hearing outcomes in the two groups. Results We have found that the outcomes for patients treated with IT dexamethasone as a primary treatment modality for the management of ISSHL presented no difference in pure-tone averages or hearing recovery rate compared with patients treated with oral steroids. However, differences were noted for hearing thresholds according to frequency: the threshold improvement at low frequencies (250, 500, and 1000 Hz) was not statistically significant between groups; at high frequencies, particularly 4000 and 8000 Hz, the threshold improvement was statistically higher in the oral group than in the IT group. Conclusion IT dexamethasone might be a good primary treatment method for ISSHL; but, for the management of ISSHL, we should keep in mind the differences in hearing outcomes with regard to frequency.