Idiopathic sudden sensorineural hearing loss: Effectiveness of salvage treatment with low-dose intratympanic dexamethasone

Abstract

ObjectivesTo evaluate hearing outcome of salvage treatment with intratympanic steroids (ITS) in idiopathic sudden sensorineural hearing loss (ISSNHL) refractory to initial systemic steroid (SS) therapy. Material and methodsA retrospective medical chart review was conducted on 54 consecutive patients with ISSNHL refractory to SS. Salvage treatment with a low dose intratympanic dexamethasone (4 mg/ml) was offered after one week of primary treatment. Patients were divided into two groups: 25 patients accepted ITS (treatment group) and 29 patients did not undergo additional treatment (control group). A pure tone average (PTA) gain of at least 10 dB was considered hearing improvement. ResultsHearing improvement rate was higher in ITS group compared to control group (40% vs. 13.8%, p = 0.035). A mean PTA improvement of 8.6 ± 9.8 dB was observed in the ITS group and, whereas the control group had an average hearing gain of 0.7 ± 2 dB (p < 0.001). Audiometric analysis revealed a significant hearing gain in ITS group at all tested frequencies compared to control group (p < 0.05). Analysis of the selected variables, identified intratympanic steroid treatment as the only independent prognostic factor for hearing improvement (OR = 4.2, 95% CI: 1.1–15.7; p = 0.04). ConclusionIntratympanic low dose dexamethasone is effective in patients with incomplete hearing recovery after primary systemic steroid treatment.