Abstract
Idiopathic sudden sensorineural hearing loss (ISSHL) is a common condition characterized by hearing threshold reduction, most often of unknown causes. The patient experiences a sudden reduction of the hearing threshold in one or both ears. Steroids are the mainstream of the treatment. This study aims to investigate the effectiveness of intratympanic steroid administration compared with systemic administration and the combination of the two steroid treatments in the hearing recovery of patients with idiopathic sudden sensorineural hearing loss. We searched electronic databases such as PubMed, ScienceDirect, CINAHL, Cochrane (Central), Ovid, and Medline from August 31, 2021, to November 31, 2021, and from February 5 to 10, 2022. We included 12 randomized controlled trials (RCTs) and performed a meta-analysis comparing the efficiency in the hearing recovery of intratympanic versus systemic steroid treatment, systemic versus combined, and intratympanic versus combined steroid treatment. The results of the intratympanic versus systemic steroid therapy comparison showed no actual difference in efficiency and no statistical significance (odds ratio: 1.07 (Mantel-Haenszel (M-H), fixed, 95% confidence interval (CI): 0.76-1.51)). Systemic steroid treatment was inferior to combined steroid treatment and was the only outcome with statistical significance (odds ratio: 0.55 (M-H, fixed, 95% CI: 0.38-0.80)). Intratympanic steroid treatment was inferior to combined steroid treatment, although the results were not statistically significant (odds ratio: 0.65 (M-H, fixed, 95% CI: 0.37-1.16)). In conclusion, systemic steroid therapy was inferior to combined steroid therapy. The comparison of intratympanic with systemic therapy and intratympanic with combined therapy showed no statistical significance. Further research is needed with more RCTs, and side effects should be considered.
Highlights
BackgroundIdiopathic sudden sensorineural hearing loss (ISSHL) is defined as a rapid decline in hearing for three days or less affecting three or more frequencies by 30 dB or more without any identifiable cause [1]
This study aims to investigate the effectiveness of intratympanic steroid administration compared with systemic administration and the combination of the two steroid treatments in the hearing recovery of patients with idiopathic sudden sensorineural hearing loss
Systemic steroid treatment was inferior to combined steroid treatment and was the only outcome with statistical significance (odds ratio: 0.55 (M-H, fixed, 95% confidence intervals (95% CIs): 0.38-0.80))
Summary
Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as a rapid decline in hearing for three days or less affecting three or more frequencies by 30 dB or more without any identifiable cause [1]. In the United States, the incidence is between 5 and 27 per 100,000 people and 60,000 new cases per year [2]. SSHL shows a tendency toward spontaneous hearing recovery, steroids are widely used in practice [3]. Intratympanic steroids offer a choice in primary care, it is not conclusive if they are better or worse than the traditional treatment option [4]. The first report of the use of intratympanic steroids for sudden SNHL was by Silverstein et al in 1996 [5]. Dexamethasone (DXM), when placed in the middle ear, diffuses into the inner ear and produces an effect on the cochlea in certain patients
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