Intratympanic Dexamethasone Injection Research Articles

The Effect of Intratympanic Injection of Dexamethasone for the Treatment of Sudden Sensorineural Hearing Loss

AbstractBackground: Steroids remain the treatment of choice for sudden hearing loss regardless the cause. With the adverse effects of systemic corticosteroids, Intratympanic injection of steroids appears to be an attractive method of management of Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) in patients with contraindication for systemic steroids.Patients and Methods: 40 patients, presented with mod-erate to severe and severe SSNHL were enrolled in the study. Patients were randomly allocated in one of two groups: (Group I) received intratympanic injection of dexamethasone 4mg for 5 times over 4 weeks and (Group II) received systemic steroid 1mg/kg for one week and tapering the dose for two weeks. Pure Tone Audiogram (PTA) and Speech Discrimina-tion (SD) were used for assessment pre and post-treatment in the two groups.Results: Group I treated with intratympanic injection of dexamethasone showed hearing improvement in 45% of patients (9 patients) and no improvement in 55% of patients (11 patients), while Group II treated with systemic corticos-teroids showed hearing improvement in 60% of patients (12 patients) and no improvement in 40% of patients (8 patients). The degree of improvement showed no statistically difference between both groups.Conclusions: The intratympanic injection of dexametha-sone is an effective alternative to systemic steroids in treatment of ISSNHL as a primary therapy.

Intratympanic Injections of Dexamethasone in Delayed Endolymphatic Hydrops: A Prospective Clinical Study

Objective: This study was designed to evaluate the effectiveness of intratympanic dexamethazone (ITD) for the treatment of ipsilateral delayed endolymphatic hydrops (DEH). Methods: Forty-one patients were diagnosed with ipsilateral DEH. Only 37 patients completed this study. Patients were randomly divided into 2 groups. Group A (n = 16) received oral medication, and group B (n = 21) received ITD once weekly for 4 consecutive weeks. Results: In group A, 6 patients showed improvement in their vertigo. Four patients (25%) showed complete vertigo control, and 2 patients (12.5%) showed substantial vertigo control. In group B, 21 patients showed improvement in their vertigo, 11 patients (52%) showed complete vertigo control, and 10 patients (47%) showed substantial vertigo control. Only 1 case did not show any improvement in their vertigo. Conclusion: ITD is proven to be a valuable and promising alternative modality for the management of ipsilateral DEH.

Comparison of 2 and 4 Intratympanic Steroid Injections in the Treatment of Idiopathic Sudden Sensorineural Hearing Loss.

We studied the effect of intratympanic steroid administration with different total injection times on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). The subjects were 191 consecutive patients (192 ears) with ISSNHL (hearing level ≥40 dB, interval between onset and treatment ≤30 days). They received systemic prednisolone (100 mg followed by tapered doses) combined with intratympanic injection of dexamethasone (4 mg/ml). Intratympanic injection was performed 4 times (days 1, 2, 4, and 7) in 92 patients (92 ears) or 2 times (days 1 and 2) in 99 patients (100 ears). The hearing outcomes were evaluated at 1 week from the start of treatment and 1 to 2 months after the completion of treatment. There was no significant difference in hearing outcomes between the 4- and 2-injection groups at either time point. Multiple regression analysis also showed that the hearing level after treatment did not depend on the total number of intratympanic steroid injections. These results indicate that a protocol using only 2 intratympanic steroid injections exerts a sufficient effect on the hearing outcomes of ISSNHL. This simplified treatment protocol would be greatly beneficial to relieve the physical and mental stress of patients.

Steroidlerin başarısız kalmasından sonraki ani sensörinöral işitme kaybında hiperbarik oksijen kurtarma tedavisinin terapötik etkinliği

Objective: The aim of this study was to evaluate the efficacy of hyperbaric oxygen (HBO) therapy as salvage therapy in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) after failure of systemic therapy. Methods: Forty-eight consecutive patients with refractory ISSNHL were enrolled retrospectively. All patients were given systemic steroid therapy by tapered doses. In addition, forty-one patients received intratympanic dexamethasone injection. Hearing outcomes were determined by recovery rate according to Siegel's criteria and hearing gains in pure-tone average (PTA) measured by audiometry before and after HBO therapy. The effects of prognostic factors on hearing recovery were also evaluated. Results: Thirteen (27%) patients responded to HBO therapy. The remaining 35 (73%) patients did not show any improvement. After HBO therapy, significant improvement was found in mean hearing thresholds at all frequencies. Only the level of initial PTA level and gender were significantly associated with recovery. Patients with severe hearing loss (≥70 dB) had significantly better results. Conclusion: Salvage HBO therapy may be beneficial in patients with ISSNHL who failed to recover by primary combined steroid therapy. Further hearing recovery with salvage HBO therapy can be expected, particularly in patients with PTA greater than 70 dB.

A Study of Intratympanic Dexamethasone Injection in Meniere's Disease : Continuation Study

Background: Meniere's disease is a condition that is thought to arise from abnormal fluid and ion homeostasis in the inner ear. The disease is named for Prospere Meniere, a French physician who was first known victim of this disease and reported that the inner ear could be the source of a syndrome manifesting episodic vertigo, tinnitus and hearing loss. The origin of Meniere's disease is presently controversial. While, in the past, it was felt that endolymphatic hydrops (excess fluid) in the inner ear were responsible for the disease, the most current opinion is that hydrops are just a marker for the Meniere's disease, rather than absolutely being responsible for the symptoms. Aim of the work: this study aimed to follow up (2 and 2.5 years) the effect intratympanic (IT) dexamethasone in the prognosis of Meniere's disease (MD) with two different concentrations (4 and 10 mg/ml). Patients and methods: twenty patients with unilateral Meniere's disease received intra tympanic dexamethasone injection were included in this study .The studied subgroups were categorized according to the concentration of dexamethasone (4 and 10 mg/ml) used into two subgroups. Detailed history was taken from all patients. They were exposed to Dizziness Handicap Inventory scale, basic audiological evaluation and cervical-vestibular evoked myogenic potential assessment. The presence or absence of spontaneous, post-head-shaking, and positional nystagmus was evaluated using a video-nystagmography system. The patients in the two groups were followed -up for 2 and 2.5 years. Results: the dosage of 10mg/ml dexamethasone showed more stability in signs and symptoms of Meniere's disease than the dose of 4 mg/ml dexamethasone in follow up study. The long term study of intratympanic (IT) dexamethasone injection in both subgroups shows nearly no improvement as regard pure tone average, speech reception thresholds, word discrimination scores, subjective hearing loss, tinnitus, aural fullness, vertigo interruption with daily activities and vertigo associated symptoms compared to the previous study thesis. Conclusion: the long-term study of intratympanic (IT) Dexamethasone injection in both subgroups showed nearly no improvement in most assessments performed.

Intratympanic Injection of Steroid for Treatment of Tinnitus.

Tinnitus has become one of the most challenging tasks faced by the medical field. It has a moderately negative impact on patient's quality of life. Different methods had been developed in medical science for managing tinnitus but none of these offered a permanent cure. In our study we used a simple procedure of intratympanic injection of dexamethasone in managing our tinnitus patients. Total number of patients involved in this study were 40, 26 females and 14 males with age spanned from 15 to 65years. Out of 40 patients, 22 of them complained of tinnitus only while the other 18 of them complained of tinnitus with impaired hearing which was confirmed further by pure tone audiometry. Injection was given under otologic microscopic vision through posteroinferior quadrant of tympanic membrane in weekly interval. After receiving several number of injections, 24 patients (60%) reported complete disappearance of tinnitus, 10 of them (25%) still had residual tinnitus but comparatively less severe and 6 (15%) of them reported no improvement.

Therapeutic effect of Intra-Tympanic Dexamethasone-Hyaluronic Acid Combination in Sudden Sensorineural Hearing Loss.

Hearing loss is fairly a common disorder which is usually treated with corticosteroids via systemic administration and/or intra-tympanic injection. This study aimed to compare the effectiveness of intra-tympanic injections of dexamethasone with its combination with hyaluronic acid in patients with sudden sensorineural hearing loss. In this clinical trial, 40 patients were randomly assigned to two groups; in the first group, 20 patients received 2.4 mg intra-tympanic dexamethasone, while in the second group patients received injections of 2.4 mg of dexamethasone plus 2 mg of hyaluronic acid in combination. Patients in both groups were injected every other day to a total of three injections. The hearing status of patients was evaluated by pure tone audiometry (bone conduction threshold) before and 2 weeks after the intervention. Assessment of hearing threshold before and after treatment in the two groups showed a significant difference between hearing thresholds at frequencies of 4,000 to 8,000 Hz (P<0.001). The difference at other frequencies was not meaningful; however, in general, we found a better therapeutic effect in patients who received the combination of dexamethasone and hyaluronic acid. A combination of dexamethasone and hyaluronic acid in patients with sudden sensorineural hearing loss may be more effective than dexamethasone alone. Because hyaluronic acid lacks certain side effects, and also makes it possible to reduce the steroid dose, we recommend the use of this combination in the treatment of patients with sudden sensorineural hearing loss.

Intratympanic dexamethasone vesus post-auricular subperiosteal injection of methylprednisolone treatment for sudden hearing loss

Objective:To compare the efficacy and side effect between intratympanic dexamethasone and subperiosteal injection of methylprednisolone treatment for sudden hearing loss.Method:One hundred and eight unilateral sudden hearing loss patients were enrolled in this study, randomly divided into A group, which was accepted intratympanic dexamethasone (10 mg/ml) , and B group, which was accepted post-auricular subperiosteal injection of methylprednisolone (40 mg/ml) by every 3 days intotal 5 times. After 3 months follow-up, analysis of the differences of pure tone threshold, tinnitus handicap inventory (THI), dizziness handicap inventory (DHI), blood glucose between pretreatment and postreatment was made. Side effect such as perforation of tympanic membrane, infection of post-auricular skin was also observed.Result:①Both in A and B group, there was no statistical changes in total efficiency and pure tone threshold decrease (P> 0.05), whereas the pure tone threshold statistical change was observed in the low frequency sudden deafness between A and B group (P< 0.05). ②Both in A and B group, there was no statistical changes in THI (P> 0.05), whereas the THI statistical decrease was observed in the high frequency sudden deafness between A and B group (P< 0.05). ③There was no statistical change in THI both in A and B group (P> 0.05). ④Both in A and B group, there was no statistical changes in fasting plasma glucose between pretreatment and postreatment (P> 0.05). ⑤There was no patient who had gotten tympanitis or postauricular infection, although in A group, there were 2 patients had gotten perforation of tympanic membrane, but they all healed after the follow-up.Conclusion:Both topical injection of glucocorticoid can improve pure tone threshold and reduce the score of THI and DHI for sudden hearing loss patients. Intratympanic dexamethasone can reduce more score of THI for high frequency sudden deafness patients whereas subperiosteal injection of methylprednisolone can improve pure tone threshold more for low frequency sudden deafness patients. None of the two administrations elevate blood glucose, but intratympanic dexamethasone have the risk of perforation of tympanic membrane.

Control of vertigo in Ménière's disease by intratympanic dexamethasone

ObjectiveThe main objective was to assess the efficacy of intratympanic dexamethasone injection in controlling vertigo in unilateral Ménière's disease refractory to medical treatment. Materials and methodsA retrospective study included 25 patients with disabling unilateral Ménière's disease, defined according to the American Academy of Otorhinolaryngology-Head and Neck Surgery (AAO-HNS) criteria. Patients received intratympanic dexamethasone during the monitoring period. Control of vertigo was classified according to AAO-HNS vertigo control index, at 6 months, 1 year, and 2 years after treatment initiation. Complications and progression of hearing were also assessed. ResultsSatisfactory control (class A or B) was obtained in 92% of patients (n=23/25) at 6 months, 68% (n=17/25) at 1 year, and 70% (n=16/23) at 2 years. There was no worsening of hearing in those patients who were well-controlled by this therapeutic strategy. No local or systemic complications were observed during follow-up. ConclusionDexamethasone is part of the management strategy for patients with Ménière's disease refractory to conventional treatment, implemented before destructive treatment. It achieves control of vertigo in 70% of patients at 2 years.

The Effects of Experimental Intratympanic Steroid Administration on Organ of Corti Type 1 Spiral Ganglion.

Introduction It is unclear how effective is the intratympanic (IT) steroid treatment on organ of Corti type 1 spiral ganglion, its optimal dosage and frequency of administration. The effect of dexamethasone on cochlear functions in individuals with a normal hearing ability is also unknown. Objective The aim of this study was to evaluate, at the electrophysiological and ultrastructural levels, the effect of IT dexamethasone administration in guinea pigs with normal hearing on organ of Corti type 1 spiral ganglion. Methods A total of 20 guinea pigs ( n = 40 ears) whose hearing was detected to be normal by electrophysiological tests were included in the study and randomly divided into 6 groups. Four groups were considered study groups, while 2 groups were considered control groups. Dexamethasone was administered intratympanically in doses of 2 mg/mL and 4 mg/mL in the guinea pigs in the study groups. The animals in the control groups received physiological saline in equal doses as the study groups. All interventions were performed under general anesthesia, and the electrophysiological tests were repeated following the IT injections. Results No statistically significant differences were found among the groups when the IT injections were evaluated in terms of the electrophysiological measurements ( p > 0.05). The ultrastructural evaluation showed a cellular mitochondrial increase in the spiral ganglions of the cochlea in the groups in which dexamethasone was administered in a dose of 4 mg/mL. Conclusion According to the findings of this study, it can be suggested that the IT injection of dexamethasone is safe, and when applied in a dose of 4 mg/mL, it increases metabolic activity at the cellular level.

돌발성 난청의 구제치료

Background and Objectives: The purpose of this study was to analyze the outcome of remedial treatment for patients who had been over 2 weeks after the onset of sudden onset of hearing loss and who did not recover after the initial treatment. Subjects and Methods: Retrospective chart review was done with the patients who were diagnosed as sudden sensorineural hearing loss and visited our clinic 2 weeks after onset or not improved after receiving oral steroid treatment from January 2010 to December 2015. Twenty four patients out of 187 SSNHL were enrolled. Hearing outcomes were determined by hearing gains in pure-tone average (PTA) measured by audiometry before and 3 months after salvage therapies. Results: Significant larger hearing gains in PTA were found in the oral steroid and intratympanic injection groups than the control group. Intratympanic group resulted in a significantly larger PTA improvement than the oral steroid group (p=0.035). Conclusion: Therefore, in the case of sudden hearing loss more than 2 weeks after onse or that failed in the first treatment, it is necessary to treat either oral steroid or intratympanic injection of dexamethasone considering the general condition and the environment of the patient. (J Clinical Otolaryngol 2017;28-:49-52)

Intratympanic Injection of Dexamethasone and Electrocochleographic Data in Cases of Definite One Sided Refractory Meniere's Disease.

Meniere's disease (MD) is a disease of the inner ear that presents itself with repeated episodes of vertigo (96.2%), tinnitus (91.1%), and sensorineural hearing loss (87.7 %). In this article we sought to assess the effects of intratympanic (IT) injections of dexamethasone on definite cases of MD using electrocochleography (ECOG). In this hospital-based case series in 36 patients, we measured audiometric values and ECOG in all patients before, 1 month and 6 months after 4-mg/mL IT injections of dexamethasone. Four patients (11%) had improved hearing following the intervention. No difference in pure tone audiometry (PTA) was observed following IT injections (P=0.492), while speech discrimination score (SDS) was significantly improved (P=0.008). There was a significant improvement in vertigo 1 month after IT injections (P<0.001), although this effect did not last for 6 months. No significant change in ECOG was observed between before and after treatment (P=0.052). IT dexamethasone injections can improve vertigo in definite cases of MD, although it seems that the effect is only temporary.

A Comparative Study of Intratympanic Injection of Dexamethasone With 4% Lignocaine for the Treatment of Tinnitus

A Comparative Study of Intratympanic Injection of Dexamethasone With 4% Lignocaine for the Treatment of Tinnitus

Clinical effect of intratympanic dexamethasone injection in acute unilateral tinnitus: A prospective, placebo‐controlled, multicenter study

The purpose of this study was to investigate the effectiveness of intratympanic dexamethasone injection (ITDI) in acute tinnitus of presumed cochlear origin. A prospective, randomized, placebo-controlled, double-blinded, multicenter study. Between August 2013 and December 2015, 54 patients with unilateral tinnitus were enrolled at four different centers. Patients were assigned either to an ITDI (n = 27) or an intratympanic normal saline injection (ITNI; n = 27) group through block randomization. Intratympanic injections were administered four times over 2 weeks. At 4 weeks after initial injection, we analyzed the improvement rates of tinnitus using the tinnitus handicap Inventory (THI) and visual analogue scale (VAS) for loudness, awareness, and annoyance. We defined improvement as the reduction of more than 7 points or of more than 20% in the final THI score compared to the initial THI score. The initial mean hearing thresholds and VAS and THI scores of the two groups did not differ significantly. At 4 weeks after initial injection, the mean VAS and THI scores of both groups had significantly reduced. However, the improvement rate did not differ significantly between the groups (ITDI, 51.9%; ITNI, 59.3%). The results indicate that ITDI might not be more effective than ITNI for the treatment of acute unilateral tinnitus. Therefore, ITDI should not be considered as the main treatment for patients presenting with acute tinnitus as the primary symptom. 1b. Laryngoscope, 128:184-188, 2018.

고실내 덱사메타손(Dexamethasone) 주입술로 호전된 난치성 이루를 동반한 호산구성 중이염 : 사례 연구

Eosinophilic otitis media (EOM) is a newly recognized intractable middle ear disease, characterized by a highly viscous otorrhea and an accumulation of eosinophils in middle ear effusion and middle ear mucosa. Since EOM can cause gradual or sudden deterioration of hearing, it is important to properly diagnose EOM. Systemic or topical steroid administration is known as the most effective treatment for patients with EOM ; however, oral steroid therapy has the potential to cause adverse drug effects. Recently, we experienced two cases of EOM that were given intratympanic dexamethasone injection had improvement in otologic symptoms including otorrhea and hearing loss. The instillation of dexamethasone into the middle ear cavity is noninvasive and effective treatment for controlling eosinophilic inflammation in this report. Identification of the characteristic manifestations of EOM, and the consequent definite diagnosis and an adequate treatment for EOM can help prevent sensorineural hearing loss in early stage. (J Clinical Otolaryngol 2016;27:306–315)

Intratympanic dexamethasone in sudden sensorineural hearing loss: A systematic review and meta-analysis.

Systemic dexamethasone has demonstrated conclusive benefits in reversing sudden sensorineural hearing loss (SSNHL) despite considerable number of potential side effects. In contrast, the intratympanic route of steroid administration averts several possible complications. This study aims to examine the literature to delineate the efficacy and side effect of intratympanic dexamethasone (ITD) injection for the treatment of SSNHL. Cochrane, Embase, and MEDLINE electronic databases from January 1950 to August 2014, with an update performed on November 10, 2014. Systematic review and meta-analysis of randomized controlled clinical trials (RCCTs), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and guidelines. Quality assessment was performed using The Cochrane Collaboration Tool for Assessing Risk of Bias. Eight RCCTs on SSNHL were included Three of the eight studies had high risk of bias. Substantial heterogeneity was found. The meta-analysis failed to detect statistically significant difference between ITD and alternative treatment (odds ratio = 0.39, 95% credible intervals = 0.11-1.27). The side-effects profile was favorable for ITD. No serious adverse events were recorded. There is no sufficient scientific evidence to support a difference between ITD and alternative therapy for SSNHL. We recommend larger RCCTs to determine the effectiveness of ITD compared to oral steroid therapy. We encourage a shift in study design selection toward noninferiority or superiority studies. Avoiding systemic corticotherapy, especially in vulnerable populations, should be the rationale for future research in the field. Laryngoscope, 127:1897-1908, 2017.

Effect of intratympanic dexamethasone injection in sudden idiopathic sensorineural hearing loss

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of this study is to assess the effect of intratympanic dexamethasone injection (ITDI) in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was conducted on 40 patients refractory to intravenous steroid therapy between May 2012 to March 2014. Intratympanic dexamethasone injection was given every week for 3 consecutive weeks. Hearing was assessed by performing pure tone audiogram before every ITDI and also 1 week after the completion of treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Hearing improvement was seen in 27 out of the 40 cases (68%).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intratympanic dexamethasone significantly improves the prognosis of ISSNHL and is a safe, inexpensive and effective treatment in ISSNHL.&lt;/p&gt;

Repeated courses of intratympanic dexamethasone injection are effective for intractable Meniere’s disease

Conclusion: Intra-tympanic dexamethasone injection (ITD) could serve as a first-line intra-tympanic (IT) treatment for Meniere’s disease (MD), regardless of hearing level. Even if the response to initial ITD course was unsatisfactory, a repeated course may be beneficial with some patients.Objectives: This study examined the effect of repeated courses of ITD administered on demand and investigated the possibility of ITD as an initial IT treatment for medically intractable MD patients.Method: Fifty-one patients who had been diagnosed with definite MD and given course(s) of ITD treatment were included. Vertigo control, pure tone average and functional disability scores were evaluated against the American Academy of Otolaryngology-Head and Neck Surgery guidelines for MD.Results: Vertigo disappeared or was substantially controlled in 58.8% and 23.5% of the patients, respectively, after the first ITD course. A repeated course further raised the complete vertigo control rate by 15.7% and intra-tympanic gentamycin injection could be postponed or avoided in 78.6% of the patients who required repeated IT treatment. Hearing was unchanged after the first course of ITD (p > .05). No significant differences were detected in the clinical profiles or laboratory findings between patients receiving single course of ITD and those on multiple courses (p > .05).

Tinnitus: Evaluation of Intratympanic Injection of Combined Lidocaine and Corticosteroids

Background: Tinnitus is an annoying problem and until now there is no consensus on its treatment. Aims: In this prospective study, we evaluated the effectiveness of intratympanic lidocaine and dexamethasone (ITLD) injections for the management of subjective idiopathic tinnitus (SIT). Methods: Forty patients with SIT attended the Department of Otorhinolaryngology, Tanta University Hospital, Egypt, between May 2013 and May 2014. The patients were categorized into two groups: group A included 20 patients treated with ITLD injection, and group B included 20 patients treated with intratympanic saline injection as a control. Intratympanic injections were performed four times within 4 weeks in a double-blind manner. At the end of the treatment program, we analyzed the improvement and worsening rates of tinnitus using the following parameters: tinnitus questionnaires, Tinnitus Handicap Index (THI), and loudness matching test. Results: The effectiveness rates of the ITLD group reported in the tinnitus questionnaires, the THI and the loudness matching test were 74.3% in all tests, compared to 26.7, 40.0 and 26.7%, respectively, in the saline group. There was a statistically significant difference between the groups within 2 months after injection. To analyze the therapeutic effect of ITLD on tinnitus of 6 months duration, the improvement rates reported in the tinnitus questionnaires, the THI and the loudness matching test were 78.5% in all tests in the ITLD group, compared to 40.0, 40.0 and 30.0%, respectively, in the saline group. Conclusion: There were statistically significant differences between both groups. ITLD seems to be effective for idiopathic tinnitus.

The Short- and Long-Term Outcome of Intratympanic Steroid Therapy as a Salvage Treatment for Acute Low-Tone Sensorineural Hearing Loss without Episodes of Vertigo

Objectives: To evaluate the hearing outcomes of intratympanic steroid (ITS) treatment for patients with acute low-tone sensorineural hearing loss (ALHL) after failure of initial therapy and to investigate the recurrence and progression to definite Ménière's disease (MD) during a long-term follow-up. Methods: We retrospectively reviewed the medical records of 90 patients with refractory ALHL who were followed up for at least 1 year between January 2000 and April 2014. Patients who responded poorly to initial medical treatment received intratympanic dexamethasone injections (ITS group) or isosorbide administration for 4 weeks (diuretic group) as salvage treatment options according to their choice of management. The control group did not receive ITS or the diuretic, due to their refusal of both medical treatments. The hearing outcomes were evaluated 1 month, 1 year and 5 years after the completion of the second-line therapy, and the rates of recurrence and progression to MD were measured during a follow-up period of at least 1 year. Results: Twenty-seven patients in the ITS group, 39 patients in the diuretic group and 24 patients in the control group were enrolled. Of these, 12 patients in the ITS group, 15 patients in the diuretic group and 12 patients in the control group were followed up for over 5 years. We found that the recovery rates and the audiometric functional values after 1 month and 1 year in the ITS group were significantly higher than those in the diuretic and control groups. However, there were no significant differences in the recovery rates or the audiometric functional values after 5 years, or in the rates of recurrence and progression to MD between the groups. Conclusions: Salvage ITS therapy can provide a relatively good short-term hearing outcome for ALHL patients who have persistent hearing loss despite conventional treatment. However, both recurrence and progression to MD after treatment were observed in some patients during the long-term follow-up.