Intratympanic steroids for combined treatment of idiopathic sudden hearing loss: when is it too late?

Abstract

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) requires early treatment.

Objective: To describe our experience on intratympanic steroid treatment (ITS) of ISSNHL analyzing the delay to start therapy as prognostic factor.

Material and methods: We perform a retrospective study on ISSNHL treated with systemic steroids without full recovery on PTA (pure tone average) according to Siegel criteria. They were divided into two different groups: one group that additionally received ITS as combined therapy (treatment group), and another without it (control group). We analyzed the hearing recovery at 6 months and 2 years, and the influence of the delay to start ITS in the recovery.

Results: After ITS was added, further complete recovery was achieved in 10 patients of the treatment group. After 6 months, PTA improvement in the treatment group was 10.84 dB, compared to 1.13 dB in the control group (p<.0001). Nevertheless, patients starting such combination of oral steroids and ITS within 8 days of diagnosis had an additional gain of 15 dB in the first 6 months, that increased to 19.17 dB after 24 months (p<.022).

Conclusions: When ITS was added within the first 8 days, a significantly better and more stable response was obtained.

Chinese abstract

背景：特发性突发性感觉神经性听力损失（ISSNHL）需要早期治疗。

目的：描述ISSNHL鼓室内类固醇治疗（ITS）的经验, 将延迟开始治疗作为预后因素进行分析。

材料和方法：我们回顾性研究了全身类固醇治疗ISSNHL, 但根据西格尔标准, 未完全恢复PTA（纯音平均值）。研究对象被分为两组：一组额外接受ITS联合治疗（治疗组）, 另一组不接受联合治疗（对照组）。我们分析了6个月和2年的听力恢复情况, 以及延迟开始ITS治疗对听力恢复的影响。

结果：增加ITS治疗后, 治疗组10例患者均获得完全康复。6个月后, 治疗组的PTA改善率为10.84 dB, 而对照组为1.13 dB（p < 0.0001）。然而, 在确诊后8天内开始口服类固醇和ITS联合治疗的患者在前6个月内额外提高15 dB, 24个月后提高到19.17 dB（p < 0.022）。

结论：在前8天内加入ITS治疗, 可获得较好、稳定的疗效。

Keywords:

• Intratympanic
• corticosteroids
• sudden
• sensorineural
• hearing loss
• idiopathic

Disclosure statement

No potential conflict of interest was reported by the authors.