Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss

Introduction: Controversy surrounds the use of salvage therapies to treat sudden sensorineurat hearing loss (SSNHL), with no consensus on recommendations. White several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. Objective: We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. Methods: Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20 dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4 mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120 min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. Results: The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p = 0.364 and p = 0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. Conclusion: ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.