Intratympanic Steroid Treatment as a Primary Therapy in Idiopathic Sudden Sensorineural Hearing Loss

Objectives: Therapy for idiopathic sudden sensorineural hearing loss (ISSHL) is still controversial. Intratympanic (IT) administration of steroids appears to be an attractive method of management of ISSHL. The purpose of this study was to evaluate the efficacy and safety of IT administered methylprednisolone (IT-MP) on ISSHL patients as a primary therapy, by comparing the results with intravenously administered dexamethasone (IV-DEX) treatment. Materials and Methods A prospective, nonrandomized, comparative study was conducted for 44 patients presenting with ISSHL. Twenty patients were treated with intratympanic methylprednisolone as a primary therapy, and 24 with intravenous dexamethasone. The hearing level was described using the pure tone average (PTA in dB) hearing level at 4 frequencies (0.5, 1, 2 and 4 kHz). The PTA in unaffected ear was used as the presumed premorbid hearing (baseline) in the affected ear. Hearing gain was expressed as absolute hearing gain and relative hearing gain. Complete hearing recovery was defined as the final PTA within 10dB of baseline. Partial recovery was defined as a final PTA with a >= 50% relative recovery. Results: Mean hearing improvement was significantly higher in IT MP group than in IV DEX group (50.7 +/- 22.11, versus 29.5 +/- 28.0, p<0.01). There was significant difference between hearing level of the unaffected ear (hearing threshold was worse in the IV DEX group) and it had an influence on high rate of relative recovery of hearing in IV DEX group. There was no difference in mean relative recovery between the two groups. Similar percent of patients in both group had complete recovery, but in the IV DEX group 42% patients had no recovery (versus 10% in IT MP group). Conclusion: Intratympanic treatment of ISSHL may be a preferable choice as primary treatment option, since it can be performed in outpatient settings, with no serious side effects and complication rate.