Treatment of idiopathic sudden sensorineural hearing loss: systemic versus intratympanic methylprednisolone acetate

Abstract Background: The etiology of sudden sensorineural hearing loss is diverse; viral, vascular, immunologic, and abnormal cell stress responses have been proposed, the presentation of the disorder is abrupt, and hearing loss is progressive over a very short period. Steroids remain the treatment of choice irrespective of the etiology of hearing loss. Intratympanic corticosteroid injections have been widely used to deliver corticosteroids directly into the inner ear for those whom systemic steroids have not been successful. Complications such as perforations of the tympanic membrane, myringitis, and otitis media have been reported rarely. Objective: To compare the hearing recovery results in patients with sudden sensorineural hearing loss receiving systemic versus intratympanic methylprednisolone acetate. Methods: A randomized clinical trial was carried out over 4 years that included 46 patients randomly assigned to two groups of 23 patients each. Pretreatment hearing levels were compared with post-treatment audiograms up to 5 weeks following initial therapy. A 20-dB gain in pure-tone audiometry or a 20% improvement in speech discrimination score was considered a significant improvement. The results of both groups were compared and tested for statistical significance. Results: The recovery rate in the systemic group was 65%, whereas the recovery rate in the intratympanic group was 56%; the overall results were comparable over different frequencies. Failure to improve was observed equally in both groups in 21% of patients. Conclusion: No statistically significant difference was observed between both the groups. Intratympanic steroid injection as a primary treatment of idiopathic sensorineural hearing loss is an effective alternative to systemic therapy. © 2012, The Egyptian Oto - Rhino - Laryngological Society.