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

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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.

References

  1. DeKleyn A. Sudden complete or partial loss of function of the octavus-system in apparently normal persons. Acta Otolaryngol. 1944; 32: 407–429

    Article  Google Scholar 

  2. Shaia FT, Sheehy JL. Sudden sensori-neural hearing impairment: a report of 1,220 cases. Laryngoscope. 1976; 86: 389–398

    CAS  Article  Google Scholar 

  3. Byl FM Jr. Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope. 1984;94(5 I):647–661

    Article  Google Scholar 

  4. Mattox DE, Simmons FB. Natural history of sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol. 1977;86(4 I):463–480

    CAS  Article  Google Scholar 

  5. Fetterman BL, Saunders JE, Luxford WM. Prognosis and treatment of sudden sensorineural hearing loss. Am J Otol. 1996; 17: 529–536

    CAS  PubMed  Google Scholar 

  6. Megighian D, Bolzan M, Barion U, Nicolai P. Epidemiological considerations in sudden hearing loss: a study of 183 cases. Arch Otorhinolaryngol. 1986; 243: 250–253

    CAS  Article  Google Scholar 

  7. Alexiou C, Arnold W, Fauser C, Schratzenstaller B, Gloddek B, Fuhrmann S, Lamm K. Sudden sensorineural hearing loss: does application of glucocorticoids make sense? Arch Otolaryngol Head Neck Surg. 2001; 127: 253–258

    CAS  Article  Google Scholar 

  8. Kallinen J, Laurikainen E, Bergroth L, Grénman R. A follow-up study of patients suffering from sudden sensorineural hearing loss. Acta Otolaryngol. 2001; 121: 818–822

    CAS  Article  Google Scholar 

  9. Nakashima T, Itoh A, Misawa H, Ohno Y. Clinicoepidemiologic features of sudden deafness diagnosed and treated at university hospitals in Japan. Otolaryngol Head Neck Surg. 2000; 123: 593–597

    CAS  Article  Google Scholar 

  10. Yanagita N, Nakashima T, Ohno Y, Kanzaki J, Shitara T. Estimated annual number of patients treated for sensorineural hearing loss in Japan. Results of a nationwide epidemiological survey in 1987. Acta Otolaryngol Suppl. 1994;514:9–13

    CAS  Article  Google Scholar 

  11. Minoda R, Masuyama K, Habu K, Yumoto E. Initial steroid hormone dose in the treatment of idiopathic sudden deafness. Am J Otol. 2000; 21: 819–825

    CAS  PubMed  Google Scholar 

  12. Merchant SN, Durand ML, Joe C. NIDCD sudden deafness. 2003. Available at: http://www.nidcd.nih.gov/health/hearing/sudden.asp. [Accessed 3 November 2008]

  13. Wilson WR, Byl FM, Laird N. The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double-blind clinical study. Arch Otolaryngol. 1980; 106: 772–776

    CAS  Article  Google Scholar 

  14. Chrousos GP. Adrenocorticosteroids & adrenocortical antagonists. In: Katzung BG, editor. Basic Clin Pharmacol. Harvard Medical School, Boston, MA, USA: The McGraw-Hill Companies Inc.; 2007.

    Google Scholar 

  15. Lefebvre PP, Staecker H. Steroid perfusion of the inner ear for sudden sensorineural hearing loss after failure of conventional therapy: a pilot study. Acta Otolaryngol. 2002; 122: 698–702

    CAS  Article  Google Scholar 

  16. Slattery WH, Fisher LM, Iqbal Z, Friedman RA, Liu N. Intratympanic steroid injection for treatment of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg. 2005; 133: 251–259

    Article  Google Scholar 

  17. Battista RA. Intratympanic dexamethasone for profound idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg. 2005; 132: 902–905

    Article  Google Scholar 

  18. Cinamon U, Bendet E, Kronenberg J. Steroids, carbogen or placebo for sudden hearing loss: a prospective double-blind study. Eur Arch Otorhinolaryngol. 2001; 258: 477–480

    CAS  Article  Google Scholar 

  19. Xenellis J, Papadimitriou N, Nikolopoulos T, Maragoudakis P, Segas J, Tzagaroulakis A, Ferekidis E. Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: a control study. Otolaryngol Head Neck Surg. 2006; 134: 940–945

    Article  Google Scholar 

  20. Carhart R, Jerger J. Preferred method for clinical determination of pure tone thresholds. J Speech Hear Dis. 1959; 24: 330–345

    Article  Google Scholar 

  21. American National Standards Institute. Methods for manual puretone threshold audiometry. ANSI S3.21–1978 R-1986 [report]. New York: American National Standards Institute; 1978.

    Google Scholar 

  22. Stokroos RJ, Albers FWJ, Tenvergert EM. Antiviral treatment of idiopathic sudden sensorineural hearing loss: a prospective, randomized, double-blind clinical trial. Acta Otolaryngol. 1998; 118: 488–495

    CAS  Article  Google Scholar 

  23. Tucci DL, Farmer JC Jr, Kitch RD, Witsell DL. Treatment of sudden sensorineural hearing loss with systemic steroids and valacyclovir. Otol Neurotol. 2002; 23: 301–308

    Article  Google Scholar 

  24. Uri N, Doweck I, Cohen-Kerem R, Greenberg E. Acyclovir in the treatment of idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg. 2003; 128: 544–549

    Article  Google Scholar 

  25. Westerlaken BO, Stokroos RJ, Dhooge IJ, Wit HP, Albers FW. Treatment of idiopathic sudden sensorineural hearing loss with antiviral therapy: a prospective, randomized, double-blind clinical trial. Ann Otol Rhinol Laryngol. 2003; 112: 993–1000

    Article  Google Scholar 

  26. Itoh A, Sakata E. Treatment of vestibular disorders. Acta Otolaryngol Suppl. 1991; 481: 617–623

    CAS  Article  Google Scholar 

  27. Lautermann J, Sudhoff H, Junker R. Transtympanic corticoid therapy for acute profound hearing loss. Eur Arch Otorhinolaryngol. 2005; 262: 587–591

    Article  Google Scholar 

  28. Hochman J, Blakley B, Abdoh A, Aleid H. Post-tympanostomy tube otorrhea: a meta-analysis. Otolaryngol Head Neck Surg. 2006; 135: 8–11

    Article  Google Scholar 

  29. Licameli G, Johnston P, Luz J, Daley J, Kenna M. Phosphorylcholine-coated antibiotic tympanostomy tubes: are post-tube placement complications reduced? Int J Pediatr Otorhinolaryngol. 2008; 72: 1323–1328

    Article  Google Scholar 

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Correspondence to Mohamed R. Ahmed MD.

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Youssef, T.F., Ahmed, M.R. Treatment of idiopathic sudden sensorineural hearing loss: systemic versus intratympanic methylprednisolone acetate. Egypt J Otolaryngol 28, 184–188 (2012). https://doi.org/10.7123/01.EJO.0000418074.85587.8c

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  • DOI: https://doi.org/10.7123/01.EJO.0000418074.85587.8c

Keywords

  • deafness
  • local
  • sudden
  • steroid