IT Steroid Treatment, Oral Corticosteroid Therapy Similar for Sudden Sensorineural Hearing Loss

Is intratympanic steroid treatment effective for the management of idiopathic sudden sensorineural hearing loss?

Background: The optimal treatment of idiopathic sudden sensorineural hearing loss has not been clearly determined. Oral corticosteroid therapy is considered by many to be the standard therapy. The role of intratympanic (IT) steroid therapy in comparison with oral steroid therapy has been investigated in numerous studies, with varying results.

Study design: Retrospective review of published studies.

Setting: Private practice.

Synopsis: A systematic online search of published articles using the following word combinations, hearing loss or deafness and steroids and intratympanic or transtympanic resulted in 176 articles. Limiting articles to English language, humans and original research resulted in 32 published studies. The studies were stratified into five tiers of overall research quality, with the gradation ranging from tier 5, requiring a research protocol simply using intratympanic steroid, to tier 1, requiring a randomized, prospective blinded study with discrete inclusion criteria, adequate follow-up and a placebo arm. In addition, studies were classified by therapy intent as either initial intratympanic steroid treatment or as salvage intratympanic steroid treatment following a course of high-dose oral steroids.

For salvage intratympanic steroid treatment, five tier 2 studies and one tier 1 study had sufficient data to perform a random effects meta-analysis for the outcome measure of pre- and post-treatment improvement in pure-tone audiometry. A positive effect of intratympanic steroid treatment over control treatment of 13.3 dB was found for salvage intratympanic steroid treatment.

For initial intratympanic steroid treatment, there were two tier 2 studies and one tier 1 study. A meta-analysis was not performed, due to insufficient information.

Bottom line: A very limited number of quality studies comparing intratympanic steroids with oral steroids for the treatment of idiopathic sudden sensorineural hearing loss exists. A meta-analysis found a 13.3 dB benefit of intratympanic steroid therapy as salvage treatment after high-dose oral steroids, but it is unclear if this represents a clinically significant improvement.

Reference: Spear SA, Schwartz SR. Intratympanic steroids for sudden sensorineural hearing loss: a systematic review. Otolaryngol Head Neck Surg. 2011;145(4):534-543.