Intratympanic vs. Oral Steroids for Treatment of Idiopathic Sudden Sensorineural Hearing Loss: A Randomized Controlled Study
Ali Maeed S. Al-Shehri *
Ear, Nose and Throat Division, Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia
*Author to whom correspondence should be addressed.
Abstract
Objective: To compare the efficacy of oral to intratympanicsteroids for treatment of idiopathic sudden sensorineural hearing loss (ISSHL).
Patients and Methods: A total of 39 ISSHL patients were included in this study. They were consecutively randomized into the “control” group, who received oral prednisone (started with 60 mg/day tapering over 14 days) or the “study” group, who received intratympanic methylprednisolone sodium succinate (four 1- mL doses of 40 mg/mL of methylprednisolone over 2 weeks, with a dose given every 3-4 days by injection through the tympanic membrane into the middle ear). Pure tone audiometry (PTA) was measured for all patients before injection as baseline. Patients were asked to come to the outpatient clinic after two weeks, one month and at the end of the second month to assess hearing, vital signs, otological examination and adverse events.
Results: At the last follow up visit, patients in the study group had significantly lower PTA than those in the control group (39.2±6.0 dB and 43.8±6.4 dB, respectively, p=0.027). Improvement in hearing was significantly higher among patients in the study group than those in the control group (32.1±6.9 dB and 27.5±6.5 dB respectively, p=0.041). Significantly higher proportions of patients in the control group had mood change (p=0.035), sleep change (p=0.044) and mouth dryness (p=0.020) than patients in the study group. On the other hand, a significantly higher proportion of patients in the study group had earache (p=0.030). Patients in both groups did not differ significantly as regard blood glucose problems, increased appetite, pain due to injection or weight gain. Patients’ age correlated negatively with improvement in pure tone average (r= -0.267). However, this correlation was not statistically significant.
Conclusions: Treatment with intratympanic steroid injection is better than oral steroid treatment of patients with ISSHR. Adverse effects associated with intratympanic injections are less than those associated with systemic steroid therapy.
Keywords: Idiopathic sudden hearing loss, steroid therapy, pure tone audiometry, adverse events