Intratympanic steroids: Do they acutely improve hearing in cases of cochlear hydrops?

Objective: To study the acute effects on hearing of intratympanic dexamethasone in patients with cochlear hydrops. Study Design: Retrospective review. Methods: Patients who met established criteria for the diagnosis of Meniere's disease or had a history of fluctuating hearing loss and met hearing loss criteria for Meniere's disease, indicating cochlear hydrops, underwent a series of one to three intratympanic injections of dexamethasone in the affected ear. Follow-up audiograms were obtained 1 week after each injection and, in many patients, several months after injection. Results: Fifty patients met inclusion criteria and were studied. Using the American Academy of Otolaryngology-Head and Neck Surgery reporting guidelines, hearing improved acutely in 20 of the 50 patients (40%), was worse in 2 (4%), and did not change in 28 (56%). For those who improved, the average decrease in threshold was 14.2 dB. Whether the patient had typical Meniere's disease or cochlear bydrops did not affect the response to therapy. There were no significant complications from the injections. Conclusions: Intratympanic administration of dexamethasone may acutely affect sensorineural hearing loss associated with endolymphatic hydrops. A prospective, controlled study is required.