Intratympanic methylprednisolone for sudden sensorineural hearing loss

Objective: Corticosteroids are commonly used for the treatment of sudden sensorineural hearing loss (SSHL). In this study, the effectiveness of intratympanic (IT) corticosteroid injection was studied and compared with a control group on patients with SSHL who failed systemic corticosteroid treatment. Materials and Methods: A total of 19 patients as a retreatment group (RG) and 18 patients as a control group (CG), all failed high-dose intravenous and oral corticosteroid treatments, were included in this study. These patients were invited back, and IT methylprednisolone was injected five times via 3-day intervals in RG and followed-up for a mean period of 24.9 months (range, 7-30 mo). Audiological evaluations were performed initially, a week after the completion of the injections, monthly in the following first 3 months, and at the end of follow-up period in RG. The CG was followed-up for 3 months after the completion of systemic corticosteroid treatment without any additional drug administration. Results: The mean age was 52.6 years (range, 20-79 yr) in RG and 59.9 years in CG. The mean pure-tone average for speech frequencies (500-4,000 Hz) at baseline audiogram and at the first month, at the third month, and at last controls were 65.2 (range, 43-102 dB), 45.4 (range, 23-77 dB), 43.6 (range, 30-77 dB), and 44.5 (range, 33-77 dB) dB, respectively, in RG. The mean pure-tone averages for speech frequencies (500-4,000 Hz) at the end of systemic treatment and at third-month control were 63.5 (range, 44-98 dB) and 59.0 (range, 40-100 dB) dB, respectively, in CG. The hearing gain that is equal to or more than 10 dB was achieved in 14 patients (73.6%) at the last control in RG. No hearing gain could be detected in the CG. No serious side effect was observed with IT treatment. Conclusion: We conclude that IT methylprednisolone injection provides more significant hearing improvement for patients that failed with previous high-dose systemic corticosteroid administration than systemic corticosteroid treatment alone. So it may be the first-step medical treatment of idiopathic SSHL alone or at least may be combined with the systemic corticosteroid administration.