Sudden Sensorineural Hearing Loss—Treatment Status
Dallan, De Vito, and colleagues (2010) re-stated the previously declared nature of sudden sensorineural hearing loss (SSNHL) as a true audiological emergency. However, they state that the natural history of SSNHL is currently unknown (i.e., how often does it occur, how much will resolve if untreated, what are the natural outcomes if untreated, which treatments have a scientific basis, what are the outcomes of the scientifically proven treatments, etc.). Dallan, De Vito, and colleagues report that the unknowns are important factors in understanding and evaluating treatments. Therefore, as best is known and understood, they report that spontaneous recovery seems to occur in 30 percent to perhaps 60percent of SSNHL cases, most often occurring within the first week or two of onset. Importantly, they note that many cases likely recover spontaneously and quickly and thus, medical treatment is never sought and these same patients are likely not represented in the literature. Further, recovery seems most likely for patients with mid- and low-frequency hearing loss, rather than flat- or high-frequency hearing loss.
The authors note that no therapy has been demonstrated as effective based on "evidence criteria" although the available data "seem to confirm intratympanic steroids (ITS) exert at least some activity in refractory hearing loss and this encouraging trend seems to be confirmed even in randomized clinical trial." They state that their preliminary clinical experience was "extremely encouraging" but as more data was gathered, it became slightly less so.
The authors conclude that "the intratympanic application of steroids represents a valid solution" for patients with refractory SSNHL as it is easily applied and has almost no systemic side effects—all of which make the treatment "at least interesting." They state that "the lack of actual evidence for this method calls for serious evaluation through a randomized study. However, until conclusive data are reached, it can be considered a valuable solution in patients in whom traditional therapy has failed."
For More Information, Recommendations, and References
Dallan I, De Vito A, Fattori B, Casani AP, Panicucci E, Berrettini S, Marchetti M, Nacci, A. (2010) Intratympanic methylprednisolone in refractory sudden hearing loss: a 27-patient case series with univariate and multivariate analysis. Otology & Neurotology 31(1):25-30.