Sudden Sensorineural Hearing Loss and Steroids
Dallan and colleagues (2010) noted that the natural history of sudden sensorineural hearing loss (SSNHL) is currently unknown. That is, it is unclear how often spontaneous recovery occurs, but spontaneous recovery may occur in 30 to 60 percent of SSNHL cases…and when spontaneous recovery occurs; it usually occurs within the first week or two of onset. They stated no pharmacologic treatments had been shown to be effective using “evidence criteria” and “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.”
Alexander et al (2015) compared outcomes in 37 patients with SSNHL using 10 versus 24 mg/mL of intratympanic (IT) dexamethasone. They report that “irrespective of the delivery method, literature on the efficacy of steroids in general for the treatment of idiopathic SSNHL is conflicting….” Further, they state that “recent meta-analysis have questioned the benefit of primary treatment with…systemic or IT steroids….” As such, their study was designed to compare the effect of two different concentrations of IT dexamethasone for SSNHL.
Alexander and colleagues report that baseline measures were similar across the two groups. Group One received 10 mg/mL of IT dexamethasone, Group Two received 24 mg/mL of the same. The follow-up period was 10 weeks. They report 10 of 19 patients (53 percent) in the higher dose group responded favorably with clinically significant improvements in their pure tone averages (9 of 19 patients did not) whereas only 3 of the 18 (17 percent) treated with the lower does responded favorably (15 of 18 patients did not). They conclude their data suggests treatment should be initiated as soon as possible and a “prospective randomized trial to confirm the optimal does is warranted.”
Editor’s note: Although it certainly appears the higher dose (24 mg/mL) offers an improved outcome compared to the lower dose there was no actual ‘control group’ referenced (i.e., no treatment offered). Further, it is important to note that Dallan, DeVito, and colleagues [above] report spontaneous recovery may occur 30-60 percent of the time in the first weeks, and Alexander, Harris, and colleagues report did not exceed the Dallan et al suspicion/guideline of spontaneous recovery in 30-60 percent of patients. Of note, a total of 24 of 37 patients did not respond favorably to IT dex treatment. I remain encouraged and open to the possibility that IT therapy may indeed hold promise for SSNHL and I eagerly await control versus experimental and/or RCT studies to conclusively address and resolve the issue. ---DLB)
For More Information, Recommendations, and References
Alexander TH, Harris JP, Quyen TN, Vorasubin N. (2015) Does Effect of Intratympanic Dexamethasone for Idiopathic Sudden Sensorineural Hearing Loss – 24 mg/mL Is Superior to 10 mg/mL. Otology & Neurotology 36:1321-1327.
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.