Intratympanic Steroid Treatment for Sudden Hearing Loss after Failure of Systemic Steroid Therapy

It would appear that the result of treatment of sudden hearing loss remains unsatisfactory. In particular, it is difficult to treat patients with sudden hearing loss after failure of treatment with systemic steroids. The purpose of this study was to assess the effect of intratympanic steroid (IT-S). On the other hand, systemic steroids are the only proven drugs. Therefore, ethically, we could not simply compare IT-S with intravenous steroid (IV-S) therapy. Conventionally, we have treated sudden hearing loss patients after failure of systemic steroid therapy with both IV-S and hyperbaric oxygen (HBO), as the secondary modality. In a recent study, it has been suggested that IT-S obtained better hearing improvement in sudden hearing loss, and had few systemic side effects. We examined the effect of IT-S by adding it to the combined therapy with IV-S and HBO. Retrospectively, we clinically examined the effect of the combined therapy with IV-S and HBO (A group) for 10 subjects—5 men and 5 women (median age: 57 years) with sudden hearing loss after failure of systemic steroid therapy between September, 2009 and July, 2010. Prospectively, we also examined clinically the effect of triple combined therapy with IV-S and HBO and IT-S (B group) for 10 subjects—7 men and 3 women (median age: 57 years) with sudden hearing loss after failure of systemic steroid therapy between August, 2010 and April, 2011. In the A group, 4 patients (40%) demonstrated mild recovery, while no change was noted in 6 patients (60%). In the B group, 3 patients (30%) recovered completely, mild recovery was seen in 5 patients (50%), and the remaining 2 patients (20%) showed no change. There was a significant difference (P<0.05) between the A group (IV-S and HBO) and the B group (IV-S and HBO, IT-S). All 3 patients with complete recovery in the B group were treated within 14 days from the first onset. We concluded that the triple combined therapy with IV-S and HBO, IT-S (B group) gave better hearing improvement than the double combined therapy with IV-S and HBO (A group). Therefore, IT-S could be effective for the sudden hearing loss patients after failure of systemic steroid therapy. Our results further suggested that early IT-S therapy for sudden hearing loss after failure of systemic steroid could be effective as a secondary therapy.