Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss

Objective: To investigate the role of intratympanic (IT) therapy in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: This study was a retrospective review. Patients were treated for ISSNHL from January 1, 2011 to April 12, 2015 with the following: pre/posttreatment audios, treatment initiated ≤90 days and idiopathic etiology. Fifty-three ISSNHL patients were analyzed in the following subgroups: oral steroids (n = 8), combination oral+IT (n = 39), and IT (n = 6). Main outcomes measured were pre/posttreatment pure tone average (PTA) scores. Results: The PTA changes for all treatment groups improved by 8.0 ± 19.5 dB (P =.004); for 31 patients treated ≤2 weeks after onset, PTA improved by 13.8 ± 16.6 dB (P <.001). Multivariable generalized linear model for repeated measures was conducted to investigate the association between PTA changes for treatment groups adjusted for age, gender, time-to-treatment, and vertigo. Earlier time-to-treatment and older age were statistically correlated towards improved outcomes. As time-to-treatment increased by each day, change in PTA decreased by 0.324 (95% CI [0.12, 0.52], P =.002). As age increased by each year, PTA changes increased by 0.802 (95% CI [0.36, 1.24], P <.001). For the oral+IT group, PTA changes for concurrent oral+IT (n = 20, 7.10 dB) and delayed/salvage oral+IT (n = 19, 5.43 dB) were not statistically different (P =.79); earlier time-to-treatment (P =.001), and older age (P =.006) remained statistically correlated towards improved outcomes. Conclusion: Results suggest outcomes can be improved with early identification and oral steroid therapy by primary care providers. Poorer prognosis for younger patients potentially suggests a need for more aggressive diagnostic and therapeutic management for this subgroup. Level of Evidence: 3b.