Combined Intratympanic and Systemic Steroid Therapy in Sudden Sensorineural Hearing Loss
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ORIGINAL ARTICLE
Combined Intratympanic and Systemic Steroid Therapy in Sudden Sensorineural Hearing Loss Sukhdev Khadav1 • Pooja Arya2 • Gaurav Gupta1 • Deep Chand1 Ramchander Bishnoi1 • Devendra Singh Chawra1
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Received: 23 May 2020 / Accepted: 10 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Sudden sensorineural hearing loss (SSNHL) is a true otological emergency that must be diagnosed and treated immediately. This study aimed to assess the efficacy of treatment with intratympanic dexamethasone (ITD) plus oral prednisolone with that of oral prednisolone or intratympanic dexamethasone alone and to determine factor affecting treatment outcome for SSNHL. Forty-five patients with SSNHL that had been present within 2 weeks of onset of symptoms were included in this prospective case control study. Patients were allocated to three different groups. Patients in group A were treated with oral prednisolone 1 mg/kg/d full dose 14 days then tapered over next 14 days. Patients in group B were treated with ITD 0.5 ml (4 mg/ml) every 7 days for a total 4 weeks along with oral prednisolone 1 mg/kg/d in tapering dose for 4 weeks. Patients in group C were got ITD 0.5 ml (4 mg/ ml) every 7 days for a total 4 weeks. Audiogram was performed before each subsequent injection and at completion of treatment course. Among all participants, 22 patients (48.89%) showed improvement in pure tone audiogram to within 50% of pre- sudden hearing loss. On comparing the results of group A, B and C, there were no statistically significant difference with each other (p value 0.185). The mean audiometric gain was 37.71 dB in recovered cases. The combination therapy of intratympanic dexamethasone and oral steroid is more effective in comparison with intratympanic or oral steroid alone in the & Sukhdev Khadav [email protected] 1
Department of ENT, Sardar Patel Medical College, Bikaner, Rajasthan, India
2
Department of ENT, S. K. Medical College, Sikar, Rajasthan, India
treatment of SSNHL as the patients benefitted from the therapeutic effects of both local and systemic steroids. Keywords Intratympanic dexamethasone Sudden sensorineural hearing loss Pure tone audiometry Prednisolone
Introduction Sudden sensorineural hearing loss (SSNHL) is one of the most challenging and commonly encountered issues in the otolaryngologic practice. Idiopathic SSNHL (ISSNHL) is defined as a sensorineural hearing impairment of 30 dB or greater, affecting three or more contiguous audiometric frequencies, with an abrupt onset within 3 days or fewer, with none recognizable cause [1–3]. Despite extensive analysis on the causes of this disease, its risk factors aren’t however well recognized. Etiological factors may be found in only 10–15% of SSNHL patients, while other patients remain idiopathic [4]. Although the mechanism behind SSNHL is multifactorial and remains to be fully elucidated, there is increasing information on the involvement of immunomodulatory cells and accumulated concentrations of pro-inflammatory cytokines within t
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