What is the role of anti-inflammatory agents for the treatment of sudden hearing loss?

Updated: Aug 28, 2019
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Corticosteroids are the primary anti-inflammatory agents used to treat ISSHL. The mechanism of action in sudden hearing loss is unknown, although reduction of cochlear and auditory nerve inflammation is the presumed pathway. However, the value of steroids in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) remains unclear. [16, 17, 18, 19, 20]

In a randomized, controlled study, intratympanic injection of dexamethasone is shown to effectively improve hearing in patients with severe or profound SSNHL after treatment failure with standard therapy and is not associated with major side effects. [21] Similar results were reported in yet another study. [22] Its trial to salvage hearing in cases where other medical therapy fails is justified.

A prospective study by Battaglia et al indicated that a greater percentage of patients with ISSNHL recover following combination therapy with high-dose prednisone taper (HDPT) and intratympanic dexamethasone (IT-Dex) than do those treated with HDPT alone. The investigators found that among those individuals with class-D hearing, 49% of patients who underwent combination therapy (10 mg/mL of IT-Dex every week for 3 wks, administered concomitantly with 60 mg/day of HDPT for 7 days, with a 7-day taper) recovered a serviceable amount of hearing, compared with 29% of patients who received only HDPT. It was also found that the likelihood of hearing recovery was higher when combination therapy was administered within 7 days of the onset of ISSNHL, with 56% of class-D patients achieving serviceable hearing. [23]

However, a prospective, randomized, multicenter clinical trial by Tsounis et al reported that in patients with ISSNHL, systemic, intratympanic, and combined systemic/intratympanic steroid administration led to similar hearing outcomes. By 90-day follow-up, mean hearing improvements of 29.0 dB HL, 27.0 dB HL, and 29.8 dB HL, respectively, had been achieved. [24]

A paucity of data exists on the use of nonsteroidal anti-inflammatory agents.


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