What outcomes have been reported for specific treatments 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

A review of outcomes for the various therapeutic regimens produces conflicting results, again because of differences in reporting. With different inclusion criteria, exclusion criteria, recovery criteria, and duration of follow-up, comparisons between studies are often not valid. Many studies lack control subjects.

Several studies using vasodilator therapy as a component of treatment did not show significant differences from placebo. However, in 1996, Fetterman et al reported their best recovery results (63% improved pure-tone average [PTA] by more than 10 dB or speech discrimination more than 15%) when treatment included vasodilators. [35] Based on controlled studies, little data support vasodilator therapy.

Several studies assessing low molecular weight dextrans and/or pentoxifylline did not demonstrate recovery rates better than placebo. One exception by Redleaf et al in 1995 reported 64% of patients improving. [36] In this study, concomitant diatrizoate therapy was also administered, and no placebo arm was used.

Corticosteroid therapy has been investigated with varying outcomes. Published recovery rates range from 41-61%. In 1980, Wilson et al demonstrated a significant improvement, finding 61% improved on oral corticosteroids compared to a 32% improvement rate on placebo. [37] They also stratified their patient groups by audiometric patterns, and determined that hearing losses from 40-90 dB responded better to steroid therapy; 78% improved.

Diatrizoate has not been studied to any great extent. In 1987, Wilkins et al found no significant difference in recovery using diatrizoate in a multidrug regimen compared to spontaneous recovery rates. [38] Redleaf et al reported a beneficial effect using diatrizoate and dextran, improving 64% of patients. [36] Interestingly, using the hearing recovery criteria of Wilkins et al, recalculated data from the 1995 Redleaf study indicated only a 36% recovery rate to a classification of complete or good.

A review of hyperbaric oxygen therapy found a beneficial effect, especially if therapy was instituted within 2-6 weeks of the onset of the hearing loss. Fifty percent of patients improved by 20 decibels. If therapy was delayed, less improvement was found, with no beneficial effect for delays of longer than 3 months.

At an average 8-year follow-up, a study by Härkönen et al indicated that patients who suffered unilateral ISSNHL who had not recovered normal hearing in the affected ear experienced not just lower quality of hearing but also significantly lower quality of life, as well as more tinnitus and greater balance problems, than did patients with unilateral ISSNHL whose hearing did recover to normal. [39]


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