Intratympanic Steroids Not Better Than Systemic Steroids for Sudden Hearing Loss

By Reuters Staff

March 24, 2020

NEW YORK (Reuters Health) - There is no evidence that intratympanic corticosteroid administration is more effective than systemic treatment (ST) for sudden hearing loss, according to a new review and meta-analysis.

Combined intratympanic and systemic corticosteroids did not appear to result in better hearing outcomes than either treatment given alone, Dr. Christian Mirian and Dr. Therese Oveson of Aarhus University and Region Hospital Holstebro in Holstebro, Denmark, found.

"Future research and guidelines should determine which patient groups should be allocated to receive what administration (e.g., systemic corticosteroids in elderly patients may be associated with increased risk of adverse effects, and so these patients should be treated intratympanically)," they write in JAMA Otolaryngology-Head & Neck Surgery.

Up to 90% of cases of sudden sensorineural hearing loss (SSNHL) are idiopathic, the authors note. Idiopathic SSNHL is almost always unilateral, they add, affecting men and women equally, usually between ages 43 and 53. "The incidence rate has been estimated between 5 and 20 per 100 000 person-years but is most likely underestimated because many who recover quickly and spontaneously never seek medical attention," Dr. Mirian and Dr. Oveson write.

Oral corticosteroids are often used to treat ISSNH, they note, and were shown to be effective in a 1980 randomized trial. Intratympanic injection of corticosteroids is increasingly used based on the idea that it is more localized and concentrated than ST, they add, with fewer adverse effects.

The authors analyzed seven studies including a total of 710 patients given either intratympanic treatment (IT, 33%), ST (46%) or a combination (21%). Mean pure tone average (PTA) gain was 2.10 decibels higher with ST than IT, and both groups had a similar likelihood of full recovery. Recovery odds were also similar for the combination and ST groups.

"This meta-analysis did not indicate any differences in hearing outcomes for intratympanic vs systemic corticosteroids in a first-line treatment of ISSNHL equivalent of a moderate to severe hearing loss," Dr. Mirian and Dr. Oveson write.

They note that it is also not clear if dexamethasone and methylprednisolone are equally effective. "The literature is sparse concerning this question, but it has been reported that no difference exists between the two drugs in association with intratympanic administration," they add. "Based on this, we do not intuitively consider the application of different corticosteroids to be a significant limitation; however, future randomized or noninferiority trials should settle this question."

SOURCE: JAMA Otolaryngology-Head & Neck Surgery, online March 12, 2020.