Effectiveness of intratympanic dexamethasone injection in sudden-deafness patients as salvage treatment.
OBJECTIVE
To study the effectiveness of intratympanic dexamethasone (IT-DEX) in patients with severe or profound sudden sensorineural hearing loss (SSNHL) after treatment failure with conventional therapy.


METHODS
Randomized, controlled study.


METHODS
Patients who met the criteria for SSNHL, with a severity of severe to profound, underwent 10 days of standard treatment with oral steroid and other facilitating agents. Patients showing poor response to standard treatment were assigned randomly to a control group or to a group receiving IT-DEX. IT-DEX injections were performed once a week for 3 consecutive weeks. Pure-tone audiometry was obtained before each injection. Minimum follow-up time was 1 month. Successful treatment was defined as a hearing improvement of greater than 30 dB.


RESULTS
Thirty-nine patients meeting the inclusion criteria were studied. After treatment with oral steroid, 10 of 39 (26%) patients demonstrated hearing improvement, whereas the remaining 29 (74%) patients showed a hearing improvement of less than 30 dB. For those without hearing improvement, 15 received IT-DEX, and 14 received further standard treatment (except oral steroid and carbogen inhalation). Hearing improved in 8 of 15 (53.3%) compared with 1 of 14 (7.1%), with an average decrease in threshold of 28.4 dB and 13.2 dB for the IT-DEX group and the control group, respectively (P <.05). Prognostic factors such as age, treatment delay time, and sex did not significantly affect the response to therapy.


CONCLUSIONS
IT-DEX injection effectively improves hearing in patients with severe or profound SSNHL after treatment failure with standard therapy and is not associated with major side effects. It is therefore a reasonable alternative as salvage treatment.
Ho
Ho Guan-Min
HG
Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan.
Lin
Hung-Ching
HC
Shu
Min-Tsan
MT
Yang
Cheng-Chien
CC
Tsai
Hsun-Tien
HT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001301:Audiometry, Pure-Tone; D016009:Chi-Square Distribution; D002648:Child; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D003639:Hearing Loss, Sudden / Q000188:drug therapy*; D006801:Humans; D007267:Injections; D008875:Middle Aged; D016879:Salvage Therapy; D016896:Treatment Outcome; D014432:Tympanic Membrane
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone