Intratympanic methylprednisolone in refractory sudden hearing loss: a 27-patient case series with univariate and multivariate analysis.
BACKGROUND
Treatment of sudden hearing loss is a significant matter of discussion. Lack of knowledge of the natural history of the disease and the use of different success criteria are 2 of the main reasons why it is difficult to critically evaluate the data available in the literature. To date, no therapy has proved effective according to the evidence criteria. However, there has been a trend toward the use of steroids in recent years. The management of patients who fail to respond to standard therapy is even more complex; in these cases, intratympanic steroids have been proposed as a valuable solution.


METHODS
Twenty-seven patients unresponsive to traditional systemic therapy were treated with intratympanic steroids.


RESULTS
The mean pure-tone average before intratympanic treatment was 79.9 +/- 21.4 SD dB; at Day 30, after local steroid administration, the mean pure-tone average was 60.6 +/- 24.9 SD dB. According to our criteria, 15 (55%) of 27 patients presented a "useful" improvement in the hearing status. No serious complications have been observed.


CONCLUSIONS
Local application is confirmed as easy to perform and is associated with negligible complications. Our experience, although retrospective, seems to confirm the usefulness (at least in 50% of patients) of local steroids administration in cases of refractory sudden sensorineural hearing loss. Our encouraging data strongly call for further and serious evaluation through randomized studies.
Dallan
Iacopo
I
Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Tuscany, Italy. iacopodallan@tiscali.it
De Vito
Andrea
A
Fattori
Bruno
B
Casani
Augusto Pietro
AP
Panicucci
Erica
E
Berrettini
Stefano
S
Marchetti
Manuela
M
Nacci
Andrea
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone; D016009:Chi-Square Distribution; D004333:Drug Administration Routes; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy*; D003639:Hearing Loss, Sudden / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D020127:Recovery of Function; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000187:drug effects*
D005938:Glucocorticoids; D008775:Methylprednisolone