title: Intratympanic and systemic steroids for sudden hearing loss.
abstract: OBJECTIVE
  To investigate the therapeutic efficacy of intratympanic dexamethasone combined with systemic prednisolone in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).
  
  
  METHODS
  Prospective, quasirandomized, multicenter clinical trial.
  
  
  METHODS
  One university hospital and 2 affiliated hospitals.
  
  
  METHODS
  A total of 92 eligible patients with ISSNHL were allocated into 2 groups. Patients in the control group were treated with systemic prednisolone alone. Patients of the combined treatment group received additionally 3 intratympanic dexamethasone injections within 5 days.
  
  
  METHODS
  The main outcome measures used were the differences between pretreatment and posttreatment pure-tone audiometry averages (PTAs) and speech discrimination scores (SDSs). Successful treatment was defined as a greater than 10 dB improvement in PTA and 15% in SDS. The final assessment of hearing was performed 3 months after completion of treatment.
  
  
  RESULTS
  Significant hearing recovery was observed in 31 (67.39%) of 46 cases, and in 24 (52.17%) of 46 control patients. Patients receiving combination therapy had a median improvement in PTA of 23.12 dB and a median increase in SDS of 32%. In the control group, the median hearing gain was 16.87 dB and 18%, respectively. The differences between the 2 groups were not statistically significant (p = 0.10 and p = 0.13). However, after performing a post hoc analysis by excluding individuals with profound hearing loss (PTA, >90 dB), the combined treatment group showed significant improvement compared with the control group (p = 0.04). No serious complications or adverse reactions were reported.
  
  
  CONCLUSIONS
  The addition of intratympanic steroids to the conventional systemic steroid therapy may provide a safe and potentially effective therapeutic option in patients with mild-to-severe ISSNHL.
authors: ENT Department, General Hospital of Volos Achillopoulio, Volos, Greece. petkoltsid@yahoo.gr
authors: Petros
authors: P
authors: Koltsidopoulos
authors: Athanasios
authors: A
authors: Bibas
authors: Aristides
authors: A
authors: Sismanis
authors: Anastasia
authors: A
authors: Tzonou
authors: Ioannis
authors: I
authors: Seggas
mesh_terms: D000328:Adult; D000368:Aged; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy*; D003639:Hearing Loss, Sudden / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D011239:Prednisolone