title: Comparison of intratympanic steroid injection, hyperbaric oxygen and combination therapy in refractory sudden sensorineural hearing loss.
abstract: OBJECTIVE
  The objective of this study was to compare the efficacy of intratympanic steroid injection (ITS), hyperbaric oxygen (HBO), and combination therapy as salvage treatment in patients with sudden sensorineural hearing loss (SSNHL) after failure of systemic therapy.
  
  
  METHODS
  A historical cohort study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  One hundred three refractory SSNHL patients are enrolled. Among them, 35 received ITS alone (ITS group), 22 received HBO alone (HBO group), 19 received combined ITS and HBO (combined group), and 27 received no salvage therapies (control group). Hearing outcomes were determined by hearing gains in pure-tone average (PTA), recovery rate, and word recognition score (WRS) measured by audiometry before and after salvage therapies.
  
  
  RESULTS
  Significant larger hearing gains in PTA were found in the ITS, HBO, and combined groups than the control group. The combination of ITS and HBO resulted in a significantly larger WRS improvement than the control group (p = 0.035) and larger hearing gains than the ITS and HBO groups in 250 Hz (p < 0.05).
  
  
  CONCLUSIONS
  ITS, HBO, and combined therapy offered some benefits in hearing improvement. Combined ITS/HBO may result in a larger WRS improvement and recovery of hearing, especially in lower frequencies. Further randomized prospective studies are needed for confirmation.
authors.affiliation: *Department of Otolaryngology, and †Hyperbaric Oxygen Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.
authors.forename: Chao-Hui
authors.initials: CH
authors.lastname: Yang
authors.forename: Re-Wen
authors.initials: RW
authors.lastname: Wu
authors.forename: Chung-Feng
authors.initials: CF
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy / Q000628:therapy*; D003639:Hearing Loss, Sudden / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy; D016896:Treatment Outcome; D014432:Tympanic Membrane
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone