title: A prospective, multi-centered study of the treatment of idiopathic sudden sensorineural hearing loss with combination therapy versus high-dose prednisone alone: a 139 patient follow-up.
abstract: OBJECTIVE
  To compare combination therapy (high-dose prednisone taper (HDPT) + intratympanic dexamethasone (IT-Dex)) hearing recovery results in ISSNHL patients with those treated with HDPT alone.
  
  
  METHODS
  Prospective, multicentered trial.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Eighty ISSNHL patients with class C or D hearing.
  
  
  METHODS
  Eighty qualifying patients were treated with IT-Dex (10 mg/ml) every week for 3 weeks concomitant with HDPT (60 mg/d for 7 d with 7-d taper) and followed prospectively.
  
  
  METHODS
  Four-tone pure tone average (PTA) at 0.25, 0.5, 1, and 2 kHz and speech discrimination scores (SDS) 2 months posttreatment; Hearing results compared retrospectively with those of 59 ISSNHL treated with HDPT alone.
  
  
  RESULTS
  Combination therapy and HDPT alone both provided a statistically significant benefit in audiometric parameters, especially if treated within 7 days of onset. However, 49% versus 29% (p = 0.02) of class D patients receiving combination therapy versus HDPT achieved serviceable hearing. Patients receiving combination therapy versus HDPT experienced a significantly greater improvement in PTA (34.1 ± 27 dB versus 12.0 ± 21 dB; p < 0.0001) and SDS (49.9.2 ± 38% versus 19.2 ± 36%; p < 0.0001) while achieving a significantly better final PTA (50.6 ± 28 dB versus 65.5 ± 29 dB; p = 0.005) and SDS (62.4 ± 40% versus 44.7 ± 41%; p = 0.01). Approximately 56% of class D and 40% of profound patients treated within 7 days with combination therapy achieved serviceable hearing.
  
  
  CONCLUSIONS
  Combination therapy offers ISSNHL patients the highest likelihood of achieving class A and B hearing. Differential results with combination therapy and HDPT compared with previous studies suggest time- and dose-dependent responses to the treatment of ISSNHL.
authors.affiliation: *Department of Otolaryngology, Head and Neck Surgery, Southern California Permanente Medical Group, San Diego; and †Department of Research and Evaluation, Regional Offices of Southern California Permanente Medical Group, Pasadena, California, U.S.A.
authors.forename: Alex
authors.initials: A
authors.lastname: Battaglia
authors.forename: Annette
authors.initials: A
authors.lastname: Lualhati
authors.forename: Harrison
authors.initials: H
authors.lastname: Lin
authors.forename: Raoul
authors.initials: R
authors.lastname: Burchette
authors.forename: Roberto
authors.initials: R
authors.lastname: Cueva
mesh_terms: D000328:Adult; D000368:Aged; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006309:Hearing / Q000187:drug effects; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy*; D003639:Hearing Loss, Sudden / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage*; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D011241:Prednisone