title: Dose Effect of Intratympanic Dexamethasone for Idiopathic Sudden Sensorineural Hearing Loss: 24 mg/mL Is Superior to 10 mg/mL.
abstract: OBJECTIVE
  To compare outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) treated with intratympanic (IT) dexamethasone (DEX) at either 10 mg/mL or 24 mg/mL.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Thirty-seven adults with ISSNHL.
  
  
  METHODS
  In addition to concurrent prednisone taper, patients received a series of IT DEX injections for 2 weeks with either 10 mg/mL or 24 mg/mL.
  
  
  METHODS
  Greater than 30-dB improvement in pure-tone average (PTA).
  
  
  RESULTS
  Baseline characteristics were similar between groups. Mean follow-up was 10 weeks. Ten (53%) of 19 patients treated with 24 mg/mL had greater than 30-dB improvement in PTA compared with 3 (17%) of 18 treated with 10 mg/mL (p = 0.0382, Fisher's exact test). There was a trend toward improved word recognition score outcome with 24 mg/mL. The interval between onset and initiation of IT DEX significantly affected outcome, with earlier treatment resulting in greater improvement in PTA and word recognition score. Multivariate logistic regression confirmed that IT DEX dose and interval to starting treatment were both independent predictors of PTA outcome. Change in PTA was not significantly affected by age, sex, pretreatment hearing levels, or concurrent treatment with hyperbaric oxygen.
  
  
  CONCLUSIONS
  To our knowledge, this is the first demonstration of superiority of IT DEX at 24 mg/mL for the treatment of ISSNHL, with significantly better recovery of PTA. Our data suggest that treatment should be initiated as soon as possible. A prospective randomized trial to confirm the optimal dose is warranted.
authors.affiliation: *University of California, San Diego Division of Otolaryngology Head and Neck Surgery; and †Veterans Affairs Medical Center San Diego, San Diego, California, U.S.A.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Alexander
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Harris
authors.forename: Quyen T
authors.initials: QT
authors.lastname: Nguyen
authors.forename: Nopawan
authors.initials: N
authors.lastname: Vorasubin
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001301:Audiometry, Pure-Tone; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy*; D003639:Hearing Loss, Sudden / Q000188:drug therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D000069555:Injection, Intratympanic; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D013067:Speech Perception; D013069:Speech Reception Threshold Test; D016896:Treatment Outcome; D014432:Tympanic Membrane
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D011241:Prednisone