title: Potential Benefits of Combination Therapy as Primary Treatment for Sudden Sensorineural Hearing Loss.
abstract: OBJECTIVE
  We analyzed the effectiveness of combination therapy (CT) for idiopathic sudden sensorineural hearing loss (ISSNHL) and the utility of intratympanic dexamethasone injection (ITDI) reapplication as salvage treatment for ISSNHL refractory to CT.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic university hospital.
  
  
  METHODS
  We reviewed 229 patients with ISSNHL and divided these patients into 2 groups according to treatment: systemic steroid therapy (SST) and CT groups. The SST group received prednisolone therapy. The CT group also received ITDI daily. Patients who demonstrated no recovery (<10 dB) after initial treatment were defined as refractory and received salvage ITDI therapy: ITDI reapplication in the CT group and ITDI application in the SST group.
  
  
  RESULTS
  Hearing recovery rates were 77.8% (77/99) in the CT group and 60.8% (79/130) in the SST group. The difference was statistically significant (P = .011). Initial pure-tone audiometry and vertigo were affective factors on hearing recovery rates in the CT group. After salvage therapy, hearing improvement of 10 dB or greater was noted in 6 of the 22 (27.3%) patients in the CT group and 16 of the 51 (31.4%) patients in the SST group. The difference in efficacy of salvage therapy between the CT and SST groups was simply not significant (P = .612).
  
  
  CONCLUSIONS
  Combination therapy was more effective for ISSNHL in achieving hearing gain than SST alone. Furthermore, ITDI reapplication for ISSNHL refractory to CT was as effective as salvage ITDI for ISSNHL refractory to SST.
authors.affiliation: Department of Otorhinolaryngology, College of Medicine, Konyang University, Daejon, Republic of Korea.
authors.forename: Jong Bin
authors.initials: JB
authors.lastname: Lee
authors.affiliation: Department of Otorhinolaryngology, College of Medicine, Konyang University, Daejon, Republic of Korea akas9238@hanmail.net.
authors.forename: Seong Jun
authors.initials: SJ
authors.lastname: Choi
mesh_terms: D000284:Administration, Oral; D001301:Audiometry, Pure-Tone; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006309:Hearing / Q000502:physiology*; D006319:Hearing Loss, Sensorineural / Q000503:physiopathology / Q000628:therapy*; D003639:Hearing Loss, Sudden / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D000069555:Injection, Intratympanic; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D008876:Middle Ear Ventilation / Q000379:methods*; D011239:Prednisolone / Q000008:administration & dosage; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D011239:Prednisolone
keywords: combination therapy; intratympanic steroids; salvage therapy; sudden hearing loss