title: Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss.
abstract: BACKGROUND
  Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL.
  
  
  OBJECTIVE
  We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL.
  
  
  METHODS
  Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies.
  
  
  RESULTS
  The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p=0.364 and p=0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement.
  
  
  CONCLUSIONS
  ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss.
authors.affiliation: Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey.
authors.forename: Filiz
authors.initials: F
authors.lastname: Gülüstan
authors.affiliation: Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey.
authors.forename: Zahide Mine
authors.initials: ZM
authors.lastname: Yazıcı
authors.affiliation: Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey.
authors.forename: Wesam M E
authors.initials: WME
authors.lastname: Alakhras
authors.affiliation: Selcuk University, Otolaryngology Department, Konya, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Erdur
authors.affiliation: Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey. Electronic address: harunacipayam@gmail.com.
authors.forename: Harun
authors.initials: H
authors.lastname: Acipayam
authors.affiliation: Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Kufeciler
authors.affiliation: Bakirkoy Dr Sadi Konuk Training and Research Hospital, Otolaryngology Clinic, Istanbul, Turkey.
authors.forename: Fatma Tulin
authors.initials: FT
authors.lastname: Kayhan
keywords: Hyperbaric oxygen therapy; Intratympanic treatment; Oxigenoterapia hiperbárica; Perda auditiva súbita; Salvage treatment; Sudden hearing loss; Terapia de resgate; Tratamento intra-timpânico