Article Abstract

Evaluating and comparing the efficacy of intratympanic high dose dexamethasone (24 mg/mL) and high dose methylprednisolone (125 mg/mL) as a primary and salvage treatment for idiopathic sudden sensorineural hearing loss

Authors: Candice Chiew Yin Li Sung Sang, Emily Zhen, Chi-Kee Leslie Shaw

Abstract

Background: To evaluate and compare the efficacy of intratympanic high dose dexamethasone (24 mg/mL) and high dose methylprednisolone (125 mg/mL) as a primary therapy and as a salvage therapy in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).
Methods: A prospective study was undertaken observing two groups with newly diagnosed ISSNHL treated with either high dose intratympanic dexamethasone (ITD) or equivalent potency high dose intratympanic methylprednisolone (ITM). The dexamethasone group consisted of twenty patients (seven receiving primary ITD) and the methylprednisolone group consisted of ten patients (one receiving primary ITM). The remaining participants received IT steroids as part of a salvage therapy after failure to improve upon completion of a 3 weeks course of oral prednisolone at a tapering dose (dose of 1 mg/kg/day with ceiling dose of 50 mg/day). Each cohort received 1 mL of the respective steroid through ventilation tubes weekly, over four treatment sessions. Clinical response was assessed weekly for the first month, at 6 months and at 12 months, using pure tone audiometry (PTA).
Results: In the ITM group, 20% experienced complete recovery of hearing loss (HL) in their affected ear within 10 dB of their unaffected ear. Fifty percent experienced partial recovery and the remaining 30% demonstrated non-significant improvement. Only one participant demonstrated partial recovery in the ITD group.
Conclusions: Patients with low-mid frequencies ISSNHL had favourable hearing improvements with either complete hearing recovery or significant partial hearing recovery if ITM was administered within eight weeks after onset of HL.