@article{AJO5226,
author = {Shifa Wong and Nadine De Alwis},
title = {Outcomes for high-dose intratympanic dexamethasone (24 mg/mL): a retrospective single-surgeon cohort study in sudden sensorineural hearing loss, Ménière’s disease, and labyrinthitis},
journal = {Australian Journal of Otolaryngology},
volume = {9},
number = {0},
year = {2026},
keywords = {},
abstract = {Background: Intratympanic steroids (ITS) deliver superior peri-lymph concentrations whilst minimising systemic toxicity. Optimal dosing, timing, and efficacy is uncertain; however, higher concentrations have been associated with superior outcomes. The objective of this study was to evaluate outcomes of high-dose intratympanic dexamethasone (24 mg/mL) in sudden sensorineural hearing loss (SSNHL), Ménière’s disease (MD), and labyrinthitis.Methods: A retrospective cohort study was performed on 66 patients who received 141 high-dose intratympanic dexamethasone (24 mg/mL) injections by a single surgeon between 2020 and 2024. Demographics, symptoms, outcomes, and pre- and post-treatment pure-tone average (PTA) results were analysed.Results: In SSNHL (n=30; 47 injections), mean PTA gain was 18.6±51.1 dB [95% confidence interval (CI): 3.7–33.6, P=0.02], with clinically significant recovery (≥15 dB) in 57.4% (27/47) of injections. The mean time to treatment from hearing loss onset was 46.0±22.7 days (range: 3–109 days), with 82% (39/47) of injections administered beyond the traditional 28-day treatment window. Salvage ITS therapy following systemic steroids demonstrated a non-significant trend towards greater hearing improvement (mean gain 21.7±59.0 dB; 95% CI: 0.4–43.0, P=0.055) with 56% (18/32) injections showing clinically significant recovery, compared with primary therapy ITS alone (mean gain 12.0±28.2 dB; 95% CI: −3.6 to 27.6, P=0.12), with a 60% (9/15) recovery rate. In labyrinthitis (n=6), mean PTA improved by 37.5±69.7 dB (95% CI: −12.4 to 87.4); however, it was not statistically significant (P=0.12). In MD (n=30; 84 injections), 75% reported sustained vertigo control with quarterly injections. No long-term complications were observed.Conclusions: Clinically significant recovery (≥15 dB) was observed in 57.4% of SSNHL with high-dose intratympanic dexamethasone (24 mg/mL), despite the majority receiving delayed treatment. The greatest benefit was seen in salvage therapy after systemic steroids, although gains were modest (21.7 dB). Importantly, these findings suggest ITS may represent a potential therapeutic option beyond the conventional 28-day treatment window. The greatest clinical utility of high-dose ITS, however, may be in providing sustained vertigo control in refractory MD using a quarterly injection regimen.},
issn = {2616-2792}, url = {https://www.theajo.com/article/view/5226}
}