Abstract
Objectives:
Describe the role of salvage intratympanic steroids (ITS) in refractory cases of idiopathic sudden sensorineural hearing loss and review the results.
Methods:
Case note review of 24 consecutive adult patients having salvage therapy in an out-patient setting. At 7-10 day post-initial treatment if there was failure of improvement in hearing thresholds, between 1 and 5 injections of intratympanic methylprednisolone (40mg/ml) were administered via a round window cannula (Silverstein MicroWick) or ventilation tube. Post-ITS hearing thresholds were calculated, with significant improvement in hearing recorded as an average change in threshold equal to or greater than 10dB.
Results:
The first intratympanic injection was given at a mean of 29 days after the onset of symptoms (range 14-74 days). Fifty-two percent (11/21) of patients were considered to have an improvement in their hearing. The mean change in threshold was 24dB. In this group the mean number of days following onset of symptoms at which they presented was 19 days (range 1-60 days) and the mean number of days after onset of symptoms at which they received their first ITS treatment was 27 days (range 12-74 days).
Conclusions:
Approximately half of the patients treated with salvage ITS responded with an improvement in average threshold of 10dB or more, suggesting that patients with SSNHL are a heterogenous group with steroid responsive and non-steroid responsive pathologies. Salvage ITS can be offered to patients who do not respond to oral steroids with a possible 50% chance of improvement in thresholds.
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