Hearing outcomes differences between treatment modalities in sudden sensorineural hearing loss

Abstract

Objective: To compare three steroid treatment modalities (oral, synchronous and sequential) in relation to hearing recovery measured with pure tone average difference before and after treatment (Δ PTA) obtained by audiometry in patients diagnosed with sudden sensorineural hearing loss.

Study design: Observational, longitudinal and retrospective study.

Settings: The study was conducted in a tertiary otologic center with 93 patients diagnosed with SSNHL between October 2018 to November 2024.

Methods:  All patients were treated within 42 days from onset audiological tests were performed before starting treatment and one month after. Three different treatment modalities were used: oral steroid for 10 days and tapering (Oral group), oral steroid with intratympanic dexamethasone (Synchronous group) and oral steroid followed by intratympanic dexamethasone (Sequential group). All intratympanic dexamethasone was given once a day for 5 consecutive days. All patients received detailed information regarding the nature of the treatment, including its potential risk and benefits. Prior initiating of treatment therapy, each patient provided written informed consent, acknowledging their understanding and agreement to proceed with treatment.

Results: The 3 groups had similar hearing recovery after treatment, with no significant difference. The synchronous group had a more negative and significant correlation between days from onset to treatment and hearing recovery. Correlation with the other groups was negative but not statistically significant.

Conclusions: There was no significant difference in hearing gain and recovery rates for the 3 groups. This suggests that the role of intratympanic dexamethasone is poor with the 4mg/ml dosage. Treatment effectiveness decreases over time for all treatment modalities. Early initiation of treatment is associated with better hearing recovery.

IRB approval was obtained in 30 November 2024 with the registry INRLGII 117/20

Main Points

• All groups show hearing improvement regardless of modality. Oral steroids seem to drive recovery
• No difference was shown in hearing outcomes when intratympanic steroids were added. This suggests our intratympanic dosage is insufficient as an adjuvant
• The most impactful factor in hearing recovery was the timing between onset to treatment initiation. Indicating that the earlier treatment is received, better outcomes are reached. Treatment effectiveness seems to steadily decrease over time