Intratympanic Steroids for Sudden Sensorineural Hearing Loss: A Systematic Review

Objective. To determine the evidence for efficacy of intratympanic (IT) steroid treatment for the management of idiopathic sudden sensorineural hearing loss through a systematic review of the existing literature. Data Sources. Online databases consisting of PubMed, Medline, OVID, Google Scholar, Cochrane Review, and collected additional publications cited in bibliographies. Review Methods. Literature search by both authors with structured criteria to select studies evaluated for systematic review. Results. The authors identified 176 articles, of which 32 represented studies of initial or salvage intratympanic steroid injections for sudden hearing loss that included 6 randomized trials and only 2 randomized controlled trials. Despite the paucity of well-executed trials, the vast majority of studies of intratympanic steroids for salvage treatment in all tiers demonstrated a benefit of intratympanic steroid therapy. A limited meta-analysis of the higher quality studies revealed a mean difference in improvement of 13.3 dB (95% confidence interval [CI], 7.7-18.9; P < .0001). Although statistically significant, it is still unclear if this difference is clinically significant. Initial intratympanic therapy was equivalent to standard therapy in the existing literature of all qualities. Conclusion. Intratympanic steroid treatment as primary treatment for sudden sensorineural hearing loss appears equivalent to treatment with high-dose oral prednisone therapy. As salvage therapy, intratympanic steroids offer the potential for some degree of additional hearing recovery, although it remains uncertain if this improvement is clinically significant and what percentage of patients is likely to show benefit.