Comparison of Different Intratympanic steroid Injection Protocols in the Treatment of Sudden Hearing Loss

Yıl 2025, Cilt: 2 Sayı: 3, 159 - 164, 28.10.2025

Volkan Güngör , Onur Levent

https://doi.org/10.70058/cjm.1766417

Öz

Objective:
There is no consensus regarding treatment modalities for idiopathic sudden sensorineural hearing loss. The aim of this study was to evaluate the clinical and audiological outcomes of three-dose versus five-dose intratympanic dexamethasone administration as an adjunct to systemic steroid therapy in patients with sudden sensorineural hearing loss.
Methods:
We retrospectively analyzed data from 30 patients diagnosed with sudden sensorineural hearing loss between 2022 and 2025 who received combined oral steroid therapy and intratympanic dexamethasone. Patients were divided into two groups: 20 received three intratympanic injections, and 10 received five injections. Pure tone audiometry (PTA) and speech discrimination scores (SDS) were measured before treatment and within 10 days after completion of therapy. Changes in audiometric outcomes were compared between the two groups.
Results:
The mean age was 47.3 years in the three-dose group and 48.6 years in the five-dose group. Tinnitus was present in all patients, and vertigo in 20%. PTA improvement was 16.1 ± 10.4 dB in the three-dose group and 14.7 ± 11.5 dB in the five-dose group (p > 0.05). The mean SDS improvement was 10.7% ± 14.6 in the three-dose group and 6.9% ± 11.5 in the five-dose group (p > 0.05). Overall PTA improvement rates were 28.23% and 23.28%, while SDS improvements were 30.94% and 43.81% for three- and five-dose groups, respectively. No statistically significant differences were observed between protocols.
Conclusion:
Both three- and five-dose intratympanic dexamethasone regimens, when added to systemic steroids, yielded significant hearing improvements in patients with sudden sensorineural hearing loss. However, increasing the number of injections did not confer additional benefit. These findings suggest that a lower-dose regimen maybe sufficient, reducing procedural risks and patient discomfort. Larger, randomized controlled trials are needed to establish standardized dosing protocols.
Keywords: Sudden sensorineural hearing loss, intratympanic steroid, dexamethasone, pure tone audiometry, speech discrimination score

Anahtar Kelimeler

Sudden sensorineural hearing loss , intratympanic steroid , pure tone audiometry , speech discrimination score

Etik Beyan

This study was approved by the Clinical Research Ethics Committee of Giresun Training and Research Hospital on 16.04.2025 (Decision No: 16.04.2025/01).

Destekleyen Kurum

The authors have declared that there is no financial support fort his study.

Ani İşitme Kaybı Tedavisinde Farklı İntratimpanik Steroid Enjeksiyon Protokollerinin Karşılaştırılması

Öz

Amaç:
İdiyopatik ani sensörinöral işitme kaybının tedavi yöntemleri konusunda fikir birliği bulunmamaktadır. Bu çalışmanın amacı, ani sensörinöral işitme kaybı olan hastalarda sistemik steroid tedavisine ek olarak uygulanan üç doz ile beş doz intratimpanik deksametazon uygulamasının klinik ve odyolojik sonuçlarını değerlendirmektir.

Yöntem:
2022–2025 yılları arasında ani sensörinöral işitme kaybı tanısı konulan ve kombine oral steroid tedavisi ile intratimpanik deksametazon alan 30 hastanın verileri retrospektif olarak incelendi. Hastalar iki gruba ayrıldı: 20 hasta üç intratimpanik enjeksiyon, 10 hasta ise beş enjeksiyon aldı. Saf ses odyometri (SSO) ve konuşmayı ayırt etme skorları (KAS) tedavi öncesinde ve tedavinin tamamlanmasından sonraki 10 gün içinde ölçüldü. İşitme sonuçlarındaki değişiklikler iki grup arasında karşılaştırıldı.

Bulgular:
Üç doz grubunun ortalama yaşı 47,3 yıl, beş doz grubunun ortalama yaşı 48,6 yıl idi. Tinnitus tüm hastalarda, vertigo ise %20’sinde mevcuttu. SSO düzelmesi üç doz grubunda 16,1 ± 10,4 dB, beş doz grubunda ise 14,7 ± 11,5 dB bulundu (p > 0,05). Ortalama KAS düzelmesi üç doz grubunda %10,7 ± 14,6, beş doz grubunda ise %6,9 ± 11,5 idi (p > 0,05). Genel SSO düzelme oranları sırasıyla %28,23 ve %23,28, KAS düzelme oranları ise %30,94 ve %43,81 olarak bulundu. Protokoller arasında istatistiksel olarak anlamlı fark saptanmadı.

Sonuç:
Sistemik steroide ek olarak uygulanan hem üç hem de beş doz intratimpanik deksametazon rejimleri, ani sensörinöral işitme kaybı olan hastalarda anlamlı işitme düzelmeleri sağlamıştır. Ancak enjeksiyon sayısının artırılması ek bir fayda göstermemiştir. Bu bulgular, daha düşük doz rejiminin yeterli olabileceğini, böylece prosedürel risklerin ve hasta rahatsızlığının azaltılabileceğini düşündürmektedir. Standart doz protokollerinin belirlenmesi için daha büyük, randomize kontrollü çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Ani sensörinöral işitme kaybı , intratimpanik steroid , saf ses odyometrisi , konuşma ayırt etme skoru

Etik Beyan

Bu çalışma için Giresun Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu’ndan 16.04.2025 tarihli ve 16.04.2025/01 sayılı karar ile onay alınmıştır.

Destekleyen Kurum

Yazarlar, bu çalışma için herhangi bir mali destek bulunmadığını beyan etmişlerdir.

Kaynakça

• Kanotra, S., Kumar, A., Langar, B., et al. (2022). Intratympanic dexamethasone in sudden sensorineural hearing loss. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(Suppl 3), 3947–3956. https://doi.org/10.1007/s12070-021-02713-7
• Nosrati-Zarenoe, R., & Hultcrantz, E. (2012). Corticosteroid treatment of idiopathic sudden sensorineural hearing loss: Randomized triple-blind placebo-controlled trial. Otolaryngology–Head and Neck Surgery, 33(4), 523–531. https://doi.org/10.1097/MAO.0b013e31824b78da
• Cinamon, U., Bendet, E., & Kronenberg, J. (2001). Steroids, carbogen or placebo for sudden hearing loss: A prospective double-blind study. European Archives of Oto-Rhino-Laryngology, 258(9), 477–480. https://doi.org/10.1007/s004050100366
• Wilson, W. R., Byl, F. M., & Laird, N. (1980). The efficacy of steroids in the treatment of idiopathic sudden hearing loss: A double-blind clinical study. Archives of Otolaryngology, 106(12), 772–776. https://doi.org/10.1001/archotol.1980.00790360050013
• Alexander, T. H., & Harris, J. P. (2013). Incidence of sudden sensorineural hearing loss. Otolaryngology–Head and Neck Surgery, 34(9), 1586–1589. https://doi.org/10.1097/MAO.0000000000000222
• Singh, A., & Kumar Irugu, D. V. (2020). Sudden sensorineural hearing loss – A contemporary review of management issues. Journal of Otology, 15(2), 67–73. https://doi.org/10.1016/j.joto.2019.07.001
• Stachler, R. J., Chandrasekhar, S. S., Archer, S. M., et al. (2012). Clinical practice guideline: Sudden hearing loss. Otolaryngology–Head and Neck Surgery, 146(3 Suppl), S1–S35. https://doi.org/10.1177/0194599812436449
• Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R. et al. (2019). Clinical practice guideline: Sudden hearing loss (Update). Otolaryngology–Head and Neck Surgery, 161(1 Suppl), S1–S45. https://doi.org/10.1177/0194599819859885
• Haynes, D. S., O'Malley, M., Cohen, S., et al. (2007). Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy. Laryngoscope, 117(1), 3–15. https://doi.org/10.1097/01.mlg.0000245058.11866.15
• Bird, P. A., Murray, D. P., Zhang, M et al. (2011). Intratympanic versus intravenous delivery of dexamethasone and dexamethasone sodium phosphate to cochlear perilymph. Otolaryngology–Head and Neck Surgery, 32(6), 933–936. https://doi.org/10.1097/MAO.0b013e3182255933
• Hughes, C. K., Fischer, J., Esquivel, C. R., et al. (2018). Sudden sensorineural hearing loss in the Department of Defense. Otolaryngology–Head and Neck Surgery, 159(2), 354–358. https://doi.org/10.1177/0194599818768511
• Stew, B. T., Fishpool, S. J., & Williams, H. (2012). Sudden sensorineural hearing loss. British Journal of Hospital Medicine, 73(2), 86–89. https://doi.org/10.12968/hmed.2012.73.2.86
• Pezzoli, M., Magnano, M., Maffi, L., et al. (2015). Hyperbaric oxygen therapy as salvage treatment for sudden sensorineural hearing loss: A prospective controlled study. European Archives of Oto-Rhino-Laryngology, 272(7), 1659–1666. https://doi.org/10.1007/s00405-014-2948-z
• Aydın, S., Şanlı, A., Altın, G. et al. (2011). Comparison of intratympanic steroid treatment versus hemodilution and vasoactive treatment combination in sudden hearing loss. South Clinical Istanbul Eurasia, 22(1), 20–24. https://doi.org/10.5505/jkartaltr.2011.18199
• Mattox, D. E., & Simmons, F. B. (1977). Natural history of sudden sensorineural hearing loss. Annals of Otology, Rhinology & Laryngology, 86(4 Pt 1), 463–480. https://doi.org/10.1177/000348947708600406
• Parnes, L. S., Sun, A. H., & Freeman, D. J. (1999). Corticosteroid pharmacokinetics in the inner ear fluids: An animal study followed by clinical application. Laryngoscope, 109(7 Pt 2), 1–17. https://doi.org/10.1097/00005537-199907001-00001
• Skarżyńska, M. B., Kołodziejak, A., Gos, E. et al. (2022). Effectiveness of various treatments for sudden sensorineural hearing loss—A retrospective study. Life, 12(1), 96. https://doi.org/10.3390/life12010096
• Durmuş, K., Terzi, H., Karataş, T. D. et al. (2016). Assessment of hematological factors involved in development and prognosis of idiopathic sudden sensorineural hearing loss. Journal of Craniofacial Surgery, 27(1), e85–e91. https://doi.org/10.1097/SCS.0000000000002241
• Al-Azzawi, A., & Stapleton, E. (2023). Blood tests as biomarkers for the diagnosis and prognosis of sudden sensorineural hearing loss in adults: A systematic review. The Journal of Laryngology & Otology, 137(9), 977–984. https://doi.org/10.1017/S0022215123000282
• Cao, Z., Li, Z., Xiang, H., Huang, S., et al. (2018). Prognostic role of haematological indices in sudden sensorineural hearing loss: Review and meta-analysis. Clinica Chimica Acta, 483, 104–111. https://doi.org/10.1016/j.cca.2018.04.025
• Doo, J. G., Kim, D., Kim, Y., et al. (2020). Biomarkers suggesting favorable prognostic outcomes in sudden sensorineural hearing loss. International Journal of Molecular Sciences, 21(19), 7248. https://doi.org/10.3390/ijms21197248