European Archives of Oto-Rhino-Laryngology

, Volume 266, Issue 8, pp 1205–1212 | Cite as

Use of intratympanic dexamethasone for the therapy of low frequency hearing loss

  • Necat Alatas


The objective was to assess the efficacy of intratympanic dexamethasone in treatment of sensorineural hearing loss at lower frequencies (LFSHL). The design is a prospective study. Eleven female and three male patients with LFSHL were included in this study. They were evaluated with pure-tone audiometry, acoustic admittance, transient evoked otoacoustic emission, and glycerol test. Seven, four, and three patients were seen within the mean of 2.86 ± 1.35 (1–5), 18.25 ± 2.36 (15–20), and 750 ± 700 (60–1,460) days from onset of LFSHL, respectively. They were treated with daily intratympanic dexamethasone (ITD) injection and reviewed with repeated daily audiograms during the intratympanic treatment. As complementary treatment, they were given oral prednisolone 1 mg/kg (maximum 60 mg), with 10 mg decreasing doses for every 3 days. Results were compared with their unaffected ear. The mean ± SD hearing level at 0.125 up to 1.5 kHz improved from 64.29 ± 19.18 to 25.93 ± 13.54 (< 0.001), pure tone average improved from 62.7 ± 25.7 to 22.9 ± 17.8 (< 0.001), speech reception thresholds improved from 34.6 ± 29.45 to 17.5 ± 16.38 (= 0.028), speech discrimination scores improved from 65.7 ± 39.8 to 84.6 ± 24.7% (= 0.024) with treatment. Complete recovery in 10 of 14 patients, partial recovery in 3 patients, was achieved after therapy; and in one patient the situation was unchanged. The mean hearing level at 0.125 up to 1.5 kHz was elevated from 45.6 ± 17.5 to 9.1 ± 10.3 dB (< 0.001) when compared with unaffected ear. The mean recovery rate was 77.9 ± 25.3%. ITD is an effective therapy for LFSHL.


Hearing loss Intratympanic Steroid Low frequency 


  1. 1.
    Imamura S, Nozawa I, Imamura M, Murakami Y (1997) Clinical observations on acute low-tone sensorineural hearing loss. Ann Otol Rhinol Laryngol 106:746–750CrossRefPubMedGoogle Scholar
  2. 2.
    Kitajiri SI, Tabuchi K, Hiraumi H, Hirose T (2002) Is corticosteroid therapy effective for sudden-onset sensorineural hearing loss at lower frequencies? Arch Otolaryngol Head Neck Surg 128:365–367CrossRefPubMedGoogle Scholar
  3. 3.
    Yamasoba T, Kikuchi S, Sugasawa M, Yagi M, Harada T (1994) Acute low-tone sensorineural hearing loss without vertigo. Arch Otolaryngol Head Neck Surg 120:532–535CrossRefPubMedGoogle Scholar
  4. 4.
    Abe T (1982) Acute sensorineural hearing loss in low tone frequencies. Otolaryngol Tokyo 54:385–392Google Scholar
  5. 5.
    Chandrasekhar SS (2001) Intratympanic dexamethasone for sudden sensorineural hearing loss: clinical and laboratory evaluation. Otol Neurotol 22:18–23. doi: 10.1097/00129492-200101000-00005 CrossRefPubMedGoogle Scholar
  6. 6.
    Wilson WR, Byl FM, Laird N (1980) The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double-blind clinical study. Arch Otolaryngol 106:772–776CrossRefPubMedGoogle Scholar
  7. 7.
    Chen CY, Halpin C, Rauch SD (2003) Oral steroid treatment of sudden sensorineural hearing loss: a ten year retrospective analysis. Otol Neurotol 24:728–733. doi: 10.1097/00129492-200309000-00006 CrossRefPubMedGoogle Scholar
  8. 8.
    Zadeh MH, Storper IS, Spitzer JB (2003) Diagnosis and treatment of sudden-onset sensorineural hearing loss: a study of 51 patients. Otolaryngol Head Neck Surg 128:92–98. doi: 10.1067/mhn.2003.50 CrossRefPubMedGoogle Scholar
  9. 9.
    Fuse T, Aoyagi M, Funakubo T, Sakakibara A, Yoshida S (2002) Short-term outcome and prognosis of acute low-tone sensorineural hearing loss by administration of steroid. ORL J Otorhinolaryngol Relat Spec 64:6–10. doi: 10.1159/000049079 CrossRefPubMedGoogle Scholar
  10. 10.
    Slattery WH, Fisher LM, Iqbal Z, Liu N (2005) Oral steroid regimens for idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 132:5–10. doi: 10.1016/j.otohns.2004.09.072 CrossRefPubMedGoogle Scholar
  11. 11.
    Moskowitz D, Lee KJ, Smith HW (1984) Steroid use in idiopathic sudden sensorineural hearing loss. Laryngoscope 94:664–666. doi: 10.1288/00005537-198405000-00016 CrossRefPubMedGoogle Scholar
  12. 12.
    Byl FM Jr (1984) Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope 94:647–661. doi: 10.1288/00005537-198405000-00014 CrossRefPubMedGoogle Scholar
  13. 13.
    Mattox DE, Simmons FB (1977) Natural history of sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol 86:463–480CrossRefPubMedGoogle Scholar
  14. 14.
    Cinamon U, Bendet E, Kronenberg J (2001) Steroids, carbogen or placebo for sudden hearing loss: a prospective double-blind study. Eur Arch Otorhinolaryngol 258:477–480. doi: 10.1007/s004050100366 CrossRefPubMedGoogle Scholar
  15. 15.
    Silverstein H, Choo D, Rosenberg SI, Kuhn J, Seidman M, Stein I (1996) Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report). Ear Nose Throat J 75:468–471PubMedGoogle Scholar
  16. 16.
    Parnes LS, Sun AH, Freeman DJ (1999) Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. Laryngoscope 109:1–17. doi: 10.1097/00005537-199907001-00001 CrossRefPubMedGoogle Scholar
  17. 17.
    Chandrasekhar SS, Rubinstein RY, Kwartler JA et al (2000) Dexamethasone pharmacokinetics in the inner ear: comparison of route of administration and use of facilitating agents. Otolaryngol Head Neck Surg 122:521–528. doi: 10.1016/S0194-5998(00)70094-5 PubMedGoogle Scholar
  18. 18.
    Bachmann G, Su J, Zumegen C, Wittekindt C, Michel O (2001) Permeability of the round window membrane for prednisolone-21-hydrogen succinate. Prednisolone content of the perilymph after local administration vs. systemic injection. HNO 49:538–542. doi: 10.1007/s001060170078 CrossRefPubMedGoogle Scholar
  19. 19.
    Xenellis J, Papadimitriou N, Nikolopoulos T, Maragoudakis P, Segas J, Tzagaroulakis A et al (2006) Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: a control study. Otolaryngol Head Neck Surg 134:940–945. doi: 10.1016/j.otohns.2005.03.081 CrossRefPubMedGoogle Scholar
  20. 20.
    Haynes DS, O’Malley M, Cohen S, Watford K, Labadie RF (2007) Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy. Laryngoscope 117(1):3–15. doi: 10.1097/01.mlg.0000245058.11866.15 CrossRefPubMedGoogle Scholar
  21. 21.
    Okuno T, Sando I (1987) Localization, frequency and severity of endolymphatic hydrops and the pathology of the labyrinthine membrane in Meniere’s disease. Ann Otol Rhinol Laryngol 96:438–445CrossRefPubMedGoogle Scholar
  22. 22.
    Toru S, Michiko N, Atsushi M, Akiko Y, Tomonori T, Masafumi S (2003) Three cases of cochleosaccular endolymphatic hydrops without vertigo revealed by furosemide-loading vestibular evoked myogenic potential test. Otol Neurotol 24:807–811. doi: 10.1097/00129492-200309000-00019 CrossRefGoogle Scholar
  23. 23.
    Junicho M, Aso S, Fujisaka M, Watanabe Y (2008) Prognosis of low-tone sudden deafness—does it inevitably progress to Meniere’s disease? Acta Otolaryngol 128:304–308. doi: 10.1080/00016480601002096 CrossRefPubMedGoogle Scholar
  24. 24.
    Cvorovic L, Deric D, Probst R, Hegemann S (2008) Prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss. Otol Neurotol 29:464–469CrossRefPubMedGoogle Scholar
  25. 25.
    Eisenman DJ, Arts HA (2000) Effectiveness of treatment for sudden sensorineural hearing loss. Arch Otolaryngol Head Neck Surg 126:1161–1164CrossRefPubMedGoogle Scholar
  26. 26.
    Jackson LE, Silverstein H (2002) Chemical perfusion of the inner ear. Otolaryngol Clin North Am 35:639–653. doi: 10.1016/S0030-6665(02)00023-3 CrossRefPubMedGoogle Scholar
  27. 27.
    Ho GM, Lin HG, Shu MT (2004) Effectiveness of intratympanic dexamethasone injection in sudden deafness patients as salvage treatment. Laryngoscope 114:1184–1189. doi: 10.1097/00005537-200407000-00010 CrossRefPubMedGoogle Scholar
  28. 28.
    Nadel DM (1996) The use of systemic steroids in otolaryngology. Ear Nose Throat J 75:502–516PubMedGoogle Scholar
  29. 29.
    Yilmaz I, Yilmazer C, Erkan AN, Aslan SG, Ozluoglu LN (2005) Intratympanic dexamethasone injection effects on transient-evoked otoacoustic emission. Am J Otolaryngol 26:113–117. doi: 10.1016/j.amjoto.2004.11.001 CrossRefPubMedGoogle Scholar
  30. 30.
    Lefebvre PP, Staecker H (2002) Steroid perfusion of the inner ear for sudden sensorineural hearing loss after failure of conventional therapy: a pilot study. Acta Otolaryngol 122:698–702. doi: 10.1080/003655402/000028037 CrossRefPubMedGoogle Scholar
  31. 31.
    Fetterman BL, Saunders JE, Luxford WM (1996) Prognosis and treatment of sudden sensorineural hearing loss. Am J Otol 17:529–536PubMedGoogle Scholar
  32. 32.
    Linssen O, Schultz-Coulon HJ (1997) Prognostic criteria in sudden deafness. HNO 45:22–29. doi: 10.1007/s001060050083 CrossRefPubMedGoogle Scholar
  33. 33.
    Saijo S, Kimura RS (1984) Distribution of HRP in the inner ear after injection into the middle ear cavity. Acta Otolaryngol 97:593–610. doi: 10.3109/00016488409132937 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyBaskent University Medical FacultyAnkaraTurkey
  2. 2.Baskent Universitesi Konya Arastirma Uygulama Merkezi, Kulak Burun Bogaz HastalıklarıSelçuklu, KonyaTurkey

Personalised recommendations