European Archives of Oto-Rhino-Laryngology

, Volume 270, Issue 11, pp 2823–2832

Intratympanic steroids as primary initial treatment of idiopathic sudden sensorineural hearing loss

The Hospital Universitario Ramón y Cajal experience and review of the literature
  • Tomás Labatut
  • María José Daza
  • Antonio Alonso


The objective of this study was to determine the effectiveness, dosage, safety and comfort of intratympanic steroids as primary initial treatment of idiopathic sudden sensorineural hearing loss (ISSHL). Prospective nonrandomized clinical practice study was performed in Tertiary referral center university hospital. A total of 35 consecutive patients suffering from newly diagnosed sudden sensorineural hearing loss with mean pure-tone average thresholds of 81 ± 21 dB were treated. No previous therapy had been undertaken. Intratympanic steroid injection as primary initial treatment was administered during 2 weeks on a twice a week schedule, between 2010 and 2011. Treatment was started on average within 2 days of symptoms onset. Pre and post-treatment audiometric evaluations were analyzed on follow-up as well as tolerance of the procedure and possible adverse effects. 66–85 % of patients achieved successful treatment according to the different outcome criteria used to evaluate hearing improvement (Furuhashi criteria/improvement of ≥10 dB in pure-tone average). Mean post-treatment improvement regarding pure-tone average was 34 ± 21 dB. A 48 ± 43 % improvement in speech discrimination score was observed. Patients received an average of 18 mg of methylprednisolone per injection and a total dose of 72 mg per treatment cycle. No serious adverse effects were noted. Intratympanic steroid injection is an effective, safe and well-tolerated office based-procedure for the treatment of ISSHL as primary initial treatment that can avoid the potential adverse effects of systemic steroids. A higher dose, schedule of administration as well as standardization of hearing recovery criteria still need to be established.


Intratympanic steroids Sudden sensorineural hearing loss Methylprednisolone Hearing recovery criteria Idiopathic Treatment Transtympanic steroids Sensorineural hearing loss 


  1. 1.
    Conlin AE, Parnes LS (2007) Treatment of sudden sensorineural hearing loss: I. A systematic review. Arch Otolaryngol Head Neck Surg 133(6):573–581PubMedCrossRefGoogle Scholar
  2. 2.
    Conlin AE, Parnes LS (2007) Treatment of sudden sensorineural hearing loss: II. A meta-analysis. Arch Otolaryngol Head Neck Surg 133(6):582–586PubMedCrossRefGoogle Scholar
  3. 3.
    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(12):772–776PubMedCrossRefGoogle Scholar
  4. 4.
    Moskowitz D, Lee KJ, Smith HW (1984) Steroid use in idiopathic sudden sensorineural hearing loss. Laryngoscope 94(5 Pt 1):664–666PubMedGoogle Scholar
  5. 5.
    Byl FM Jr (1984) Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope 94(5 Pt 1):647–661PubMedGoogle Scholar
  6. 6.
    Cinamon U, Bendet E, Kronenberg J (2001) Steroids, carbogen or placebo for sudden hearing loss: a prospective double-blind study. Eur Arch Otorhinolaryngol 258(9):477–480PubMedCrossRefGoogle Scholar
  7. 7.
    Mattox DE, Simmons FB (1977) Natural history of sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol 86(4 Pt 1):463–480PubMedGoogle Scholar
  8. 8.
    Hamid M, Trune D (2008) Issues, indications, and controversies regarding intratympanic steroid perfusion. Curr Opin Otolaryngol Head Neck Surg 16(5):434–440PubMedCrossRefGoogle Scholar
  9. 9.
    Parnes LS, Sun AH, Freeman DJ (1999) Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. Laryngoscope 109(7 Pt 2):1–17PubMedCrossRefGoogle Scholar
  10. 10.
    Chandrasekhar SS (2001) Intratympanic dexamethasone for sudden sensorineural hearing loss: clinical and laboratory evaluation. Otol Neurotol 22(1):18–23PubMedCrossRefGoogle Scholar
  11. 11.
    Slattery WH, Fisher LM, Iqbal Z, Friedman RA, Liu N (2005) Intratympanic steroid injection for treatment of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg 133(2):251–259PubMedCrossRefGoogle Scholar
  12. 12.
    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(6):940–945PubMedCrossRefGoogle Scholar
  13. 13.
    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):3–15PubMedCrossRefGoogle Scholar
  14. 14.
    Kakehata S, Sasaki A, Oji K, Futai K, Ota S, Makinae K et al (2006) Comparison of intratympanic and intravenous dexamethasone treatment on sudden sensorineural hearing loss with diabetes. Otol Neurotol 27(5):604–608PubMedCrossRefGoogle Scholar
  15. 15.
    Kara E, Cetik F, Tarkan O, Surmelioglu O (2010) Modified intratympanic treatment for idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 267(5):701–707PubMedCrossRefGoogle Scholar
  16. 16.
    Filipo R, Covelli E, Balsamo G, Attanasio G (2010) Intratympanic prednisolone therapy for sudden sensorineural hearing loss: a new protocol. Acta Otolaryngol 130(11):1209–1213PubMedCrossRefGoogle Scholar
  17. 17.
    Tsai YJ, Liang JG, Wu WB, Ding YF, Chiang RP, Wu SM (2011) Intratympanic injection with dexamethasone for sudden sensorineural hearing loss. J Laryngol Otol 125(2):133–137PubMedCrossRefGoogle Scholar
  18. 18.
    Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM et al (2012) Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg 146(3 Suppl):S1–S35PubMedCrossRefGoogle Scholar
  19. 19.
    Furuhashi A, Matsuda K, Asahi K, Nakashima T (2002) Sudden deafness: long-term follow-up and recurrence. Clin Otolaryngol Allied Sci 27(6):458–463PubMedCrossRefGoogle Scholar
  20. 20.
    Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma) (1995) American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 113(3):179–180CrossRefGoogle Scholar
  21. 21.
    Seggas I, Koltsidopoulos P, Bibas A, Tzonou A, Sismanis A (2011) Intratympanic steroid therapy for sudden hearing loss: a review of the literature. Otol Neurotol 32(1):29–35PubMedCrossRefGoogle Scholar
  22. 22.
    Plaza G, Herraiz C (2007) Intratympanic steroids for treatment of sudden hearing loss after failure of intravenous therapy. Otolaryngol Head Neck Surg 137(1):74–78PubMedCrossRefGoogle Scholar
  23. 23.
    Kopke RD, Hoffer ME, Wester D, O’Leary MJ, Jackson RL (2001) Targeted topical steroid therapy in sudden sensorineural hearing loss. Otol Neurotol 22(4):475–479PubMedCrossRefGoogle Scholar
  24. 24.
    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(7):698–702PubMedCrossRefGoogle Scholar
  25. 25.
    Dispenza F, Amodio E, De Stefano A, Gallina S, Marchese D, Mathur N et al (2011) Treatment of sudden sensorineural hearing loss with transtympanic injection of steroids as single therapy: a randomized clinical study. Eur Arch Otorhinolaryngol 268(9):1273–1278PubMedCrossRefGoogle Scholar
  26. 26.
    Hong SM, Park CH, Lee JH (2009) Hearing outcomes of daily intratympanic dexamethasone alone as a primary treatment modality for ISSHL. Otolaryngol Head Neck Surg 141(5):579–583PubMedCrossRefGoogle Scholar
  27. 27.
    Banerjee A, Parnes LS (2005) Intratympanic corticosteroids for sudden idiopathic sensorineural hearing loss. Otol Neurotol 26(5):878–881PubMedCrossRefGoogle Scholar
  28. 28.
    Rauch SD, Halpin CF, Antonelli PJ, Babu S, Carey JP, Gantz BJ et al (2011) Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial. JAMA 305(20):2071–2079PubMedCrossRefGoogle Scholar
  29. 29.
    Han CS, Park JR, Boo SH, Jo JM, Park KW, Lee WY et al (2009) Clinical efficacy of initial intratympanic steroid treatment on sudden sensorineural hearing loss with diabetes. Otolaryngol Head Neck Surg 141(5):572–578PubMedCrossRefGoogle Scholar
  30. 30.
    Robey AB, Morrow T, Moore GF (2010) Systemic side effects of transtympanic steroids. Laryngoscope 120(Suppl 4):S217PubMedCrossRefGoogle Scholar
  31. 31.
    Borden RC, Saunders JE, Berryhill WE, Krempl GA, Thompson DM, Queimado L (2011) Hyaluronic acid hydrogel sustains the delivery of dexamethasone across the round window membrane. Audiol Neurootol 16(1):1–11PubMedCrossRefGoogle Scholar
  32. 32.
    Gouveris H, Selivanova O, Mann W (2005) Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy. Eur Arch Otorhinolaryngol 262(2):131–134PubMedCrossRefGoogle Scholar
  33. 33.
    Banerjee A, Parnes LS (2004) The biology of intratympanic drug administration and pharmacodynamics of round window drug absorption. Otolaryngol Clin North Am 37(5):1035–1051PubMedCrossRefGoogle Scholar
  34. 34.
    Nagura M, Iwasaki S, Wu R, Mizuta K, Umemura K, Hoshino T (1999) Effects of corticosteroid, contrast medium and ATP on focal microcirculatory disorders of the cochlea. Eur J Pharmacol 366(1):47–53PubMedCrossRefGoogle Scholar
  35. 35.
    Stokroos RJ, Albers FW, Schirm J (1998) The etiology of idiopathic sudden sensorineural hearing loss. Experimental herpes simplex virus infection of the inner ear. Am J Otol 19(4):447–452PubMedGoogle Scholar
  36. 36.
    Tabuchi K, Oikawa K, Uemaetomari I, Tsuji S, Wada T, Hara A (2003) Glucocorticoids and dehydroepiandrosterone sulfate ameliorate ischemia-induced injury of the cochlea. Hear Res 180(1–2):51–56PubMedCrossRefGoogle Scholar
  37. 37.
    Yao X, Buhi WC, Alvarez IM, Curtis LM, Rarey KE (1995) De novo synthesis of glucocorticoid hormone regulated inner ear proteins in rats. Hear Res 86(1–2):183–188PubMedCrossRefGoogle Scholar
  38. 38.
    Trune DR, Wobig RJ, Kempton JB, Hefeneider SH (1999) Steroid treatment improves cochlear function in the MRL.MpJ-Fas(lpr) autoimmune mouse. Hear Res 137(1–2):160–166PubMedCrossRefGoogle Scholar
  39. 39.
    Fetterman BL, Saunders JE, Luxford WM (1996) Prognosis and treatment of sudden sensorineural hearing loss. Am J Otol 17(4):529–536PubMedGoogle Scholar
  40. 40.
    Hughes GB, Freedman MA, Haberkamp TJ, Guay ME (1996) Sudden sensorineural hearing loss. Otolaryngol Clin North Am 29(3):393–405PubMedGoogle Scholar
  41. 41.
    Kronenberg J, Almagor M, Bendet E, Kushnir D (1992) Vasoactive therapy versus placebo in the treatment of sudden hearing loss: a double-blind clinical study. Laryngoscope 102(1):65–68PubMedCrossRefGoogle Scholar
  42. 42.
    Heiden C, Porzsolt F, Biesinger E, Hoing R (2000) Spontaneous remission of sudden deafness. HNO 48(8):621–623PubMedCrossRefGoogle Scholar
  43. 43.
    Weinaug P (2001) How high is the rate of spontaneous healing of sudden deafness? Comments on the contribution “Spontaneous healing of sudden deafness”. HNO 49(6):431–432PubMedCrossRefGoogle Scholar
  44. 44.
    Laird N, Wilson WR (1983) Predicting recovery from idiopathic sudden hearing loss. Am J Otolaryngol 4(3):161–164PubMedCrossRefGoogle Scholar
  45. 45.
    Labus J, Breil J, Stutzer H, Michel O (2010) Meta-analysis for the effect of medical therapy vs. placebo on recovery of idiopathic sudden hearing loss. Laryngoscope 120(9):1863–1871PubMedCrossRefGoogle Scholar
  46. 46.
    Zernotti ME, Paoletti OA, Zernotti M, Martinez ME, Roques-Revol M, Prina AC (2009) Intratympanic dexamethasone as therapeutic option in sudden sensorineural hearing loss. Acta Otorrinolaringol Esp 60(2):99–103PubMedCrossRefGoogle Scholar
  47. 47.
    Wycherly BJ, Thompkins JJ, Kim HJ (2011) Early posttreatment audiometry underestimates hearing recovery after intratympanic steroid treatment of sudden sensorineural hearing loss. Int J Otolaryngol 2011:465831PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Tomás Labatut
    • 1
  • María José Daza
    • 1
  • Antonio Alonso
    • 1
  1. 1.Otolaryngology DepartmentHospital Universitario Ramón y CajalMadridSpain

Personalised recommendations