European Archives of Oto-Rhino-Laryngology

, Volume 272, Issue 10, pp 2777–2782 | Cite as

Intratympanic steroids as a salvage treatment for sudden sensorineural hearing loss? A meta-analysis

  • Jia Hui Ng
  • Roger Chun Man Ho
  • Crystal Shuk Jin Cheong
  • Adele Ng
  • Heng Wai Yuen
  • Raymond Yeow Seng Ngo
Otology

Abstract

Sudden sensorineural hearing loss is typically treated with systemic steroids. The aim of this meta-analysis was to evaluate the efficacy of salvage intratympanic steroid treatment in patients who have initial treatment failure with systemic steroids. A MEDLINE literature search was performed, supported by searches of Web of Science, Biosis, and Science Direct. Articles of all languages were included. Selection of relevant publications was conducted independently by three authors. Only randomized controlled trials were considered. In one arm of the studies, the patients received salvage intratympanic steroids. In the other arm, patients did not receive further treatment. The standard difference in mean (SDM) amount of improvement in hearing threshold between patients who did and did not receive salvage intratympanic steroids was calculated. From an initial 184 studies found via the search strategy, 5 studies met inclusion criteria and were included. There was a statistically significant greater reduction in hearing threshold on pure-tone audiometry in patients who received salvage intratympanic steroids than in those who did not (SDM = −0.401, p = 0.005). Subgroup analysis showed that administration by intratympanic injection (SDM = −0.375, p = 0.013) rather than a round window catheter (SDM = −0.629, p = 0.160) yielded significant improvement in outcome. The usage of dexamethasone yielded better outcomes (SDM = −0.379, p = 0.039) than the use of methylprednisolone (SDM = −0.459, p = 0.187). No serious side effect of treatment was reported. In patients who have failed initial treatment with systemic steroids, additional treatment with salvage intratympanic dexamethasone injections demonstrate a statistically significant reduction in the hearing thresholds as compared to controls.

Keywords

Sudden sensorineural hearing loss Intratympanic Steroids Dexamethasone Methylprednisolone Injections Salvage Treatment 

References

  1. 1.
    Kubo T, Matsunaga T, Asai H et al (1988) Efficacy of defibrinogenation and steroid therapies on sudden deafness. Arch Otolaryngol Head Neck Surg 114:649–652CrossRefPubMedGoogle Scholar
  2. 2.
    Byl FM (1984) Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope 94 Pt 1(5):647–661Google Scholar
  3. 3.
    Chandrasekhar SS (2003) Updates on methods to treat sudden hearing loss. Oper Tech Otolaryngol Head Neck Surg 14:288–292CrossRefGoogle Scholar
  4. 4.
    Reisser CH, Weidauer H (2001) Gingko biloba extract EGb 761 or pentoxifylline for the treatment of sudden deafness: a randomized, reference-controlled, double blind study. Acta Otolaryngol 121(5):579–584CrossRefPubMedGoogle Scholar
  5. 5.
    Ogawa K, Takei S, Inoue Y et al (2002) Effect of prostaglandin E1 on idiopathic sudden sensorineural hearing loss: a double-blind clinical study. Otol Neurotol 23(5):665–668CrossRefPubMedGoogle 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):477–480CrossRefPubMedGoogle Scholar
  7. 7.
    Probst R, Tschopp K, Ludin E et al (1992) A randomized, doubleblind, placebo-controlled study of dextran/pentoxifylline medication in acute acoustic trauma and sudden hearing loss. Acta Otolaryngol 112(3):435–443CrossRefPubMedGoogle Scholar
  8. 8.
    Kronenberg J, Almagor M, Bendet E et al (1992) Vasoactive therapy versus placebo in the treatment of sudden hearing loss: a double-blind clinical study. Laryngoscope 102(1):65–68CrossRefPubMedGoogle Scholar
  9. 9.
    Burschka MA, Hassan HA, Reineke T et al (2001) Effect of treatment with Ginkgo biloba extract EGb 761 (oral) on unilateral idiopathic sudden hearing loss in a prospective randomized double-blind study of 106 outpatients. Eur Arch Otorhinolaryngol 258(5):213–219CrossRefPubMedGoogle Scholar
  10. 10.
    Gordin A, Goldenberg D, Golz A et al (2002) Magnesium: a new therapy for idiopathic sudden sensorineural hearing loss. Otol Neurotol 23(4):447–451CrossRefPubMedGoogle Scholar
  11. 11.
    Nageris BI, Ulanovski D, Attias J et al (2004) Magnesium treatment for sudden hearing loss. Ann Otol Rhinol Laryngol 113(8):672–675CrossRefPubMedGoogle Scholar
  12. 12.
    Suckfüll M (2002) Hearing Loss Study Group. Fibrinogen and LDL apheresis in treatment of sudden hearing loss: a randomized multicentre trial. Lancet 360(9348):1811–1817CrossRefPubMedGoogle Scholar
  13. 13.
    Mann W, Beck C, Beck C (1986) Calcium antagonists in the treatment of sudden deafness. Arch Otorhinolaryngol 243(3):170–173CrossRefPubMedGoogle Scholar
  14. 14.
    Joachims HZ, Segal J, Golz A et al (2003) Antioxidants in treatment of idiopathic sudden hearing loss. Otol Neurotol 24(4):572–575CrossRefPubMedGoogle Scholar
  15. 15.
    Mora R, Barbieri M, Mora F et al (2003) Intravenous infusion of recombinant tissue plasminogen activator for the treatment of patients with sudden and/or chronic hearing loss. Ann Otol Rhinol Laryngol 112(8):665–670CrossRefPubMedGoogle Scholar
  16. 16.
    Topuz E, Yigit O, Cinar U et al (2004) Should hyperbaric oxygen be added to treatment in idiopathic sudden sensorineural hearing loss? Eur Arch Otorhinolaryngol 261(7):393–396PubMedGoogle Scholar
  17. 17.
    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
  18. 18.
    Moskowitz D, Lee KJ, Smith HW (1984) Steroid use in idiopathic sudden sensorineural hearing loss. Laryngoscope 94:664–666CrossRefPubMedGoogle Scholar
  19. 19.
    Xenellis J, Papadimitriou N, Nikolopoulos T et al (2006) Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: a control study. Otolaryngol Head Neck Surg 134(6):940–945CrossRefPubMedGoogle Scholar
  20. 20.
    Ho HG, Lin HC, Shu MT et al (2004) Effectiveness of intratympanic dexamethasone injection in sudden-deafness patients as salvage treatment. Laryngoscope 114(7):1184–1189CrossRefPubMedGoogle Scholar
  21. 21.
    Wu HP, Chou YF, Yu SH et al (2011) Intratympanic steroid injections as a salvage treatment for sudden sensorineural hearing loss: a randomized, double-blind, placebo controlled study. Otol Neurotol 32(5):774–779CrossRefPubMedGoogle Scholar
  22. 22.
    Lee JB, Choi SJ, Park K et al (2011) The efficiency of intratympanic dexamethasone injection as a sequential treatment after initial systemic steroid therapy for sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 268(6):833–839CrossRefPubMedGoogle Scholar
  23. 23.
    Plontke SK, Löwenheim H, Mertens J et al (2009) Randomized, double blind, placebo controlled trial on the safety and efficacy of continuous intratympanic dexamethasone delivered via a round window catheter for severe to profound sudden idiopathic sensorineural hearing loss after failure of systemic therapy. Laryngoscope 119(2):359–369CrossRefPubMedGoogle Scholar
  24. 24.
    Li P, Zeng XL, Ye J et al (2011) Intratympanic methylprednisolone improves hearing function in refractory sudden sensorineural hearing loss: a control study. Audiol Neurootol 16(3):198–202CrossRefPubMedGoogle Scholar
  25. 25.
    Mak KK, Kong WY, Mak A et al (2013) Polymorphisms of the serotonin transporter gene and post-stroke depression: a meta-analysis. J Neurol Neurosurg Psychiatry 84(3):322–328CrossRefPubMedGoogle Scholar
  26. 26.
    Sutton AJ, Abrams KR, Jones DR et al (1999) Systematic reviews of trials and other studies. Health Technol Assess 2:1–276Google Scholar
  27. 27.
    Cochrane Handbook for Systematic Reviews of Interventions, Part 9.2.3.2. http://handbook.cochrane.org/index.htm#chapter_9/9_2_3_2_the_standardized_mean_difference.htm. Accessed 2 Jan 2014
  28. 28.
    Bridle C, Spanjers K, Patel S et al (2012) Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 201:180–185CrossRefPubMedGoogle Scholar
  29. 29.
    Egger M, Davey Smith G, Schneider M et al (1997) Bias in meta-analysis detected by a simple graphical test. BMJ. 315:629–634PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Spear SA, Schwartz SR (2011) Intratympanic steroids for sudden sensorineural hearing loss: a systematic review. Otolaryngol Head Neck Surg. 145(4):534–543CrossRefPubMedGoogle Scholar
  31. 31.
    Wei BP, Mubiru S, O’Leary S (2006) Steroids for idiopathic sudden sensorineural hearing loss. Cochrane Database Syst Rev (1):CD003998Google Scholar
  32. 32.
    Conlin AE, Parnes LS (2007) Treatment of sudden sensorineural hearing loss: II. A meta-analysis. Arch Otolaryngol Head Neck Surg 133(6):582–586CrossRefPubMedGoogle Scholar
  33. 33.
    Labus J, Breil J, Stützer H et al (2010) Meta-analysis for the effect of medical therapy vs. placebo on recovery of idiopathic sudden hearing loss. Laryngoscope 120(9):1863–1871CrossRefPubMedGoogle Scholar
  34. 34.
    Battaglia A, Burchette R, Cueva R (2008) Combination therapy (intratympanic dexamethasone + high-dose prednisone taper) for the treatment of idiopathic sudden sensorineural hearing loss. Otol Neurotol 29(4):453–460CrossRefPubMedGoogle Scholar
  35. 35.
    Rauch SD, Halpin CF, Antonelli PJ et al (2011) Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial. JAMA 305(20):2071–2079CrossRefPubMedGoogle Scholar
  36. 36.
    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):579–583CrossRefPubMedGoogle Scholar
  37. 37.
    Han CS, Park JR, Boo SH et al (2009) Clinical efficacy of initial intratympanic steroid treatment on sudden sensorineural hearing loss with diabetes. Otolaryngol Head Neck Surg 141(5):572–578CrossRefPubMedGoogle Scholar
  38. 38.
    Kara E, Cetik F, Tarkan O et al (2010) Modified intratympanic treatment for idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 267(5):701–707CrossRefPubMedGoogle Scholar
  39. 39.
    Zhou Y, Zheng H, Zhang Q et al (2011) Early transtympanic steroid injection in patients with ‘poor prognosis’ idiopathic sensorineural sudden hearing loss. ORL J Otorhinolaryngol Relat Spec 73(1):31–37CrossRefPubMedGoogle Scholar
  40. 40.
    Kakehata S, Sasaki A, Futai K et al (2011) Daily short-term intratympanic dexamethasone treatment alone as an initial or salvage treatment for idiopathic sudden sensorineural hearing loss. Audiol Neurootol 16(3):191–197CrossRefPubMedGoogle Scholar
  41. 41.
    Arslan N, Oğuz H, Demirci M et al (2011) Combined intratympanic and systemic use of steroids for idiopathic sudden sensorineural hearing loss. Otol Neurotol 32(3):393–397CrossRefPubMedGoogle Scholar
  42. 42.
    Fu Y, Zhao H, Zhang T et al (2011) Intratympanic dexamethasone as initial therapy for idiopathic sudden sensorineural hearing loss: Clinical evaluation and laboratory investigation. Auris Nasus Larynx 38(2):165–171CrossRefPubMedGoogle Scholar
  43. 43.
    Gouveris H, Schuler-Schmidt W, Mewes T et al (2011) Intratympanic dexamethasone/hyaluronic acid mix as an adjunct to intravenous steroid and vasoactive treatment in patients with severe idiopathic sudden sensorineural hearing loss. Otol Neurotol 32(5):756–760CrossRefPubMedGoogle Scholar
  44. 44.
    Lautermann J, Sudhoff H, Junker R (2005) Transtympanic corticoid therapy for acute profound hearing loss. Eur Arch Otorhinolaryngol 262(7):587–591CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jia Hui Ng
    • 1
  • Roger Chun Man Ho
    • 2
  • Crystal Shuk Jin Cheong
    • 3
  • Adele Ng
    • 4
  • Heng Wai Yuen
    • 5
  • Raymond Yeow Seng Ngo
    • 3
  1. 1.Department of OtolaryngologySinghealthSingaporeSingapore
  2. 2.Department of Psychological MedicineNational University HospitalSingaporeSingapore
  3. 3.Department of OtolaryngologyNational University HospitalSingaporeSingapore
  4. 4.Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  5. 5.Department of OtolaryngologyChangi General HospitalSingaporeSingapore

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