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Efficacy of systemic and intratympanic corticosteroid combination therapy versus intratympanic or systemic therapy in patients with idiopathic sudden sensorineural hearing loss: a randomized controlled trial

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objective

The present study was conducted to compare the rates of recovery from idiopathic sudden deafness after the treatment with oral and intratympanic corticosteroids in both mono and combination therapies.

Study design

Triple-blind randomized clinical trial.

Settings

Tertiary referral hospital.

Subjects and methods

A total of 112 patients who were admitted to the ENT emergency department randomly divided into three groups: an oral corticosteroid plus intratympanic placebo (systemic corticosteroid monotherapy group); an intratympanic corticosteroid plus oral placebo group (IT monotherapy group); and a combination therapy group (IT plus systemic combination group). All patients were treated additionally with antiviral and proton pomp inhibitor. An audiometry was performed once before beginning the therapies and again at the end of the therapy.

Results

Of the total of 112 patients, 32 received intratympanic (IT) corticosteroids, 45 were receiving systemic corticosteroids, and 35 were receiving a combination of the two. A total of 74 patients (66.1%) responded positively [response to treatment was calculated as gain of at least 10 dB in 10 dB in average threshold or with the minimum improvement of 15% in speech discrimination scores (SDS)] to corticosteroid therapy. No significant differences were observed between the three groups (IT, systemic group, and combination therapy group) in their overall response to treatment (p = 0.5). Patients who suffered from concomitant tinnitus and dizziness responded less positively to the treatment (p < 0.002). Positive family history of SSNHL seems to be negative prognostic factors in the response to treatment (p < 0.001). The response to treatment was not related to the pattern (p = 0.04) and initial severity of hearing loss (p = 0.9).

Conclusion

This study did not find any difference in the rate of hearing improvement between systemic, intratympanic, and combined corticosteroid therapy for sudden hearing loss.

Level of evidence

1b.

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Acknowledgements

The present study was funded and supported by the Tehran University of Medical Sciences (TUMS) under Grant No. 90-03-48-15295.

Author information

Authors and Affiliations

  1. Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mohammadtaghi Khorsandi Ashtiani, Farzad Firouzi, Shahin Bastaninejad, Sasan Dabiri, Sevil Nasirmohtaram, Niloufar Saeedi, Hossein Ghazavi & Leyla Sahebi

  2. Department of Otorhinolaryngology and Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran

    Mohammadtaghi Khorsandi Ashtiani, Farzad Firouzi, Shahin Bastaninejad, Sasan Dabiri, Sevil Nasirmohtaram, Niloufar Saeedi & Hossein Ghazavi

  3. Amir’Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Mohammadtaghi Khorsandi Ashtiani, Shahin Bastaninejad & Sasan Dabiri

  4. Tehran University of Medical Sciences, Tehran, Iran

    Farzad Firouzi, Sevil Nasirmohtaram, Niloufar Saeedi & Hossein Ghazavi

  5. ENT Department, Amir’Alam Hospital, North Sadee Avenue, Tehran, Iran

    Shahin Bastaninejad

Authors
  1. Mohammadtaghi Khorsandi Ashtiani
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Correspondence to Shahin Bastaninejad.

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Conflict of interest

There were no conflicts of interest and no financial relationships between authors, and also all authors contribute in the research process (e.g., study design, interpretation, revising, data analysis, and final approval). Authors did not submit or publish this article in another journal. Funding of this research was the Tehran University of Medical Sciences.

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Ashtiani, M.K., Firouzi, F., Bastaninejad, S. et al. Efficacy of systemic and intratympanic corticosteroid combination therapy versus intratympanic or systemic therapy in patients with idiopathic sudden sensorineural hearing loss: a randomized controlled trial. Eur Arch Otorhinolaryngol 275, 89–97 (2018). https://doi.org/10.1007/s00405-017-4808-0

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  • DOI: https://doi.org/10.1007/s00405-017-4808-0

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