Treatment of sudden sensorineural hearing loss with transtympanic injection of steroids as single therapy: a randomized clinical study.

The aim of this study was to verify the efficacyand the safety of transtympanic dexamethasone to treatsudden sensorineural hearing loss as first and single drugmethod. Considering ethical implication of performing amininvasive procedure on middle ear, we matched suchproposed treatment with systemic prednisone administrationthat represents the widest adopted protocol. Randomizedprospective study was conducted. The inclusioncriterion was a sudden sensorineural hearing loss of at least30 dB across three contiguous frequencies over a period of24 h. Group A received transtympanic steroid injections;Group B received oral administration of steroids. 25patients were treated with transtympanic therapy whereas21 underwent systemic treatment. The mean of initial PTAwas 59 dB for the whole series: 65 dB for group A and51 dB for group B. The recovery better than 10 dB wasobtained in 80% of patients of group A and in 17 81% ofpatients of group B, with a total of 80.5%. The mean relativegain in PTA was 41.16% in the group A and 44.7% inthe group B. In the frequencies tested (0.5, 1, 2, and 4 kHz)PTA improvements after transtympanic treatment werehigher than after systemic treatment, but these differenceswere not statistically significant (P = 0.61). Both transtympanicand systemic treatment had similar clinicalrecovery times. This prospective randomized clinical studyshowed good result in terms of hearing recovery, betterthan the expected results of the simple observation withouttreatment. We can consider transtympanic administrationas a first line treatment, because of the statistical analysisconfirmed similar results with systemic therapy, reducingpossible side effects of systemic drug administration. Thedelay of treatment does not influence the outcome, allowingtreating patients within 10 days of onset.