Intratympanic corticosteroid for sudden hearing loss: does it really work?

Barreto, Monique Antunes de Souza Chelminski; Ledesma, Aleluia Lima Losno; Oliveira, Carlos Augusto Costa Pires de; Bahmad Jr, Fayez

doi:10.1016/j.bjorl.2015.06.007

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Brazilian Journal of Otorhinolaryngology

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REVIEW ARTICLES • Braz. j. otorhinolaryngol. 82 (03) • May-Jun 2016 • https://doi.org/10.1016/j.bjorl.2015.06.007 copy

Intratympanic corticosteroid for sudden hearing loss: does it really work?^{^☆} ☆ Please cite this article as: Barreto MASC, Ledesma ALL, de Oliveira CACP, Bahmad Jr F. Intratympanic corticosteroid for sudden hearing loss: does it really work? Braz J Otorhinolaryngol. 2016;82:353-64. ^{^☆☆} ☆☆ Institution: Universidade de Brasília (UnB), Brasília, DF, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

INTRODUCTION:

Sudden deafness is characterized by an abrupt hearing loss of at least 30 dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids.

OBJECTIVE:

To determine the effectiveness of therapy with intratympanic steroids in sudden deafness.

METHODS:

A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids.

RESULTS:

Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies.

CONCLUSION:

Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient.

Keywords:
Sudden hearing loss; Sudden deafness; Corticosteroids

Author and origin	Journal	Study design	Subjects (n)	Therapy	Medication and IT dosage	Audiometry frequency (kHz)	Results	Effectiveness rate (%)
Plontke et al., 2005 Germany	Acta Otolaryngol	Retrospective, placebo-controlled clinical trial	46: 23 (IT post OS), 23 (OS)	IT post OS × OS	MET 40 mg/mL DEX 4 mg/mL	0.5, 1, 2, 3	The study provided strong arguments for the need for controlled studies to investigate the efficacy of IT therapy.	(23) 95.0 (23) 25.0
Dallan et al., 2006 Italy	ORL J Otorhinolaryngol Relat Spec	Prospective	8	IT post OS × OS	MET 40 mg/mL	0.5, 1, 2, 3	IT is safe and effective in cases of refractory SHL.	(8) 75.0
Choung et al., 2006 Korea	Laryngoscope	Case–control, prospective and retrospective	67: 33 (IT post OS), 34 (OS)	IT post OS × OS	DEX	0.5, 1, 2, 4	IT is simple and effective post OS.	(33) 39.4 (34) 6.1
Raymundo et al., 2010 Brazil	Braz J Otorhinolaringol	Prospective	14	IT post OS	MET 40 mg/mL	0.5, 1, 2	IT is effective in patients who did not improve with OS therapy.	(14) 71.4
Chen et al., 2010 China	J Otolaryngol Head Neck Surg	Prospective	36 (IT post OS)	IT post OS	MET 40 mg/mL	0.125, 0.25, 0.5, 1, 2, 4, 8	IT is effective in cases of SHL or contraindication.	(36) 34.2
She et al., 2010 China	Otolaryngol Head Neck Surg	Prospective	49: 26 (IT) 23 (without treatment)	IT post OS	MET 40 mg/mL	0.25, 0.5, 1, 2, 3, 4, 8	IT through microcatheter is promising for refractory SHL.	(26) 61.9 (23) 21.7
Moon et al., 2011 Korea	Otol Neurotol	Retrospective	151: 59 (OS), 26 (OS 2 cycles), 66 (OS + IT)	IT post OS	DEX 0.4 at 0.5 mL	0.5, 1, 2, 3	IT as rescue therapy was more effective than another dose of OS.	(59) 16.9 (26) 15.3 (66) 48.4
Lee et al., 2011 Korea	Eur Archi Otorhinolaryngol	Prospective, case–control, randomized	46: 21 (IT post OS), 25 (OS)	IT post OS × OS	DEX 0.3 at 0.4 mL	0.5, 1, 2, 3	IT is simple and effective post OS.	(21) 47.6 (25) 16.0
Barreto et al., 2012 Brazil	Int Tinnitus J	Prospective	8	IT post OS	MET	0.5, 1, 2, 4	IT was effective in relief of tinnitus.	(8) 25.0
Wang et al., 2012 China	J Zhejiang Univ Sci B	Clinical trial, nonrandomized, retrospective	55 (IT), 32 (OS)	IT post OS	DEX 10 mg	0.5, 1, 2, 3, 4	IT is simple and effective post OS.	(55) 82.0 (32) 9.4
Chou et al., 2013 Taiwan	Laryngoscope	Case–control, prospective and retrospective	60: 30 (IT), 30 transtympanic	IT post OS		0.5, 1, 2, 4	IT had better audiological results.	(30) 53.3 (30) 43.3

Author and origin	Journal	Study design	Subjects (n)	Therapy	Medication and IT dosage	Audiometry frequency (kHz)	Results	Effectiveness rate (%)
Kakehata et al., 2006 Japan	Otol Neurotol	Prospective	Diabetics 31: 10 (IT), 21 (IV)	IT ×IV	DEX 4 mg/mL	0.25, 0.5, 1, 2, 4	IT is as effective as IV.	(10) 100.0 (21) 67.0
Xenellis et al., 2006 Greece	Otolaryngol Head Neck Surg	Prospective	37: 19 (IT post IV), 18 (IV)	IT post IV	MET 40 mg/mL	0.5, 1, 2, 4	IT post failure IV is safe and effective in cases of refractory SHL.	(19) 47.0 (18) 0.0
Plaza and Herráiz, 2007 Spain	Otolaryngol Head Neck Surg	Prospective, non-randomized	18: 9 (IT post IV), 9 (OS post IV)	IT post IV	MET 20 mg/mL	0.5, 1, 2, 3	IT is safe and effective in cases of refractory SHL.	(9) 55 (9) 0.0
Plontke et al., 2009 Germany	Laryngoscope	Randomized, double-blind, placebo-controlled, multicenter	23	IT post IV	DEX	0.5, 1, 2, 4	IT had better results.	(23) 24.4
Dallan et al., 2010 Italy	Otol Neurotol	Retrospective	27	IT post IV	MET 40 mg/mL	0.5, 1, 2, 3	IT is effective in cases of refractory SHL.	(27) 55
Li et al., 2011 China	Audiol & Neurotol	Prospective	65: 24 IT post IV, 21 topic post IV, 20 IV	IT post IV	MET 40 mg/mL	0.5, 1, 2, 4	IT is efficient rescue	(24) 37 (21) 0.0 (20) 0.0

Author and origin	Journal	Study design	Subjects (n)	Therapy	Medication and IT dosage	Audiometry frequency (kHz)	Results	Effectiveness rate (%)
Banerjee and Parmers, 2005 Canada	Otol Neurotol	Retrospective	26	IT	MET 40 mg/mL	0.5, 1, 2	IT is safe and effective, no significant adverse effects.	(26) 75.4
Filipo et al., 2010 Italy	Acta Otolaryngol	Prospective	34	IT	P 62.5 mg/mL	0.5, 1, 2	IT was effective.	(34) 79.3
Rauch et al., 2011 USA	JAMA	Clinical trial, prospective, randomized, multicenter	250: 129 (IT)	IT × OS	MET 40 mg/mL	0.5, 1, 2, 4	IT can be used when there is contraindication to OS.	(129) 86.8 (121) 87.6
Kakehata et al., 2011 Japan	Audiol & Neurotol	Retrospective	76: 19 IT, 24 IT post OS, 33 OS	IT × OS × IT post OS	DEX 4 mg/mL	0.25, 0.5, 1, 2, 4	Short-term IT has high response rate and healing, and can be used as a first or second choice.	(19) 95.0 (24) 63.0 (33) 84.0
Zhang et al., 2012 China	Acta Oto-Laryngologica	Prospective	74: 35 IT, 39 IT post OS	IT	DEX 0.5 at 0.7 mL	0.25, 0.5, 1, 2, 4	IT is effective as first choice and as rescue therapy, and the Eustachian tube is a noninvasive way to provide safe medication administration.	(35) 80.0 (39) 64.1
Filipo et al., 2013 Italy	Laryngoscope	Prospective, randomized, triple-blind	50: 25 (IT), 25 (without treatment)	IT	MET 40 mg/mL	0.25, 0.5, 1, 2, 3, 4, 8	IT was effective.	(25) 76.0 (25) 20.0

Author and origin	Journal	Study design	Subjects (n)	Therapy	Medication and IT dosage	Audiometry frequency (kHz)	Results	Effectiveness rate (%)
Lautermann et al., 2005 Germany	Eur Arch Otorhinolaryngol	Prospective, nonrandomized	27: 14 (IV), 13 (IT + IV)	IV × IT + IV	MET 32 mg/mL	0.5, 0.75, 1, 2, 3, 4	IT did not increase the hearing gain.	(14) 51.8 (13) 48.4
Gouveris et al., 2011 Germany	Otol Neurotol	Retrospective	170: 94 HL moderate (IV) 76 HL severe (IV+ IT)	IV × IV + IT	DEX 0.4 mL, 8 mg/mL	0.5, 1, 2, 4, 8	There was no difference between the groups.	(94) 70.0 (76) 73.0
Arslan et al., 2011 Turkey	Otol Neurotol	Prospective	128: 73 (IV + OS), 84 (IT post OS)	IT post OS × IV + OS	MET 0.5 mL 125 mg/mL	0.5, 1, 2, 4	IT as rescue therapy increased the likelihood of hearing recovery.	(73) 40.0 (84) 70.0
Bae et al., 2013 Korea	Acta Oto-Laryngologica	Retrospective	735: 94 (IT), 444 (OS), 197 (OS + IT)	IT × OS × IT + OS	DEX 0.5 at 0.6 mL	0.5, 1, 2, 3	IT was as effective as OS and OS + IT should indicate when there is a contraindication to OS.	94 (64.9) 444 (68.7) 197 (59.3)
Koltsidopoulos et al., 2013 Greece	Otol Neurotol	Prospective, clinical trial, quasi- randomized, controlled	92 46 (IT + OS) × 46 (IV + OS)	IT + OS × IV + OS	DEX 0.4 at 0.6 mL	0.5, 1, 2, 4	IT + OS were more effective in patients with moderate to severe HL.	(46) 75.0 (46) 41.1
Baysal et al., 2013 Turkey	J Craniofac Surg	Retrospective	69: 30 (OS), 39 (OS + IT)	OS + IT X OS	DEX 0.5 mL	0.5, 1, 2, 4	There was no difference between the groups.	30 (74.3) 39 (77.4)
Gundogan et al., 2013 Turkey	Otolaringol Head Neck Surg	Clinical trial, prospective, randomized	73: 37 (IT + OS), 36 (OS)	OS + IT × OS	MET 0.4 mL	0.5, 1, 2, 3	Combination therapy achieved better hearing threshold and auditory discrimination, and should be considered as initial treatment.	(37) 89.0 (36) 61.1

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[1] * Corresponding author. E-mail:fayez@gmail.com (F. Bahmad Jr).