Combination Therapy for the Treatment of Idiopathic SSNHL

Abstract

Objective: To determine whether combination therapy (highdose prednisone taper [HDPT]+intratympanic dexamethasone [IT-Dex]) improves pure tone average scores (PTA) and speech discrimination scores (SDS) relative to HDPT alone or intratympanic steroid (IT-S) alone in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Method: From June 2008 to January 2012, 84 (15 dropouts) patients diagnosed with ISSNHL were administered IT-De (10 mg/cc) once-a-week for 3 weeks + HDPT (60 mg/day for 7 days with 7-day taper). Final audiogram results are compared to previously published results of combination therapy, HPDT alone, and IT-S alone. Results: Treatment began on average 6.6 days after onset of ISSNHL. The average pretreatment 3-tone PTA was 83.2, and the average pretreatment SDS was 16%. The overall PTA improved significantly by an average of -38. The overall SDS improved significantly by an average of 49%. The average overall posttreatment SDS was 65%. 60/69 (87%) patients started with an SDS score less than or equal to 50%, and 38 (63%) of these ended above 50%. 24/42 (57%) of the profound patients recovered with an SDS above 50%. According to published reports, HDPT and IT-S alone improve SDS by only 39%. Conclusion: ISSNHL patients treated with IT-De+ HDPT experienced statistically significant PTA and SDS improvements, comparable to previously published combination therapy results. The audiologic data indicate that combination therapy improves hearing recovery relative to HDPT or IT-S alone, possibly by improving hair cell and spiral ganglion survival.