Choice of steroids for intratympanic therapy– a retrospective comparison

Abstract

Purpose: Comparison of dexamethasone phosphate (DXA) and triamcinolone acetonide (TCA) for intratympanic therapy (IT) in patients with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) to reveal a potential superiority regarding the efficiency to improve hearing function. Methods: Retrospective, monocentric, two-armed cohort-study. Analysis of clinical and audiometric data of patients treated with IT for unilateral ISSNHL. 118 adults, who received IT with DXA (n = 67) or TCA (n = 51) were included. Main outcome parameters were hearing improvement in percent and decibel (dB) in relation to the healthy ear within a follow-up period of three months. Response to therapy was defined as an improvement of at least 10dB in affected frequencies. Results: Median improvement was 24.6% and 6.2 dB in the DXA group, 31.4% and 10.0 dB in the TCA group. For the response analysis, 7 patients dropped out. Of the remaining 111 patients, 27 (43,5%; 95%CI 30,9–56,7) in the DXA and 26 (53,0%; 95%CI 38,2–67,4) in the TCA group showed response. Analysis of the outcome parameters showed no statistically remarkable difference (p < 0,05) between the two cohorts. The difference of initial pure tone average between the affected and healthy ear and the time between symptom onset and first IT, was confirmed as an influencing factor to the outcome. Conclusion: For intratympanic treatment of ISSNHL dexamethasone phosphate and triamcinolone acetonide seem equivalent considering its ability to improve hearing function. A more severe hearing loss and a short duration between onset and therapy may favor the chance of hearing recovery.