Intratympanic Dexamethasone Injection as Effective as Alternative Treatments for SSNHL

How effective is intratympanic dexamethasone (ITD) injection for the treatment of sudden sensorineural hearing loss (SSNHL) compared to systemic administration?

Bottom line
There is no sufficient scientific evidence to support a difference between ITD and alternative therapy for SSNHL. Larger andomized controlled clinical trials (RCCTs) are needed to determine ITD effectiveness compared to oral steroid therapy.

Background: Idiopathic SSNHL has been widely studied. The majority of treatment protocols are centered on glucocorticoids due to their antioxidant and anti-inflammatory properties, but there are potential adverse effects. IT steroid administration is a promising technique, but a consensus has not been reached on IT steroid indications, concentrations, dosage, and a standardized treatment protocol.

Study design: Systematic review and meta-analysis of eight RCTs, with 416 participants across the studies (192 treatment, 224 control).

Setting: Cochrane, Embase, and MEDLINE electronic databases from January 1950 to August 2014, with an update performed on Nov. 10, 2014.

Synopsis: ITD dosing regimens and ITD concentrations varied, ranging from 4 mg/mL23 to 12 mg/mL. ITD volume injected varied between 0.3 and 0.7 mL. Efficacy rates varied between 89% and 50% as a second-line treatment for refractory SSNHL. Hearing improvement was seen in 72% of all treatment patients; complete hearing recovery was achieved in 20%, with 52% achieving partial hearing improvement and 28% showing no improvement. A meta-analysis comparing treatment groups to control groups did not reach statistical significance. There were no serious or life-threatening side effects (SE).

SE Group 1 (procedure-related, very short-term, self-resolving) included 54 events (81% of all SE; 13% of study population) such as otalgia, ear fullness, headache, short-lived vertigo, and dizziness. SE Group 2 (procedure-related short-term, requiring medical or surgical intervention) included five events (7.7% of all SE; 1.2% of study population). SE Group 3 (procedure-related long-term, requiring medical or surgical intervention) included three events (4.6% of all SE; 0.7% of study population). SE Group 4 (drug-related) included one case of acne.

Limitations included potential bias from not blinding participants, personnel, and assessors, and a lower data reporting quality.

Citation: El Sabbagh, NG, Sewitch MJ, Bezdjian A, Daniel SJ. Intratympanic dexamethasone in sudden sensorineural hearing loss: a systematic review and meta-analysis. Laryngoscope. 2017;127:1897–1908.