Is there evidence to support the use of oral corticosteroids and concurrent intratympanic steroid injections for sudden sensorineural hearing loss (SSNHL)?

From the Guidelines

Yes, there is evidence supporting the use of combined oral steroids and intratympanic steroid injections for sudden sensorineural hearing loss (SSNHL). The recommended approach is to start oral prednisone at 1 mg/kg/day (maximum 60 mg daily) for 7-14 days with a taper over an additional week, alongside intratympanic dexamethasone injections (typically 10-24 mg/mL) administered 1-3 times weekly for 2-3 weeks, as suggested by the clinical practice guideline: sudden hearing loss (update) 1.

Key Considerations

• The dual approach works by reducing inflammation and swelling in both systemic and targeted ways - oral steroids provide systemic anti-inflammatory effects while intratympanic injections deliver medication directly to the inner ear, bypassing the blood-labyrinth barrier.
• This combination is particularly valuable for patients with moderate to severe hearing loss (>40-50 dB), those with incomplete recovery after oral steroids alone, or individuals with contraindications to high-dose oral steroids.
• Patients should be informed that multiple intratympanic injections may cause temporary dizziness, pain, or tympanic membrane perforation, though these complications are generally minor and self-limiting.
• The benefits of therapy may include more prompt and complete recovery of hearing, but there are also side effects that must be considered when choosing among the available options, as noted in the guideline 1.

Treatment Guidelines

• Clinicians may offer corticosteroids as initial therapy to patients with SSNHL within 2 weeks of symptom onset, as stated in the guideline 1.
• Clinicians should offer, or refer to a clinician who can offer, intratympanic steroid therapy when patients have incomplete recovery from SSNHL 2 to 6 weeks after onset of symptoms, as recommended in the guideline 1.
• The guideline also emphasizes the importance of patient education and shared decision-making, considering patient preferences and values, which result in mutual decision-making, leading to better patient adherence and outcomes 1.

Important Considerations for Treatment

• The lack of clear evidence supporting systemic steroids for SHL and the existence of potential adverse treatment effects support a large role for shared decision making with patients, as noted in the guideline 1.
• Most serious side effects, however, occur with chronic use, and adverse events are rare and manageable for the short 10- to 14-day course of steroids recommended for SSNHL, as stated in the guideline 1.

Audiometric Evaluation and Follow-up

• Clinicians should obtain follow-up audiometric evaluation for patients with SSNHL at the conclusion of treatment and within 6 months of completion of treatment, as recommended in the guideline 1.
• Clinicians should counsel patients with SSNHL who have residual hearing loss and/or tinnitus about the possible benefits of audiologic rehabilitation and other supportive measures, as suggested in the guideline 1.

From the Research

Evidence for Oral Steroids and Concurrent Intratympanic Steroid Injections

• There is evidence to support the use of oral steroids and concurrent intratympanic steroid injections for sudden sensory neural hearing loss, as seen in studies 2, 3.
• A study published in 2021 found that the combination of intravenous dexamethasone and intratympanic methylprednisolone injection was effective in treating unilateral sudden sensorineural hearing loss, with similar hearing threshold improvement in both groups 2.
• Another study published in 2020 found that combined therapy (CT) comprising intratympanic steroid therapy (IST) and systemic steroid therapy (SST) had significant recovery rate improvement and better hearing improvement compared to SST alone 3.
• A systematic review published in 2024 found that high-dose corticosteroid therapy may be more effective than standard-dose therapy in treating sudden sensorineural hearing loss, but the overall quality of the available evidence was deemed to be low 4.
• Other studies have also shown that oral corticosteroid therapy is a good therapeutic option for the treatment of sudden sensorineural hearing loss, with better response to therapy in patients with milder hearing loss and those who present early to the otologist for treatment 5, 6.

Key Findings

• The use of oral steroids and concurrent intratympanic steroid injections may be an effective treatment for sudden sensory neural hearing loss 2, 3.
• High-dose corticosteroid therapy may be more effective than standard-dose therapy in treating sudden sensorineural hearing loss, but more research is needed to confirm this 4.
• Early presentation and milder hearing loss are associated with better response to therapy 5, 6.
• Intratympanic methylprednisolone injection may be a useful treatment option for patients who fail systemic corticosteroid treatment 6.