Efficacy of Intratympanic Steroid on Idiopathic Sudden Sensorineural Hearing Loss: An Analysis of Cases With Negative Prognostic Factors.

Purpose: We retrospectively studied the efficacy of intratympanic steroid administration in comparison with hyperbaric oxygen (HBO) therapy for idiopathic sudden sensorineural hearing loss (ISSNHL) with negative prognostic factors. Method: We enrolled 301 patients (302 ears) with ISSNHL (average hearing level at 250-4000 Hz >= 40 dB; time from onset to treatment <= 30 days). From August 2002 to March 2009, 174 patients (174 ears) received systemic steroid plus HBO therapy (HBO group), and from June 2015 to January 2018, 127 patients (128 ears) received systemic plus intratympanic steroid (IT group). Hearing outcomes were evaluated by 6 indices: cure rate, marked-recovery rate (percent of patients with hearing gain >= 30 dB), recovery rate (percent of patients with hearing gain >= 10 dB), hearing gain, hearing level after treatment, and percent hearing improvement compared to the unaffected contralateral ear. Results: The recovery rate was significantly higher in the IT group than in the HBO group (80.5% vs. 68.4%, p=.019). The IT group showed a higher recovery rate than the HBO group in patients aged >= 60 years (p=.010), patients with early (<= 7 days from onset) treatment (p=.005), patients with initial hearing levels >= 90 dB (p=.037), and patients with vertigo/dizziness (p=.040). The IT group also showed higher hearing gain and percent hearing improvement than the HBO group in patients with vertigo/dizziness (p=.046 and p=.026, respectively). Conclusions: Systemic plus intratympanic steroid is more effective for ISSNHL than systemic steroid plus HBO, particularly in patients with negative prognostic factors, such as old age, profound hearing loss, and/or presence of vertigo/dizziness.