The 2012 American Academy of Otolaryngology- Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines on sudden sensorineural hearing loss (SNHL) have two statements that address steroid use. Statement eight indicates an option to offer corticosteroid as initial treatment for idiopathic SSHL. Statement 11 indicates a recommendation to offer intratympanic (IT) steroid perfusion for incomplete recovery after failure of initial treatment for idiopathic SSHL. The objective of this study was to compare the effectiveness of oral vs. IT vs. both corticosteroids in SSHL treatment. A subset of 117 patients who underwent corticosteroid treatment for SSHL was recruited from an initial larger CHEER network study on clinical practice guideline compliance. The average age was 56.3 and 56.3% were female. Right and left ears were affected equally. Of the patients, 55 (47%) received oral corticosteroid alone, 30.4% received oral + IT simultaneously, while 9.9% received IT alone, and 12.6% received oral followed by IT. The majority of patients (87.1%) reported a starting dose of 60mg. The number of days treated ranged from three to 34 with median days of oral alone = 12, simultaneous oral + IT = 14, and oral followed by IT = 10. Three injections was most common among oral + IT while one or two for IT alone.

Improvements were seen in all audiometry and speech testing scores with 57.7% of patients reporting minor or major subjective improvement. Analyses comparing oral alone vs. simultaneous oral + IT did not reveal significant differences.

The other two categories had inadequate sample sizes. This study does not show any difference between the various corticosteroid treatment approaches. The authors discuss challenges in conducting a randomised control study and instead propose a pragmatic clinical trial as the best alternative to evaluating corticosteroid treatment in SSHL.

Steroid Use for Sudden Sensorineural Hearing Loss: A CHEER Network Study.
Witsell DL, Mulder H, Rauch S, et al.
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Richard (Wei Chern) Gan

Royal Brisbane and Women's Hospital, Australia.

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