TARGETED THERAPY IN ISSNHL: COMPARING ORAL AND INTRATYMPANIC CORTICOSTEROIDS
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Keywords
ISSNHL, idiopathic sudden sensorineural hearing loss, intratympanic steroids, oral steroids, corticosteroids, hearing recovery
Abstract
Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an otologic emergency characterized by rapid, unexplained hearing loss. Corticosteroids remain the mainstay of treatment, either administered systemically (oral) or locally via intratympanic (IT) injection. While systemic steroids are widely used, their efficacy can be limited by contraindications and suboptimal cochlear drug delivery. IT steroids offer targeted therapy with minimal systemic exposure, but comparative data remain limited.
Objective: To evaluate and compare the efficacy and safety of oral versus intratympanic corticosteroids in patients with ISSNHL.
Methods: A prospective, randomized comparative study was conducted at Adesh Medical College and Hospital, Ambala, between October 2023 and May 2025. Fifty patients with ISSNHL were randomized into two groups: Group A received oral prednisolone (1 mg/kg/day for 10 days, followed by tapering), and Group B received IT dexamethasone (4 mg/mL, 4 doses over 2 weeks). Hearing outcomes were assessed using pure tone audiometry at baseline and 3 months, and recovery was classified according to Siegel’s criteria. Adverse events were monitored throughout the study period.
Results: Both treatment modalities significantly improved hearing thresholds. The IT group demonstrated a higher mean hearing gain at 3 months (25.8 ± 8.3 dB) compared to the oral group (19.6 ± 7.5 dB, p = 0.01). Complete recovery occurred in 48% of IT patients versus 32% of oral patients, and the proportion of patients with no improvement was lower in the IT group (12% vs 28%). Adverse effects were mild and transient in both groups, with minimal systemic complications in the IT group.
Conclusion: Intratympanic corticosteroids offer superior auditory recovery with fewer systemic side effects, supporting their role as a first-line or alternative therapy for ISSNHL, particularly in patients with contraindications to systemic steroids. These findings emphasize the importance of early, targeted therapy in optimizing patient outcomes and quality of life.
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Dawood Agoo
Department of Otorhinolaryngology(ENT), Adesh Medical College and Hospital, Shahbad, Kurukshetra, Haryana, India.
Gurchand Singh
Department of Otorhinolaryngology(ENT), Adesh Medical College and Hospital, Shahbad, Kurukshetra, Haryana, India.
Reetika
Department of Otorhinolaryngology(ENT), Adesh Medical College and Hospital, Shahbad, Kurukshetra, Haryana, India.
Kondru Sahrudai
Department of Otorhinolaryngology(ENT), Adesh Medical College and Hospital, Shahbad, Kurukshetra, Haryana, India.
Sudhir Kumar
Department of Otorhinolaryngology(ENT), Adesh Medical College and Hospital, Shahbad, Kurukshetra, Haryana, India.