CRITICAL EVALUATION OF TREATMENT PROTOCOLS IN IDIOPATHIC SUDDEN SENSORINEURAL HEARING LOSS
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Keywords
Idiopathic sudden sensorineural hearing loss; ISSNHL; corticosteroids; intra tympanic therapy; hyperbaric oxygen therapy; hearing recovery
Abstract
Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an otologic emergency characterized by rapid onset hearing impairment with an unclear etiology. Owing to the lack of definitive pathophysiological mechanisms, multiple management protocols are employed worldwide with variable outcomes. This study aims to critically analyze current management strategies for ISSNHL with emphasis on treatment modalities, timing of intervention, and hearing recovery outcomes.
Methodology: A structured critical review of English-language literature published between 2000 and 2024 was conducted using PubMed, Google Scholar, and the Cochrane Library. Studies involving adult patients with ISSNHL and reporting treatment outcomes were included. Data were extracted and categorized based on type of treatment modality, timing of therapy initiation, and degree of hearing recovery. A qualitative descriptive analysis was performed due to heterogeneity among studies.
Results: Corticosteroid therapy, administered systemically, intra tympanically, or in combination, emerged as the most effective management approach. Early initiation of treatment (≤7 days) was associated with significantly higher hearing recovery rates. Combined systemic and intra tympanic steroid therapy demonstrated superior outcomes compared to monotherapy, particularly in severe cases. Adjunctive hyperbaric oxygen therapy provided modest additional benefit, while non-steroidal therapies showed limited and inconsistent efficacy.
Conclusion: Early, steroid-based intervention remains the cornerstone of ISSNHL management. Combined therapeutic approaches may improve outcomes in selected patients, whereas routine use of non-steroidal treatments is not supported by strong evidence. Standardized treatment protocols and further high-quality clinical trials are required to optimize evidence-based management of ISSNHL.
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Tahir Haroon
ENT, Associate professor Ayub Medical College Abbottabad
Sohail Ahmad Malik
ENT, Associate Professor, Ayub medical college Abbottabad
Sundus Ghani
ENT, Senior Registrar ENT-A , Ayub Teaching Hospital, Abbottabad
Midrar Ullah
ENT FCPS-2 trainee registrar ENT A, ayub teaching hospital Abbottabad
Ahmed Arif
ENT, PGR (FCPS-2) ENT-A, Ayub Teaching Hospital, Abbottabad
Muhammad Asif
ENT, Professor Ayub Medical College Abbottabad
