A Prospective, Multi-Centered Study of the Treatment of Idiopathic Sudden Sensorineural Hearing Loss With Combination Therapy Versus High-Dose Prednisone Alone: A 139 Patient Follow-up

Abstract

Objective To compare combination therapy (high-dose prednisone taper (HDPT) + intratympanic dexamethasone (IT-Dex)) hearing recovery results in ISSNHL patients with those treated with HDPT alone. Design Prospective, multicentered trial. Setting Tertiary referral center. Patients Eighty ISSNHL patients with class C or D hearing. Intervention Eighty qualifying patients were treated with IT-Dex (10 mg/ml) every week for 3 weeks concomitant with HDPT (60 mg/d for 7 d with 7-d taper) and followed prospectively. Main outcome measure(s) Four-tone pure tone average (PTA) at 0.25, 0.5, 1, and 2 kHz and speech discrimination scores (SDS) 2 months posttreatment; Hearing results compared retrospectively with those of 59 ISSNHL treated with HDPT alone. Results Combination therapy and HDPT alone both provided a statistically significant benefit in audiometric parameters, especially if treated within 7 days of onset. However, 49% versus 29% (p = 0.02) of class D patients receiving combination therapy versus HDPT achieved serviceable hearing. Patients receiving combination therapy versus HDPT experienced a significantly greater improvement in PTA (34.1 ± 27 dB versus 12.0 ± 21 dB; p Conclusion Combination therapy offers ISSNHL patients the highest likelihood of achieving class A and B hearing. Differential results with combination therapy and HDPT compared with previous studies suggest time- and dose-dependent responses to the treatment of ISSNHL.