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Cited by 4Vestibular and auditory disordersHearing, Cochlea, Tinnitus, GeneticsHearing Loss and Rehabilitation

Intratympanic steroid administration and predictors of recovery in sudden sensorineural hearing loss

Open access
Kennedy, Devin J., Williams, Erin, Wolf, Lucienna, Golden, Jacquelyn, Lana, Addison, Wiefels, Matthew, Pyle, Madeline, Yunis, Valerie +1 more·2025·PLOS One
DOI 10.1371/journal.pone.0332809PMC PMC12510503
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Abstract

Objectives: Sudden sensorineural hearing loss patient outcomes remain highly variable despite established treatment modalities. This study investigates the effects of treatment modalities, individual-level risk factors, and clinical presentation on sudden sensorineural hearing loss recovery. Methods: Retrospective chart review of n = 231 patients who initiated intratympanic steroids between 01/01/2015-01/01/2025 following sudden sensorineural hearing loss. We collected individual-level risk factors and comprehensive audiometric data. Logistic and linear regression analyses were performed to identify relationships between patient, disease, and treatment-related variables to audiometric recovery (pure-tone average and word recognition score). Segmented linear regression analysis was used to assess the influence of intratympanic steroid treatment delay on patient recovery. Recovery outcomes were determined in accordance with American Academy of Otolaryngology-Head and Neck Surgery criteria. Results: Earlier intratympanic steroid initiation following sudden sensorineural hearing loss symptom onset significantly predicted increased pure-tone average recovery (p < 0.001) irrespective of intratympanic steroid status as primary treatment or as salvage therapy following oral steroids. Intratympanic steroid efficacy significantly diminished if initiated beyond 18 days following symptom onset (p < 0.001). Total number of intratympanic received and time between subsequent intratympanic injections did not impact recovery. Patient-level factors including demographics, socioeconomic status, medical and social risk factors, and medical comorbidities were largely found to have no significant relationship with recovery. Increased initial pure-tone average was associated with poorer overall pure-tone average recovery (p < 0.001). The presence of initial serviceable hearing predicted worse final recovery status (p = 0.01). Bilateral sudden sensorineural hearing loss showed significantly worse pure-tone average recovery compared to unilateral sudden sensorineural hearing loss (p = 0.04). Conclusion: Intratympanic steroids are an effective treatment option for sudden sensorineural hearing loss. Clinicians should be mindful of intratympanic steroid initiation timing and case-specific factors that may influence sudden sensorineural hearing loss recovery when treating patients with sudden sensorineural hearing loss.

AI snapshot

Written from the paper’s full text.

TL;DR

In a retrospective cohort of 231 adults with sudden sensorineural hearing loss (SSNHL), earlier intratympanic (IT) steroid initiation significantly predicted better pure-tone average (PTA) recovery, with benefit diminishing after an 18-day breakpoint. Most patient-level demographic, socioeconomic, and comorbidity factors were not significantly associated with recovery.

Key findings

  • Earlier IT steroid initiation significantly predicted greater PTA recovery (p < 0.001), whether IT was primary or salvage therapy after oral steroids; segmented regression identified an 18-day breakpoint (SE 2.92) after which recovery plateaued/worsened (p < 0.001).
  • Total number of IT injections and time between subsequent injections did not significantly affect recovery.
  • Higher initial PTA was associated with poorer PTA recovery (p < 0.001); initial serviceable hearing predicted worse final recovery status (p = 0.01); bilateral SSNHL showed worse PTA recovery than unilateral SSNHL (p = 0.04).
  • Demographics, socioeconomic status, medical/social risk factors, and comorbidities largely had no significant relationship with recovery; average improvement was 12 dB PTA and 11% word recognition score, with 41% partial/complete recovery and 59.3% no response.

Methods

  • Retrospective chart review of n = 231 patients aged 18–70 who received at least one IT steroid injection for SSNHL at an urban tertiary academic center between 01/01/2015 and 01/01/2025; exclusions included vestibular schwannoma, Meniere’s disease, chemotherapy within 4 weeks of onset, and incomplete audiometric or date data.
  • Collected demographics, census-based socioeconomic indicators, comorbidities, risk factors, SSNHL course, and audiometric data (PTA at 0.5, 1, 2, 3 kHz and word recognition scores) at initial and final timepoints; recovery classified per AAO-HNS criteria.
  • Logistic and linear regression modeled recovery and PTA change; segmented linear regression with a single breakpoint assessed IT treatment delay; α = 0.05, analyses in R.

Limitations

  • Stated: patients who recovered after oral steroids alone were not captured, so direct comparison of IT efficacy versus systemic therapy cannot be fully established; retrospective design may introduce referral bias and unmeasured confounders such as oral steroid adherence or prior care.
  • Evident from design: single-center retrospective cohort with no untreated or non-IT control arm, limiting inference about natural history or comparative effectiveness; age restriction to 18–70 and exclusions further limit generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0332809

Cites

17 of 18 references verified0 citation errors · 1 not checkable

Statistics

Claims the paper makes

4 of 25 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured

  • Findingown data
    § Discussion · p. 11

    Worse baseline PTA values predicted poorer recovery.

    “contrary to previous work [13], we found that worse baseline PTA values predicted poorer recovery.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [13] A Liebau, 2017, Hearing changes after intratympanically applied steroids for primary therapy of sudden hearing loss: a meta-analysis using mathematical simulations of drug delivery protocols, Otol Neurotol source
  • Findingcitation
    § Discussion · p. 11

    The average time from symptom onset to IT treatment in our cohort was two weeks longer than those reported by Liebau et al.

    “The average time from symptom onset to IT treatment in our cohort was two weeks longer than those reported by Liebau et. al.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [13] A Liebau, 2017, Hearing changes after intratympanically applied steroids for primary therapy of sudden hearing loss: a meta-analysis using mathematical simulations of drug delivery protocols, Otol Neurotol source

      The Methods (Data Sources and Study Selection; page unavailable) discuss delay from symptom onset to treatment, and the Results (page unavailable) analyze treatment delay. Neither passage gives an average onset-to-IT-treatment time for Liebau et al.’s study groups, so the claimed two-week difference cannot be checked against our copy. Searched for mean and average onset-to-treatment intervals and the two-week figure. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
  • Premisecitation
    § Introduction · p. 2

    Conclusive assessment of steroid efficacy has been hindered by a limited understanding of sudden sensorineural hearing loss pathogenesis and study design heterogeneity.

    “Conclusive assessment of steroid efficacy has been hindered by a limited understanding of SSNHL pathogenesis and study design heterogeneity [4].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] M Marx, 2018, International consensus (ICON) on treatment of sudden sensorineural hearing loss, Eur Ann Otorhinolaryngol Head Neck Dis source
  • Findingown data
    § Results · p. 2

    Patient-level factors including demographics, socioeconomic status, medical and social risk factors, and medical comorbidities were largely found to have no significant relationship with recovery.

    “Patient-level factors including demographics, socioeconomic status, medical and social risk factors, and medical comorbidities were largely found to have no significant relationship with recovery.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Treatment modalities · p. 6

    No other main effects and interaction terms in the linear regression model were significant.

    “No other main effects and interaction terms in this model were significant.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 13
  • May combine two claims. 8
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationown data
    § Discussion · p. 10

    The finding underscores the critical, time-sensitive nature of early referral and intervention, particularly among nonotolaryngologists.

    “More broadly, this finding underscores the critical, time-sensitive nature of early referral and intervention, particularly among nonotolaryngologists [2,8,9].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [2] SS Chandrasekhar, 2019, Clinical practice guideline: sudden hearing loss (update), Otolaryngol–Head Neck Surg source
    • cites [8] TH Alexander, 2015, Dose effect of intratympanic dexamethasone for idiopathic sudden sensorineural hearing loss: 24 mg/mL is superior to 10 mg/mL, Otol Neurotol source

      The Discussion (page unavailable) calls idiopathic sudden sensorineural hearing loss an otologic emergency and says early therapy maximizes the chance of recovery; the Conclusion recommends starting treatment as soon as possible. The paper does not address referral practices or nonotolaryngologists specifically. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [9] A Battaglia, 2014, 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, Otol Neurotol source

  • May combine two claims.

    Findingown data
    § Treatment modalities · p. 6

    Oral steroid timing and total number of injections received were largely similar between all three recovery groups.

    “Oral steroid timing and total number of injections received were largely similar between all three recovery groups.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data
    § Treatment modalities · p. 6

    Compared to concurrent intratympanic administration, patients treated with oral steroids following intratympanic had worse hearing outcomes as evidenced by higher final pure-tone average (β = 32.35, SE = 20.62, t = 1.57, p = 0.12).

    “patients treated with oral steroids following IT ( β = 32.35, SE = 20.62, t = 1.57, p = 0.12)”
    • Also stated in: § Treatment modalities · p. 6 · plain
      “had worse hearing outcomes as evidenced by a higher final PTA.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Conclusion · p. 11

    Other treatment factors (total IT injections and their chronology relative to oral steroid use) did not significantly impact recovery.

    “Other treatment factors (i.e., total IT injections and their chronology relative to oral steroid use) did not significantly impact recovery”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Discussion · p. 11

    No other comorbidities or other social risk factors were found to be significant predictors of SSNHL recovery.

    “No other comorbidities or other social risk factors were found to be significant predictors of SSNHL recovery.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Comorbidities and risk factors · p. 10

    Vaping was the only PTA-influencing behavioral or environmental risk factor and had a positive association with improved hearing outcomes (β = -29.04, SE = 15.99, t = -1.82, p = 0.07).

    “the only PTA-influencing behavioral or environmental risk factor was vaping, which had a positive association with improved hearing outcomes ( β = -29.04, SE = 15.99, t = -1.82, p = 0.07).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Demographics · p. 9

    Male sex approached but did not reach statistical significance for PTA change.

    “male sex approached but did not reach statistical significance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Demographics, Social Determinants of Health, Risk Factors, Comorbidities, SSNHL History · p. 8

    The segmented model of hearing outcomes had adjusted R2 = 0.22, substantially improving fit compared to the unsegmented model (adjusted R2 = 0.08).

    “in hearing outcomes (adjusted R² = 0.22), substantially improving fit compared to the unsegmented model (adjusted R² = 0.08).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Discussion · p. 11

    Age was not found to significantly influence outcomes, nor were any other demographic variables.

    “Age was not found to significantly influence outcomes, nor were any other demographic variables”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation
    § Discussion · p. 10

    Only 41% of patients exhibited partial or complete recovery according to AAO-HNS guidelines, with nearly 60% exhibiting no response to treatment.

    “only 41% of patients exhibited partial or complete recovery according to AAO-HNS guidelines [2], with nearly 60% of patients exhibiting no response to treatment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] SS Chandrasekhar, 2019, Clinical practice guideline: sudden hearing loss (update), Otolaryngol–Head Neck Surg source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § Discussion · p. 10

    The retrospective design raises the possibility of referral bias, as late-presenting patients may differ systematically from those who present earlier, which could influence the observed treatment outcomes.

    “the retrospective design raises the possibility of referral bias, as late-presenting patients may differ systematically from those who present earlier, which could influence the observed treatment outcomes.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation
    § Discussion · p. 10

    AAO-HNS guidelines for ideal IT therapy stipulate treatment within 14 days of SSNHL symptom onset.

    “current AAOHNS guidelines for ideal IT therapy, which stipulate treatment within 14 days of SSNHL symptom onset.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] SS Chandrasekhar, 2019, Clinical practice guideline: sudden hearing loss (update), Otolaryngol–Head Neck Surg source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction · p. 2

    Standard diagnostic criteria for sudden sensorineural hearing loss constitutes a decrease of ≥30 decibels in hearing thresholds affecting three or more consecutive frequencies.

    “Although standard diagnostic criteria for SSNHL constitutes a decrease of ≥30 decibels in hearing thresholds affecting three or more consecutive frequencies, many clinicians have adopted more flexible cutoffs to prioritize symptomatic complaints and overall clinical picture of their patients [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] SS Chandrasekhar, 2019, Clinical practice guideline: sudden hearing loss (update), Otolaryngol–Head Neck Surg source

  • May combine two claims.

    Interpretationreasoning
    § Discussion · p. 11

    The population described herein likely benefited less from spontaneous recovery, which occurs within 14 days from symptom onset, and consequently had worse hearing recovery.

    “The population described herein likely benefited less from spontaneous recovery, which occurs within 14 days from symptom onset, and as a consequence are associated with worse hearing recovery [14-17].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [14] FM Byl, 1984, Sudden hearing loss: eight years’ experience and suggested prognostic table, Laryngoscope source
    • cites [15] SD Rauch, 2004, Intratympanic steroids for sensorineural hearing loss, Otolaryngol Clin North Am source
    • cites [16] DE Mattox, 1977, Natural history of sudden sensorineural hearing loss, Ann Otol Rhinol Laryngol source
    • cites [17] G Plaza, 2007, Intratympanic steroids for treatment of sudden hearing loss after failure of intravenous therapy, Otolaryngol Head Neck Surg source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation
    § Discussion · p. 10

    The observed recovery percentages align with previous reports, such as Parnes et al. who reported improvements in approximately one-third of patients following IT steroids.

    “While these percentages align with previous reports, such as those from Parnes et al. who reported improvements in approximately one-third of patients following IT steroids [6]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] LS Parnes, 1999, Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application, Laryngoscope source

  • Classified as probably not a substantial claim.

    Study design and conductreasoning
    § Retrospective chart review · p. 3

    Patients older than 70 years were excluded to minimize confounding from presbycusis.

    “Patients older than 70 years were excluded to minimize confounding from presbycusis.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation
    § Introduction · p. 2

    Current clinical practice guidelines for sudden sensorineural hearing loss include administration of oral systemic corticosteroids and/or salvage intratympanic steroid injections.

    “Current clinical practice guidelines for SSNHL include the administration of oral, systemic corticosteroids and/or salvage intratympanic (IT) steroid injections [2], though they have been shown to be comparatively efficacious when given adjunctively [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] SS Chandrasekhar, 2019, Clinical practice guideline: sudden hearing loss (update), Otolaryngol–Head Neck Surg source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Retrospective chart review · p. 3

    All audiometric measurements were obtained by a licensed clinical audiologist with calibrated, clinically operated equipment.

    “All audiometric measurements were obtained by a licensed clinical audiologist with calibrated, clinically operated equipment.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation
    § Outcomes · p. 3

    Hearing serviceability and recovery classifications were classified according to American Academy of Otolaryngology-Head and Neck Surgery guidelines.

    “Hearing serviceability and recovery classifications were classified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines [2].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] SS Chandrasekhar, 2019, Clinical practice guideline: sudden hearing loss (update), Otolaryngol–Head Neck Surg source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data
    § Conclusion · p. 11

    The association underscores the critical importance of early intervention.

    “underscores the critical importance of early intervention.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction · p. 2

    Many clinicians have adopted more flexible cutoffs to prioritize symptomatic complaints and overall clinical picture of their patients.

    “Although standard diagnostic criteria for SSNHL constitutes a decrease of ≥30 decibels in hearing thresholds affecting three or more consecutive frequencies, many clinicians have adopted more flexible cutoffs to prioritize symptomatic complaints and overall clinical picture of their patients [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] SS Chandrasekhar, 2019, Clinical practice guideline: sudden hearing loss (update), Otolaryngol–Head Neck Surg source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion · p. 10

    IT steroid salvage therapy may be effective up to 3 months following symptom onset.

    “Work by Slattery et. al found that IT steroid salvage therapy may be effective up to 3 months following symptom onset [7]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] WH Slattery, 2005, Intratympanic steroid injection for treatment of idiopathic sudden hearing loss, Otolaryngol Head Neck Surg source
22 of 22

  • The paper relies on this without support.

    Sudden sensorineural hearing loss hearing outcomes remain highly variable despite established treatment paradigms.

    “Despite these established treatment paradigms, SSNHL hearing outcomes remain highly variable.”

  • The paper relies on this without support.

    No prior studies have investigated treatment timing, patient-level risk factors, and both primary and salvage therapy in the context of outcomes following sudden sensorineural hearing loss.

    “To date, no prior studies have investigated treatment timing, patient-level risk factors, and both primary and salvage therapy in the context of outcomes following SSNHL.”

  • The paper relies on this without support.

    In general, IT treatment consists of weekly injections for a total of 3-5 injections.

    “in general treatment consists of weekly IT injections for a total of 3-5 injections.”

  • The paper relies on this without support.

    The standard duration commonly used in practice is approximately 7 days between subsequent IT injections.

    “while the average time between subsequent IT injections approximated 7 days, the standard duration commonly used in practice”
4 of 4

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentz = 1.72reported p = .09 · recomputed p = .085

    “z = 1.72, p = .09”

  • Consistentz = 1.95reported p = .052 · recomputed p = .051

    “z = 1.95, p = .052”

  • Consistentz = -2.8reported p = .005 · recomputed p = .005

    “z = -2.80, p = .005”

3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Two different cohort means for days to first injection

    Minor

    Table 1 reports 29.6 days to first IT injection, while Table 2 reports 29.7 days for the same 231-patient cohort. Both values are printed to one decimal place, so they cannot both be the rounded mean of the same measurements.

1 of 1

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Authors
Kennedy, D. J., Williams, E., Wolf, L., Golden, J., Lana, A., Wiefels, M., Pyle, M., Yunis, V., & Hoffer, M.
Affiliations
University of Miami (US)
Corresponding author
Hoffer, Michael
ORCID
Venue
PLOS One
Publisher
Public Library of Science (PLoS)
Published
2025-10-09
Volume
20
Issue
10
Pages
e0332809
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0332809
PMC
PMC12510503
OpenAlex
W4415010288
Semantic Scholar
48e3a04989d34c692775a1345aa9d411b8328012
Cited by
4
References
16
Citations by year
2026: 2 · 2025: 2
FWCI
1.19
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
  • Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Hearing Loss and Rehabilitation
Keywords
sudden sensorineural hearing loss, intratympanic steroid injection, hearing recovery, treatment timing, pure-tone average, word recognition score, bilateral hearing loss, salvage therapy, oral corticosteroids
MeSH terms
Injection, Intratympanic, Adult, Aged, Audiometry, Pure-Tone, Hearing Loss, Sudden, Female, Hearing Loss, Sensorineural, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Steroids, Treatment Outcome, Recovery of Function

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Statistics and arithmetic are recomputed, not judged.

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