Combination Therapy for the Treatment of Idiopathic SSNHL

Objective To determine whether combination therapy (high‐dose prednisone taper [HDPT]+intratympanic dexamethasone [IT‐Dex]) improves pure tone average scores (PTA) and speech discrimination scores (SDS) relative to HDPT alone or intratympanic steroid (IT‐S) alone in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Method From June 2008 to January 2012, 84 (15 dropouts) patients diagnosed with ISSNHL were administered IT‐De (10 mg/cc) once‐a‐week for 3 weeks + HDPT (60 mg/day for 7 days with 7‐day taper). Final audiogram results are compared to previously published results of combination therapy, HPDT alone, and IT‐S alone. Results Treatment began on average 6.6 days after onset of ISSNHL. The average pretreatment 3‐tone PTA was 83.2, and the average pretreatment SDS was 16%. The overall PTA improved significantly by an average of –38. The overall SDS improved significantly by an average of 49%. The average overall posttreatment SDS was 65%. 60/69 (87%) patients started with an SDS score less than or equal to 50%, and 38 (63%) of these ended above 50%. 24/42 (57%) of the profound patients recovered with an SDS above 50%. According to published reports, HDPT and IT‐S alone improve SDS by only 39%. Conclusion ISSNHL patients treated with IT‐De+ HDPT experienced statistically significant PTA and SDS improvements, comparable to previously published combination therapy results. The audiologic data indicate that combination therapy improves hearing recovery relative to HDPT or IT‐S alone, possibly by improving hair cell and spiral ganglion survival.