Response to oral steroids for sudden sensorineural hearing loss: considerations of age, time to treatment, and degree of hearing loss.

Abstract

Introduction: Compare outcomes of oral steroids (OS) to intratympanic (IT) steroids for treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) in a retrospective cohort study at a tertiary academic center.

Methods: Patients diagnosed with ISSNHL receiving at least one course of OS between January 2009 and February 2022 were reviewed. OS patients were compared to a previously reported cohort of 74 patients who underwent IT treatment.

Interventions: OS or IT steroid therapy for ISSNHL. Full, partial or no recovery rates of hearing thresholds stratified by modality of treatment, age, degree of hearing loss, and time to initiation of treatment were measured.

Results: There were 96 patients treated with OS and 74 patients treated with IT steroid. Full recovery was more frequent in patients who underwent oral steroid therapy (43.8%) compared to IT therapy (25.68%, p=0.017). For patients under 40 years old, full recovery rates were similar between OS (60.0%) and IT (61.5%). In patients over 40 years old, however, full recovery was seen in 40.7% of patients on OS and 18% for IT. Further, while those over 65 years had the worst rates of full recovery to IT steroid (<20%), this age group had a 50% full recovery rate with oral steroids. Additional factors correlating with response to both OS and IT treatment included degree of hearing loss and time to starting steroids.

Conclusion: Oral steroid therapy was associated with greater likelihood of full recovery in all patient age groups compared to those treated with IT steroid alone, in combination with oral steroid, or for salvage. A significant difference in response was seen in those over 65 years raising consideration of age stratification in decision making for steroid modality in treatment of ISSNHL.