Does local steroid therapy improve outcomes in acute otitis media with serous labyrinthitis? A retrospective analysis.

Abstract

Purpose: Sensorineural hearing loss represents a rare but clinically relevant complication of acute otitis media (AOM). Although intratympanic glucocorticoid (GC) therapy is established in other cochleovestibular disorders, its efficacy in this context remains insufficiently investigated. The aim of this study was to retrospectively assess whether local intratympanic glucocorticoid application is associated with improved clinical outcomes in patients with acute otitis media-related sensorineural hearing loss.

Methods: A retrospective analysis was performed on patients diagnosed with AOM-associated inner ear involvement between January 2014 and November 2024. Patients were stratified according to GC treatment regimen: (1) intratympanic application of glucocorticoids (IC), (2) no intratympanic application of glucocorticoids (NIC). Subgroup analyses were performed according to the surgical drainage method and severity of inner ear involvement. Primary endpoint was improvement in bone-conduction pure-tone average (BCPTA4).

Results: A total of 137 patients were included (IC: 44, NIC: 93). Sex, affected side and subjective improvement did not differ significantly between both groups (all p > 0.08). Both groups demonstrated significant hearing improvement following treatment (p < 0.001). Although numerical trends favored the NIC group across different severity levels, no statistically significant differences in BCPTA4 improvement were observed between treatment modalities (p = 0.8); however, the non-randomized design and baseline group differences limit interpretation. In exploratory analyses, Ventilation Tube Insertion (VT) and CO₂-laser myringotomy (LP) were associated with significant hearing recovery (p < 0.001).

Conclusions: Both treatment regimens (IC, NIC) led to significant hearing improvement in AOM-associated inner ear involvement. In this non-randomized comparison, no statistically significant difference in BCPTA4 improvement was detected between groups; however, selection bias, baseline imbalances and residual confounding may have obscured small treatment effects. These findings do not constitute evidence of equivalence.