Intratympanic dexamethasone is an effective method as a salvage treatment in refractory sudden hearing loss

Objectives: This study aimed to investigate the therapeutic efficacy of intratympanic dexamethasone (ITD) as a salvage treatment in sudden hearing loss (SHL) patients who had no response to initial systemic combination steroid therapy. Patients and Methods: From May 2007 to June 2010, 415 SHL patients visited 3 tertiary referral centers within 7 days of disease onset. They were all treated with an identical protocol, a 10-day scheduled hospitalization and oral steroid treatment. Of these, 151 patients were totally unresponsive 2 weeks after treatment initiation according to Siegel's criteria. We divided these 151 refractory patients into 3 groups: those receiving no further treatment (control group, n = 59), those receiving one more 10-day cycle of oral steroids (systemic reapplication group, n = 26), and those receiving ITD therapy (ITD group, n = 66). Final assessment of hearing was conducted approximately 3 months after the onset of SHL. Hearing improvement was defined as demonstrating "any" improvement according to Siegel's criteria. Results: The initial average hearing thresholds of all groups were similar. Overall hearing improvement was observed in 10 of 59 patients in the control group, in 4 of 26 in the systemic reapplication group, and in 32 of 66 in the ITD group. No serious complications were observed. Analyzing by frequency, paradoxically, hearing of the low and mid frequencies was more significantly improved than high frequencies in the ITD group. Conclusion: Intratympanic dexamethasone administration after failure of an initial treatment is effective, and this should be used as a salvage treatment in cases of refractory SHL.