Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss

Abstract Introduction Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. Objective We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. Methods Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20 dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4 mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120 min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. Results The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p = 0.364 and p = 0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. Conclusion ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss.

【摘要】针对挽救治疗突发性感音神经性耳聋（sudden sensorineural hearing loss, SSNHL）的临床应用目前尚存争议，尚无统一的推荐方案。尽管多项研究证实鼓室内类固醇给药（intratympanic administration of steroids, ITS）与高压氧（hyperbaric oxygen, HBO）治疗具有一定有效性，但针对难治性SSNHL患者比较ITS与HBO疗法疗效的研究仍较为匮乏。目的：评估鼓室内类固醇给药与高压氧疗法治疗难治性突发性感音神经性耳聋的临床疗效。方法：对全身治疗后获益不佳的患者进行回顾性分析。难治性患者定义为初始治疗后听力提升不足20 dB者。所有难治性患者均被告知可选择的挽救治疗方案：ITS或HBO疗法，并简要说明两种疗法的优缺点。ITS方案为采用25号针头注入4 mg/mL地塞米松；HBO疗法为患者在高压氧舱内吸入100%氧气，治疗时长120分钟，治疗压力为2.5倍大气压。分别于挽救治疗前及治疗后3个月评估两组患者的听力水平，参照古桥标准（Furuhashi criteria）评估听力改善情况，并比较两种疗法的言语识别率（speech discrimination scores, SDSs）及各频率听力的恢复情况。结果：两种挽救疗法的疗效相近。ITS组与HBO组的纯音平均听阈变化及言语识别率变化均无显著统计学差异（p=0.364，p=0.113）；各频率的言语识别率与听阈比较结果也显示二者改善程度相当。结论：鼓室内类固醇给药与高压氧疗法均可使突发性感音神经性耳聋患者获得相似的听力改善，但本研究样本量较小，尚无法得出确定性结论，仍需开展大规模随机对照研究以明确难治性突发性听力损失患者的最优治疗方案。