Sudden sensorineural hearing loss (focus on steroid-based treatments)

Metrailer AM, Babu SC. Management of sudden sensorineural hearing loss. Curr Opin Otolaryngol Head Neck Surg. 2016 Oct;24(5):403-6.

Sudden sensorineural hearing loss (SNHL) is an otologic emergency and should be managed quickly and effectively. This review focuses on the management of sudden SNHL, primarily idiopathic sudden SNHL as it is the most common cause.

Management options include observation, oral steroids, intratympanic steroids, or combined oral/intratympanic steroids. One-third to two-thirds of patients will achieve spontaneous recovery, most likely within the first 2 weeks. Despite the lack of randomized controlled trials on steroid therapy efficacy, all patients should be offered steroid treatment given low risk and possible significant benefits. All patients should undergo MRI with gadolinium to rule out retrocochlear disorder. Bilateral sudden hearing loss should alert the clinician to possible systemic disease.

Full-text for Emory users.

Dedhia K, Chi DH. Pediatric sudden sensorineural hearing loss: Etiology, diagnosis and treatment in 20 children. Int J Pediatr Otorhinolaryngol. 2016 Sep;88:208-12.

The true incidence of pediatric SSNHL is not well established in our literature. Unique aspects of pediatric SSNHL are delayed presentation and higher percent of anatomic findings. In our study 70% presented more than 2 weeks after experiencing symptoms. Anatomic abnormalities are in 40% of patients. Hearing improvement occurred in 50% of children treated with oral steroids. Intratympanic steroid treatment is another option but may have practical limitation in the pediatric population.

Full-text for Children’s and Emory users.

Övet G, et al. Sudden Pediatric Hearing Loss: Comparing the Results of Combined Treatment (Intratympanic Dexamethasone and Systemic Steroids) With Systemic Steroid Treatment Alone. Otol Neurotol. 2016 Jul;37(6):742-7.

Significant hearing improvement may be obtained with use of systemic steroids alone, or simultaneous administration of systemic and intratympanic steroids in pediatric patients with SSHL. Although we did not have a control group, two treatment options appear to offer similar hearing improvements in the pediatric age group higher than the rates obtained with placebo when previous studies in the literature are taken into account.

Full-text for Emory users.

Lawrence R, et al. Controversies in the management of sudden sensorineural hearing loss: an evidence-based review. Clin Otolaryngol. 2015 Jun;40(3):176-82.

(i) Baseline Investigations: All patients should be assessed with a thorough history and examination. This should include a pure tone audiogram (PTA) where possible. Baseline and targeted laboratory tests should be carried out to diagnose specific conditions. (ii) Imaging: MRI should be carried out in all cases of ISSNHL. If MRI imaging is contraindicated either CT or auditory brainstem response (ABR) testing should be performed. (iii) Medical Management: If a specific cause for a SSNHL is found, the patient should be managed accordingly. If idiopathic in nature, patients may be offered a course of oral steroid. If systemic steroids are contraindicated and/or there is no improvement with initial oral therapy, intratympanic steroids (IT) as either primary or salvage therapy may be considered. (iv) Further Management: There is no evidence to support the routine use of antiviral therapy. The cost, limited availability and lack of strong evidence for hyperbaric oxygen therapy (HBOT) make it impractical at present. Due to the variability in the vasodilator and vasoactive agents used, there is insufficient evidence to support the routine use of these agents. Consideration should be given to both temporary and permanent hearing amplification when required.

Full-text for Children’s and Emory users.

Crane RA, et al. Steroids for treatment of sudden sensorineural hearing loss: a meta-analysis of randomized controlled trials. Laryngoscope. 2015 Jan;125(1):209-17.

A meta-analysis of randomized controlled trials does not support the use of steroids over placebo in this condition, a finding consistent with previous analyses. Although systemic or intratympanic steroid administration does not have a significant treatment effect, steroids for salvage treatment of patients failing traditional therapy appear to have an effect. However, this result should be interpreted with caution given the poor quality of component trials. Implications for clinical practice and future trial design are discussed.

Full-text for Emory users.

Wei BP, et al. Steroids for idiopathic sudden sensorineural hearing loss. Cochrane Database Syst Rev. 2013 Jul 2;(7):CD003998.

The value of steroids in the treatment of idiopathic sudden sensorineural hearing loss remains unclear since the evidence obtained from randomised controlled trials is contradictory in outcome, in part because the studies are based upon too small a number of patients.

Full-text for Children’s and Emory users.

More PubMed results on SSHL.

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