Sordera súbita idiopática: factores pronóstico y resultados del tratamiento de rescate con dexametasona intratimpánica

Abstract

Introduction and objective: idiopathic sudden sensorineural hearing loss (ISSHL) is defined as a sensorineural hearing loss of 30 dB HL or greater over at least three contiguous audiometric frequencies, occurring within a 72-hr period, of unknown cause. The effect of salvage treatment with intratympanic corticosteroids (IC) when systemic treatment (ST) fails is a current topic of debate. Our objective has been to compare the hearing recovery obtained in ISSHL, after the application of salvage IC, in the absence of complete recovery with ST.

Method: the results of two population groups with similar age and hearing loss are compared. The first, of 99 patients, received ST with corticosteroid exclusively. In the second group of 70, with ISSHL refractory to ST, we instilled IC. We analyze the differences in average hearing threshold (PTA – Pure Tone Average) at the time of diagnosis and after 3 months. We also evaluate certain factors considered risk. At the 2020 SEORL-CCC National Congress, we presented the preliminary results of this study.

Results: the study population consisted of 57% men. The mean age is 54.8 years. The mean PTA of the ear with ISSHL is 72.3 dB HL. Following Siegel´s recovery criteria, at 3 months there was complete improvement in 30% of the parenteral group and partial improvement in 34%; in the IC group there was complete improvement in 5% and partial improvement in 36%.

Discussion: we don´t know the efficacy of corticosteroid treatment in ISSHL. The type of injury and the characteristics of the patient could be decisive in the final prognosis and in the therapeutic result.

Conclusions: the intratympanic application of 3 doses of dexamethasone (8mg/ml) in refractory ISSHL has not produced, in our population, a significant change with respect to ST. Of the risk factors analyzed, in our population those with the worst prognosis are: the presence of vestibular symptoms, profound hearing loss and high-frequency hearing loss, the start of treatment after 2 weeks and fundamentally, the lack of improvement of at least 10 dB on the 4th day of treatment.