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Abstract
Idiopathic sudden sensorineural hearing loss (ISSNHL) is an otologic emergency occur over a short period of time and may vary from mild to profound hearing impairment in otherwise normal hearing individuals, incidence is 5-20 cases per 100,000 a year.
In the vast majority of patients with ISSNHL, no specific cause can be identified. The most popular theories as to cause ISSNHL include viral infection, vascular insufficiency, and immune mediated reaction.
Evaluation should begin with history taking. The patients are asked about the time of onset, progression or fluctuation since onset, and the presence or absence of any neurological deficits, trauma to the ear and previous ear surgery. Timing is an important factor in the prognosis of ISSNHL, previous studies have found that patients seen within 10 days of onset of hearing loss show more improvement than those patients seen at a later time. The most common investigations are PTA, SDS and MRI or CT scan to exclude other causes of sudden deafness.
The use of more than one agent in the treatment is common, and the choice of agents used varies among clinicians. Steroids (systemic or intratympanic) are the most widely used treatment and less common antiviral drugs.
Intratympanic steroid (IT) therapy has the ability to achieve significantly higher concentration of steroids in perilymph and endolymph compared with systemic steroids, intra-tympanic steroid therapy may have the potential to improve treatment outcomes of patient with ISSNHL, also the second advantage of the local steroids is that the majority of side effects of systemic steroids are avoided with intra-tympanic route, so it is an option for patients in whom systemic steroids are contraindicated as diabetes mellitus, hypertension and glaucoma.
Mechanism of action of steroids is through counteracting the inflammatory cascade sparing the cochlea from continued damage, recently inner ear glucocorticoid and mineralocorticoid receptors were discovered. Type of steroids used is: Methylprednisolone, Dexamethasone and hydrocortisone.
This meta-analytic study was performed to evaluate the efficacy of IT steroid therapy in patients with ISSNHL either as salvage therapy or in combination with systemic steroids.
This was done through the following steps:
• Target: Does intratympanic steroid therapy improve hearing in patients with idiopathic sudden sensorineural hearing loss.
• Identification and location of articles: By searching in the pub-med where 248 articles where found 40 of them were relevant to our study.
• Screening and evaluation: According to the inclusion criteria, where 6 articles were included and 34 articles were excluded.
• Data collection: Through the 6 included articles.
• Data analysis:
Data analysis was performed utilizing Meta-analytic Review Manger (Rev-Man 5) software. The results of the data collected from the chosen articles were fed into the above mentioned (Rev-Man 5) software.
1. Reporting and Interpretation of results:
Our study analyzing 6 articles studying 295 patients with idiopathic sudden hearing loss in which 157 received intratympanic therapy alone or in combination with systemic steroids and 138 patients received systemic steroids alone (control). Were 107 out of 157 patients received IT steroids shows improvement in hearing >10dB, while only 56 out of 138 patients received systemic steroids (control group) shows improvement in hearing.
So IT steroid therapy is an effective method for treatment of ISSNHL.