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| |  DG DISPATCH - AAO: Local Steroids May Be Effective In Treating Sudden Hearing Loss By Andrew Bowser Special to DG News NEW ORLEANS, LA -- September 30, 1999 -- Otolaryngologists typically use systemic steroids to treat sudden-onset hearing loss, but some patients don’t respond to the therapy and others can’t tolerate it.
In a study presented at the annual meeting of the American Academy of Otolaryngology - Head and Neck Surgery Foundation, in New Orleans, LA., transtympanic steroids administered via a ventilation tube positioned under local anesthesia resulted in mild improvement in almost 50 percent of patients who would have otherwise been considered treatment failures. In a prospective study of 23 patients, including 22 who failed systemic steroids and one who could not tolerate them, pure tone average improvement was documented in 10 (44 percent) patients following local steroid therapy, with an average change of 15.2 dB. Twelve patients (52 percent) had no significant improvement. One patient developed post-perfusion otitis media and experienced a drop of 10 dB in pure tone average which returned to baseline once the infection cleared. Patients averaged 63 years of age; there were no statistically significant differences in pure tone average, speech reception threshold or speech discrimination for patients under 60 years of age versus patients under 60, though the younger patients tended to have better pure tone average results. The men in the study (n = 12) had more favorable outcomes in pure tone average twice as often as the women (n = 11). Treatments included methylprednisolone and dexamethasone. More patients treated with methylprednisolone had improvement in pure tone average, speech reception threshhold and speech discrimination scores, although the number of patients in the study was too small to demonstrate statistically significant differences. The researchers plan to test higher doses, use methylprednisolone only, and try to get patients in for treatment as early as possible. "A 15 dB improvement is minimal to mild," said Dr. John Li, a private practice physician in Jupiter, FL, who co-authored the study. "If we get patients earlier, we might have a better effect." That effect might have been at work for the one patient who improved most dramatically in the study: an 80-year-old woman who was diagnosed one week after onset of hearing loss who went from a deficit of 70 dB to completely normal hearing. By comparison, average time to therapy from initial onset averaged 72 weeks for all patients.
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