Does salvage treatment in sudden sensorineural hearing loss work?
Reviewed by Clair Saxby

Many treatment strategies for sudden sensorineural hearing loss (SSNHL) have been discussed, but the high spontaneous recovery rate (32-65%) of idiopathic SSNHL and differing treatment guidelines make comparing outcomes difficult. Systemic steroids are the most common first-line therapy with significant improvement in hearing outcomes in over 60% of patients. Salvage treatment includes intratympanic steroids (ITS) and hyperbaric oxygenation (HBO) therapy, both having inconsistent results reported. This study aimed to compare the results of ITS and HBO therapy in patients with SSNHL that previously failed systemic steroid therapy. A total of 134 patients with SSNHL were enrolled at a tertiary referral otology centre. All of the patients had a SSNHL on three contiguous frequencies over 30 dB, occurring within 72 hours. All patients had received first-line therapy of intravenous steroid therapy - intravenous methylprednisolone sodium succinate, 240mg for six days, with tapering the dose, and oral steroid therapy was continued for six days with further tapering down to 16mg. The average time from the onset of SSNHL symptoms to steroid therapy application was 9.8 days. If after this treatment the pure tone audiogram did not show significant hearing improvement, the patients were eligible for inclusion in the study, receiving either HBO therapy (under O2 pressure of 2.5 atmospheres for 60 minutes daily for four weeks for a total of 20 sessions), ITS (four ITS injections over 10 days – dexamethasone - 5mg/mL) or observation (control group). Pure-tone audiograms were performed before and after the salvage therapy in the IT and HBO groups and at the same time interval in the control group. ITS and HBO therapy were associated with statistically significant hearing recovery at all frequencies compared to the control group. Presence of tinnitus before therapy was negatively correlated with hearing improvement. ITS therapy significantly reduced tinnitus compared to HBO and the control group. The results support both ITS and HBO therapy options as superior compared to observation alone after failed steroid therapy for SSNHL.

Comparison of Intratympanic Steroid and Hyperbaric Oxygen Salvage Therapy Hearing Outcomes in Idiopathic Sudden Sensorineural Hearing Loss: A Retrospective Study.
Ajduk J, Peček M, Kelava I, et al.
EAR AND HEARING
2023;44(4):894-9.