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Intratympanic Triamcinolone Acetonide as Treatment Option for Idiopathic Sudden Sensorineural Hearing Loss

Dahm, Valerie*; Nieratschker, Michael*; Riss, Dominik*; Kaider, Alexandra; Auinger, Alice*; Honeder, Clemens*; Arnoldner, Christoph*

doi: 10.1097/MAO.0000000000002283
SENSORINEURAL HEARING LOSS AND TINNITUS
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Introduction: Corticosteroids represent the most commonly used treatment option for patients with idiopathic sudden sensorineural hearing loss. In the past, these compounds were mainly formulated and tested for intravenous or oral administration. Intratympanic application is increasingly being used, often as salvage treatment. The most suitable corticosteroid for local application has yet to be identified. Trials have suggested that triamcinolone acetonide has superior molecular properties for this treatment modality.

Methods: The main aim of this study was to retrospectively assess the first audiometric results of patients diagnosed with idiopathic sudden sensorineural hearing loss and treated simultaneously with systemic prednisolone and intratympanic triamcinolone acetonide. This data was then compared to systemic treatment only, as well as to historic cohorts treated intratympanically with widely used corticosteroids, namely dexamethasone or methylprednisolone.

Results: 90 patients received intravenous prednisolone only, and 89 individuals underwent intravenous treatment combined with three to four simultaneous intratympanic applications of triamcinolone. Eight patients received intratympanic triamcinolone as first-line treatment. After adjusting data for sex, time since onset, age, and severity of hearing loss, no statistically significant difference between the two main treatment groups could be identified. No major adverse events were observed, specifically no otitis media or persistent vertigo. Two perforated tympanic membranes healed spontaneously within several days.

Conclusion: While the exact role of intratympanic injections requires additional trials, triamcinolone resulted in similar outcomes compared to studies using dexamethasone or methylprednisolone. Due to favorable pharmacological properties, triamcinolone represents a safe and efficacious alternative for intratympanic treatment in idiopathic sensorineural hearing loss.

*Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna

Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria

Address correspondence and reprint requests to Christoph Arnoldner, M.D., Waehringer Guertel 18-20, 1090 Vienna, Austria; E-mail: christoph.arnoldner@meduniwien.ac.at

All authors declare no conflict of interest.

Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company