Intratympanic steroid therapy as a salvage treatment for sudden sensorineural hearing loss after the unsuccessful therapy with systemic steroids. Our experience in 86 patients

Abstract Objective To determine the efficacy of salvage intratympanic corticosteroid therapy in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) who exhibited an insufficient response to initial systemic corticosteroids. Material and methods In this retrospective quasi-experimental study, ISSNHL patients treated from 2019 to 2024 were included. Pure tone audiometry (PTA) thresholds were measured at baseline (pre-treatment), after systemic corticosteroids, and three months post-final intervention. Outcomes were defined as. • Complete recovery: final mean PTA ≤ 10 dB poorer than the unaffected ear or pre-loss baseline. • Partial recovery: ≥ 10 dB PTA improvement, yet final PTA still > 10 dB poorer. • No recovery: < 10 dB PTA improvement. A secondary binary classification categorized patients as “recovered” (≥ 10 dB PTA gain) or “non-recovered” (< 10 dB gain). Results Systemic corticosteroids achieved a significant mean PTA improvement of 5.6 dB (p = 0.001) in this group (patients with no complete recovery after oral treatment). Subsequent intratympanic therapy added a further 1.76 dB gain, though this was not statistically significant (p = 0.115). After systemic therapy, 27.9% of patients attained partial recovery; 72.1% showed no improvement. At final follow-up, 9.3% achieved complete recovery, 29.1% partial recovery, and 61.6% no recovery. According to the binary criterion, 38.4% were classified as recovered post-intratympanic treatment, a non-significant increase (p = 0.078). Conclusions These findings indicate that systemic corticosteroid therapy provides a notable audiometric benefit in ISSNHL. However, in this cohort, salvage intratympanic steroid therapy did not yield a statistically significant additional effect. Further prospective, controlled trials are warranted to clarify the role of intratympanic steroids for patients with incomplete systemic response.