Intratympanic Versus Systemic Corticosteroids for Sudden Sensorineural Hearing Loss

Abstract

Introduction: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency. Systemic corticosteroids are standard, but intratympanic (IT) injection is increasingly used as primary or salvage therapy. Comparative efficacy remains controversial. Methods: Systematic review and meta-analysis of 14 RCTs (n=1,206) comparing IT dexamethasone or methylprednisolone (3–4 injections over 2 weeks) versus systemic prednisone (1 mg/kg/day tapering). Primary outcome: hearing recovery (≥10 dB improvement or return to baseline). Secondary: complete recovery (≥75 dB improvement or final threshold ≤25 dB). Results: As primary therapy, systemic steroids were superior to IT (recovery rate 68% vs 54%, RR 1.26, 95% CI 1.08–1.47, p=0.003). As salvage after failed systemic therapy, IT provided additional benefit (recovery in 42% vs 14% for placebo, NNT=4). Severe adverse events were rare with IT (0.5%) but included persistent tympanic membrane perforation (0.3%). Discussion: IT steroids reach high perilymph concentrations but may not replace systemic anti-inflammatory effects. Combined therapy is promising but understudied. Conclusion: Systemic corticosteroids remain first-line for SSNHL. Intratympanic salvage is effective for non-responders. Primary IT alone is not recommended.