Comparison of the Treatment Outcome Between Primary Intratympanic Steroid and Salvage Intratympanic Steroid Protocol in Sudden Sensorineural Hearing Loss: Propensity Score Matching Analysis

Abstract

Background and Objectives We aimed to compare the treatment outcomes of primary intratympanic steroid (ITS) and the salvage ITS protocol.Subjects and Method We assessed 440 patients with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) from January 2016 to December 2019. Of the 440 patients, 37 patients received ITS only as a primary treatment while other patients received systemic steroid; of those remaining patients, 276 received systemic steroid as well as ITS as a salvage treatment. We performed a 1:2 propensity score matching analysis for both groups using parameters such as the initial hearing level, presence of vertigo, onset of treatment, age, sex, hypertension and diabetes. The rate of hearing recovery was determinied by comparing the matching propensity score between the primary ITS and the control group according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline and Siegel’s criteria.Results Of the 440 ISSNHL patients, 28.9% received systemic steroid only and 62.6% of patients were managed with systemic steroid plus salvage ITS. Thirty-seven patients (8.4%) were managed with ITS only. While 36.8% of patients completely recovered, 35.0% did not recover their hearing according to AAO-HNS guideline. The propensity score matching showed that the initial hearing level, age and onset of treatment were not significantly different between the primary ITS and control group. Regarding the treatment outcome, complete recovery rate for the primary ITS group and control group were 29.7% and 33.8%, respectively. Although the recovery rate of the salvage ITS protocol group was higher than that of the primary ITS group, statistical significance was not identified.Conclusion Treatment strategies of primary ITS and salvage ITS protocol did not significantly affect the clinical outcomes of ISSNHL differently.