Intratympanic and intravenous steroid therapy of idiopathic sudden sensorineural hearing loss in patients with and without diabetes mellitus
23 April 2019 (online)
Aim of this study was to compare effectiveness of intravenous (i.v.) high-dose steroid and vasoactive therapy alone and a combination therapy with i.v. and intratympanic steroid therapy (ITS) in idiopathic sudden sensorineural hearing loss (ISSNHL) patients with and without diabetes mellitus type 2 (DM II).
In this retrospective study 194 patients were reviewed: in 58 patients diagnosis of DM II was established, 35 patients had pathologic blood sugar levels without established DM II diagnosis. 75 patients received i.v. therapy with high-dose prednisolone and pentoxifylline, whereas 119 patients were treated with ITS with a dexamethasone/hyaluronic acid mix in addition to i.v. therapy. Numerical differences of pure-tone audiometry thresholds in decibel (dB) at low-to-middle tone frequencies (0.5, 1, 2 kHz) and high-tone frequencies (4 and 8 kHz) and response rate to therapy (hearing improvement ≥10 dB) were compared between groups.
Diabetics who received i.v.-therapy alone showed significantly less hearing improvement at low-to-middle tone frequencies (Δ= 7.9 dB; p = 0.046) and at high-tone frequencies (Δ= 8.9 dB; p = 0.03) compared to patients without DM II. Under combination therapy, hearing improvement in diabetics was higher than in patients without DM II, although statistical significance was not reached. Among diabetics, those who received combination therapy achieved a significantly higher hearing improvement in both frequency ranges (Δ= 12.2 dB and 10.2 dB; p = 0.019 and 0.042).
I.v. steroid therapy is less effective in diabetics than in non-diabetics. Diabetics with ISSNHL treated by ITS and i.v. combination therapy achieve higher hearing improvement than with i.v. steroid therapy alone.