When patients are presenting at a later stage... Like greater than 7 days... U still prefer??? Oral
IT glucocorticoids are not only to be considered n patients who have a contra-indication for oral corticoids, but also have a place for rescue therapy (when oal corticoids dod not improve sudden hearing loss).
We gave given intratympanic injection for ssnhl though we did not have gratifying results, intratympanic therapy delivers the drug in a targeted fashion. There are no systemic side effects . It is easy to administer and can be done on opd basis .we administer using tympanopunction technique that is straight injecting into the posteroinferior quadrant.
Though the concentration of steroid to be injected , frequency of injections and patient variation like an extra membrane over the round window or variable permeability od the window make it difficult to assess the results of intratympanic therapy.
If systemic comorbidities are there intratympanic is preferable.. but if not why not use a combination of both the routes oral plus intratympanic?
I have always use oral steroids and my results has been good especially if they present less than 72hrs.
second choice in patients who have failed to improve with steroids iv
ı prefer as a salvage therapy or the patient who had systemic diseases such as hypertension, diabetes.
Standard in our hospital: iv corticosteroids, antiviral therapy, vitamins, bed rest. We had one case with diabetes to consider for intratympanic route but the specialist prescribing their insulin treatment ruled that recovering the hearing was more important at that moment and just raised their insulin levels and with close observation they recovered. Intratympanic for those who do not improve after this course of treatment…I do not believe it will be a miracle, but just to say that you did everything possible for the patient.
At the hospital that i work in, we do not give intratympanic steroids routinely as the first line treatment for SSHL except in patients with diabetes mellitus. We use oral steroids for 2 weeks
Oral steroids is the first choice except contraindications of which pregnant women with SSNHL.
I use intravenous methyl prednisone for 3 days. Followedby oral steroids for 1 week.
Intratympanic steroid therapy is a treatment option for SSNHL that involves the injection of steroids directly into the middle ear space. The steroids diffuse through the round window membrane into the inner ear, where they can help reduce inflammation and improve hearing.
Intratympanic steroid therapy may be considered in cases of SSNHL of unknown etiology, particularly in patients who are not good candidates for oral steroid therapy or who have had an inadequate response to oral steroids. Intratympanic steroid therapy has been shown to be effective in some cases of SSNHL, particularly when administered early in the course of the disease.
However, it is important to note that the evidence supporting the use of intratympanic steroid therapy for SSNHL is still limited, and more research is needed to determine its effectiveness compared to other treatments. Oral steroid therapy remains the standard of care for SSNHL, and it may be the preferred treatment option in many cases.
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