Comparison of intratympanic steroid injection, hyperbaric oxygen and combination therapy in refractory sudden sensorineural hearing loss

Objective: The Objective of this study was to compare the efficacy of intratympanic steroid injection (ITS), hyperbaric oxygen (HBO), and combination therapy as salvage treatment in patients with sudden sensorineural hearing loss (SSNHL) after failure of systemic therapy. Study Design: A historical cohort study. Setting: Academic medical center. Subjects and Methods: One hundred three refractory SSNHL patients are enrolled. Among them, 35 received ITS alone (ITS group), 22 received HBO alone (HBO group), 19 received combined ITS and HBO (combined group), and 27 received no salvage therapies (control group). Hearing outcomes were determined by hearing gains in pure-tone average (PTA), recovery rate, and word recognition score (WRS) measured by audiometry before and after salvage therapies. Results: Significant larger hearing gains in PTA were found in the ITS, HBO, and combined groups than the control group. The combination of ITS and HBO resulted in a significantly larger WRS improvement than the control group (p = 0.035) and larger hearing gains than the ITS and HBO groups in 250 Hz (p < 0.05). Conclusion: ITS, HBO, and combined therapy offered some benefits in hearing improvement. Combined ITS/HBO may result in a larger WRS improvement and recovery of hearing, especially in lower frequencies. Further randomized prospective studies are needed for confirmation.