Intratympanic or systemic corticosteroids, which is more effective for treating sudden hearing loss?

• The researchers did not find any studies that compared intratympanic corticosteroids to no treatment or placebo (dummy) treatment.
• Intratympanic corticosteroids might result in little or no difference in hearing when compared to people who receive systemic corticosteroids and might make little to no difference in the number of people whose hearing improves.
• The side effects may be different with these two types of treatment.
• With intratympanic treatment, people may have an increase in the risk of dizziness or ear pain as compared to systemic corticosteroids, typically at the time of injection, and some may develop a small hole in the eardrum. However, systemic treatment may also cause an increased risk of different side effects, such as problems with sugar levels in the blood.
• Taking intratympanic corticosteroids as well as systemic corticosteroids might result in a small improvement in hearing compared to systemic corticosteroids alone, but it is uncertain how many people would notice an improvement. As above, intratympanic treatment may cause some side effects, but we cannot be certain of the number of people who may experience these.

For people having additional treatment for sudden deafness (when their first treatment did not work) 

• When compared to no treatment or a placebo (dummy) treatment, intratympanic corticosteroids may result in a much larger number of people having an improvement in their hearing but may only improve hearing slightly.
• As with the first treatment, intratympanic injections might cause some side effects, such as pain or dizziness at the time of the injection, or the development of a small hole in the eardrum. The authors are not certain how often these side effects will happen.
• There is uncertainty about whether adding intratympanic treatment to systemic treatment will result in an improvement in hearing.

To sum up, for primary therapy, intratympanic corticosteroids may have little or no effect compared with systemic corticosteroids. There may be a slight benefit from combined treatment when compared with systemic treatment alone, but the evidence is uncertain.

For secondary therapy, there is low-certainty evidence that intratympanic corticosteroids, when compared to no treatment or placebo, may result in a much higher proportion of participants whose hearing is improved, but may only have a small effect on the change in hearing threshold. Whether there is an additional benefit from combined treatment over systemic steroids alone is very uncertain. 

"Although adverse effects were poorly reported, the different risk profiles of intratympanic treatment (including tympanic membrane perforation, pain and dizziness/vertigo) and systemic treatment (for example, blood glucose problems) should be considered when selecting appropriate treatment," the researchers conclude. 

Reference:

Plontke SK, Meisner C, Agrawal S, Cayé-Thomasen P, Galbraith K, Mikulec AA, Parnes L, Premakumar Y, Reiber J, Schilder AGM, Liebau A. Intratympanic corticosteroids for sudden sensorineural hearing loss. Cochrane Database of Systematic Reviews 2022, Issue 7. Art. No.: CD008080. DOI: 10.1002/14651858.CD008080.pub2.