gms | German Medical Science

Introduction: Although systemic steroids are accepted as the only efficacious treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) in controlled clinical trials, recent publications suggest new therapeutic options. The present study reviewed the available evidence for efficacy of different therapeutics for the management of ISSNHL.

Methods: Literature search was focused on articles of PubMed and MEDLINE databases published in the last 5 years.

Results: We identified 41 articles, of which 34 were evaluated. The most widely used therapeutic agents were systemic steroids in 19 (55.9%) trials. There were also in total 21 (61.8%) trials concerning efficiency of intratympanic steroids, mostly as subsequent treatment after systemic steroids in 9 (26.7%), as primary treatment in 8 (23.5%), or as simultaneous therapy in 4 (11.8%) trials. The very next were trials with hyperbaric oxygen, in total 6 (17.6%). Others, as vasodilatators and vasoactive substances, and rheopheresis researched in 4 (11.8%), while antivirals, dextran, coenzime Q, zinc gluconate, acupuncture, local hypoterimia and ozone therapy, all combined with systemic steroids, researched in 1 (2.9%) clinical trial each.

Conclusion: Patients suffering from ISSNHL, especially those with hearing impairment refractory to systemic steroids, need new therapeutic options. On the basis of recent clinical studies, intratympanic steroids can be a valuable solution. There is currently no evidence to support the use of antivirals nor vasodilatators. Although other therapeutics as hyperbaric oxygen, coenzime Q, zinc gluconate, etc. demonstrated a statistically significant benefit, it is still unclear if this difference is clinically significant. Further clinical trials are needed to validate these results.

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