Sudden hearing loss (SHL) is a dramatic hearing loss occurring over a short period, normally less than 72 hours. Although about a third of patients regain some hearing on their own, others suffer from permanent hearing loss if untreated.
The usual treatment is a course of oral steroids, but some doctors have begun treating patients with a series of steroid injections delivered through the eardrum and into the middle ear. In theory, these injections could deliver a heavier dose of steroids directly to the source of the problem, explains John Carey, M.D., a professor in the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine.
Comparison of the two methods
Carey and his colleagues have conducted a trial of the two different treatments at 16 academic medical centres. The researchers randomly assigned 250 patients, who came into these centres for SHL treatment, to receive either a two-week course of oral steroids or four steroid injections spaced out over two weeks. The patients all had a 50-decibel or greater hearing loss in one of their ears.
Two months after treatment, the researchers tested the patients' hearing again. Results showed that patients treated with oral steroids had an average 30.7-decibel improvement in the affected ear, compared to a 28.7-decibel improvement in those treated with injections.
Pros and cons
Carey explains that both methods have pros and cons. The oral steroids come with a variety of side effects such as insomnia, weight gain and an increase in blood sugar, but on the other hand this treatment has a low cost and can be conducted at home.
The steroid injections avoid these side effects, but are on the contrary expensive and potentially painful. Also, it has to be performed in a doctors' office.
"This study suggests that for most SHL patients, oral and injected steroids appear to be equally effective," Carey says. "This could lead to better options for patients that match their personal preferences."
He and his colleagues plan to eventually study whether the treatments might be even more effective if they are give concurrently or sequentially.
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