■ OBJECTIVE: Systemic steroids in idiopathic sudden sensorineural hearing loss (ISSHL) are the most widely accepted treatment today. But a significant number of patients do not respond to them and suffer from remaining hearing loss and tinnitus. Intratympanic application of steroids appears to be an additional treatment without side effects of intravenous steroids. The purpose of the present study is to investigate the effects of intratympanic application of steroid on hearing loss and tinnitus of patients who did not respond to systemic treatment.

■ METHODS: This presentation consists of two studies focusing on hearing loss and tinnitus, respectively. Concerning hearing loss, 32 patients with ISSHL, who were refractory to systemic treatment including intravenous steroid, were included. They received 0.3- 0.5ml of dexamethasone (4mg/ml) by transtympanic injection, once a week, over 3 weeks. We then retrospectively collected data from age-, sex- and hearing level-matched previous patients who did not receive an intratympanic injection of dexamethasone as a salvage treatment. Hearing improvement was defined as more than 10dB in pure-tone average. Concerning tinnitus, 9 patients with ISSHL, whose hearing levels were already fixed and severe tinnitus remained, were enrolled. Annoyance level of tininitus was evaluated using visual analogue scale (VAS) before and after local application of dexamethasone.

■ RESULTS: Hearing improvement was observed in 13 (40.6%) of 32 patients who received an intratympanic injection of dexamethasone and in 2 (6.3%) of 32 patients in the control group. There were no apparent prognostic factors between responding patients and non-responding patients for local application of dexamethasone. Tinnitus of 4 (44.4%) out of 9 patients was markedly improved after local treatment.

■ CONCLUSION: Intratympanic dexamethasone administraion after conventional systemic therapy is an effective treatment for hearing loss and tinnitus of patients with refractory ISSHL.