Trends in Use and Timing of Intratympanic Corticosteroid Injections for Sudden Sensorineural Hearing Loss

Objective Oral corticosteroids are treatment mainstays for idiopathic sudden sensorineural hearing loss (SSNHL). Recent studies suggest that intratympanic (IT) steroid injections may be effective as an alternate or adjunctive therapy. We sought to investigate nationwide trends in treatment patterns for SSNHL. Study Design Retrospective cross-sectional study. Setting A large nationwide health care claims database spanning 2007 to 2016. Methods Patients with SSNHL were identified from the IBM Watson Health MarketScan Database. Multivariable logistic, linear, and Cox regression were used for demographic- and comorbidity-adjusted analyses. Results Overall, 19,670 patients were included. Between 2007 and 2016, use of oral corticosteroids alone decreased (83.6% to 64.6%, P < .001), while use of IT corticosteroids alone and combination IT-oral corticosteroids increased (IT only, 7.9% to 15.1%, P = .002; IT-oral, 8.5% to 20.4%, P < .001). During the study period, time to treatment initiation decreased for both administration modalities, though more dramatically for IT corticosteroids (IT, 124.0 to 10.6 days, P < .001; oral, 42.6 to 12.7 days, P < .001). In patients receiving both IT and oral corticosteroids, concurrent first-line use increased (25.2% to 52.8%, P < .001). Repeat injections have also become more common but may raise risk of persistent tympanic membrane perforations (vs no injection; hazard ratio [first injection] = 7.95, 95% CI = 5.54-11.42; hazard ratio [fifth or higher injection] = 17.47, 95% CI = 6.93-44.05). Conclusion SSNHL management increasingly involves early IT steroids as an alternative or adjunctive option to oral steroids. Use of repeat IT corticosteroid injections has also increased but may raise risk of persistent tympanic membrane perforations and subsequent tympanoplasty. Future decision analysis and cost-effectiveness studies are necessary to identify an optimal care pattern for SSNHL.

Download Full-text

Metformin decreases the risk of sudden sensorineural hearing loss in patients with diabetes mellitus: A 14-year follow-up study

Diabetes and Vascular Disease Research ◽

10.1177/1479164119826292 ◽

2019 ◽

Vol 16 (4) ◽

pp. 324-327 ◽

Cited By ~ 4

Author(s):

Hsin-Chien Chen ◽

Chi-Hsiang Chung ◽

Chieh-Hua Lu ◽

Wu-Chien Chien

Keyword(s):

Diabetes Mellitus ◽

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Cox Regression ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Lower Percentage ◽

Research Database ◽

Patients With Diabetes

Background: The risk of sudden sensorineural hearing loss associated with metformin use in patients with diabetes mellitus has not been fully examined. Study design: It is a retrospective matched-cohort study. Subjects and methods: We examined the medical records of patients with diabetes mellitus over 18 years old in Taiwan’s National Health Insurance Research Database for the period between 1 January 2000 and 31 December 2013, to establish matched cohorts (14,109 with and 42,327 without metformin use) at a ratio of 1:3 by sex, age and index year. Results: We used a Cox regression hazard model to identify risk factors of sudden sensorineural hearing loss during 14 years of follow-up, and the results indicate that a significantly lower percentage of diabetes mellitus patients with metformin use ( p = 0.033) developed sudden sensorineural hearing loss compared with those without metformin use (0.21%, 29/14,109 vs 0.32%, 136/42,327). After adjustment for age and other variables [adjusted hazard ratio: 0.630 (95% confidence interval: 0.422–0.941, p = 0.024)], this study also demonstrated that metformin use appeared to reduce the risk of developing sudden sensorineural hearing loss. Conclusion: This study demonstrated an association between metformin use and lower incidence of sudden sensorineural hearing loss among patients with diabetes mellitus.

Download Full-text

Increased risk of sudden sensorineural hearing loss in patients with depressive disorders: population-based cohort study

The Journal of Laryngology & Otology ◽

10.1017/s0022215115002960 ◽

2015 ◽

Vol 130 (1) ◽

pp. 42-49 ◽

Cited By ~ 9

Author(s):

C-S Lin ◽

Y-S Lin ◽

C-F Liu ◽

S-F Weng ◽

C Lin ◽

...

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

Hearing Loss ◽

Kidney Disease ◽

Sensorineural Hearing Loss ◽

Depressive Disorders ◽

Sudden Sensorineural Hearing Loss ◽

Hazard Ratio ◽

Sensorineural Hearing ◽

Increased Risk

AbstractObjectives:To evaluate the incidence rates and risk of sudden sensorineural hearing loss among patients with depressive disorders.Method:Data for 27 547 patients with newly diagnosed depressive disorders and 27 547 subjects without depressive disorders between 2001 and 2008 were yielded from the Taiwan National Health Insurance Research Database. Sudden sensorineural hearing loss incidence at the end of 2011 was determined. Cumulative incidence and adjusted hazard ratio were computed.Results:Sudden sensorineural hearing loss incidence was 1.45 times higher in the depressive disorders group compared to the non-depressive disorders group (p = 0.0041), with an adjusted hazard ratio of 1.460. A significant increased risk of developing sudden sensorineural hearing loss was noted in patients with diabetes mellitus, chronic kidney disease and hyperlipidaemia (p < 0.05).Conclusion:The results suggest an increased risk of developing sudden sensorineural hearing loss in patients with depressive disorders. Co-morbidities such as diabetes mellitus, chronic kidney disease and hyperlipidaemia significantly aggravated the risk. Depressive disorders might be considered a risk factor for sudden sensorineural hearing loss. It remains to be seen whether control of depressive disorders can decrease the incidence of sudden sensorineural hearing loss in patients with depressive disorders.

Download Full-text

Association of sudden sensorineural hearing loss with dementia: a nationwide cohort study

BMC Neurology ◽

10.1186/s12883-021-02106-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shu-Yu Tai ◽

Cheng-Ting Shen ◽

Ling-Feng Wang ◽

Chen-Yu Chien

Keyword(s):

Hearing Loss ◽

Cohort Study ◽

Sensorineural Hearing Loss ◽

Comparison Group ◽

Cox Regression ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Research Database ◽

Increased Risk ◽

Incidence Of Dementia

Abstract Background Impaired cochlear blood perfusion and microvascular damage can cause sudden sensorineural hearing loss (SSHL), which is a potential risk factor for dementia. This study explored the association between SSHL and dementia. Methods This retrospective cohort study used a random sample of 1000,000 individuals from Taiwan’s National Health Insurance Research Database. We identified 3725 patients newly diagnosed with SSHL between January 1, 2000, and December 31, 2009, and propensity score matching according to age, sex, index year, comorbidities, and medications was used to select the comparison group of 11,175 patients without SSHL. Participants were stratified by age (<65 and ≧65 years) and sex for the subgroup analyses. The outcome of interest was all cause dementia (ICD-9-CM codes 290.0, 290.4, 294.1, 331.0). Both groups were followed up until December 31, 2010, for diagnoses of dementia. Cox regression models were used to estimate the hazard ratio (HR) of dementia. Results During the average 5-year follow-up period, the incidence rate of dementia in the SSHL cohort was 6.5 per 1000 person-years compared with 5.09 per 10,000 person-years in the comparison group. After adjustment for potential confounders, patients with SSHL were 1.39 times more likely to develop dementia than those without SSHL (95% confidence interval = 1.13–1.71). When stratified by patients’ age and sex, the incidence of dementia was 1.34- and 1.64-fold higher in patients with SSHL aged ≥65 years (P = .013) and in women (P = .001), respectively, compared with the comparison group. Women with SSHL who were < 65 years old had the highest risk (2.14, 95% CI = 1.17–4.11, P = .022). In addition, a log-rank test revealed that patients with SSHL had significantly higher cumulative incidence of dementia than those without SSHL (P = .002). Conclusions Patients with SSHL, especially women aged < 65 years, were associated with higher risk of dementia than those without SSHL. Thus, clinicians managing patients with SSHL should be aware of the increased risk of dementia.

Download Full-text

Efficacy of oral vs. intratympanic corticosteroids in sudden sensorineural hearing loss

Journal of Basic and Clinical Physiology and Pharmacology ◽

10.1515/jbcpp-2015-0112 ◽

2016 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Kavita Swachia ◽

Dinesh Sharma ◽

Jatinder Singh

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Oral Prednisone ◽

Total Duration ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Current Standard ◽

Group I ◽

Oral Corticosteroids ◽

Group Ii

AbstractThe current standard treatment for sudden sensorineural hearing loss (SSNHL) comprises of tapered course of oral corticosteroids. Intratympanic steroids are introduced as another modality of treatment, but management of SSNHL continues to be debatable. The present study was designed to evaluate the efficacy of steroids given orally and by the intratympanic route.A prospective, randomized, open-labeled study was conducted involving 42 patients. These were randomly divided into two groups; group I patients received oral prednisone tapered over 14 days, and group II patients were treated with intratympanic methylprednisolone (40 mg/mL). One milliliter of the drug solution containing 40 mg of the drug (40 mg/mL) was injected into the middle ear cavity through the trans-tympanic route. The drug was injected twice a week for 2 weeks. The total duration of the study was 60 days, and hearing outcome was assessed on the basis of change in pure tone average.An improvement of 18.24±8.72 dB was recorded in group I patients treated with oral prednisone in comparison to 14.68±12.88 dB improvement in group II. Statistically significant improvement in hearing was observed in both groups, but it was not significant when group I and group II were compared.The post-treatment outcomes among patients who receive either oral prednisone or intratympanic methylprednisolone within 2 weeks of onset of symptoms were comparable. The outcomes were affected by degree of hearing loss and association of SSNHL with vertigo.

Download Full-text