Intratympanic vs systemic steroids for sudden sensorineural hearing loss: a systematic review of recovery

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an otologic emergency with an incidence of 5–27 per 100,000 persons per year. The primary treatment method is corticosteroids, although the most effective way of administration is a controversial issue. The aim of the study is to compare the results of hearing recovery in intratympanic and systemic corticosteroid in ISSNHL. Methods: We used PRISMA to systematically search PubMed, Scopus and Web of Science (2015–2025) to identify randomized controlled trials and prospective comparative studies. The extraction of data was done on the improvement of pure-tone averages, recovery rates and complications. Cochrane RoB 2 was used to assess the risk of bias. Findings: The number of studies and patients included was 17 and 1,649 respectively. In most studies, recovery rates ranged from 60% to 70% across studies. The largest RCT with a 67.3% efficacy rate versus 57.4% with systemic alone (n=47) was combined systemic-intratympanic therapy (n=156) (p>0.05). Salvage intratympanic therapy (n=43) yielded a mean hearing gain of 13.6 dB as compared to no improvement with observation (n=48). Such prognostic variables as vertigo (p=0.039), cardiovascular comorbidity (p=0.02) and initial severity of hearing loss (p=0.033) had a significant impact. Conclusions: Intratympanic corticosteroids have the same efficacy as systemic therapy in the treatment of primary ISSNHL and have positive safety profiles. Severe cases may be helped by combined therapy. In case of a failed systemic treatment, salvage intratympanic therapy works.