Impact of patient adherence to oral versus intratympanic steroid protocols on hearing outcomes in sudden sensorineural hearing loss
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20262359Keywords:
Sudden sensorineural hearing loss, Steroids, Adherence, Intratympanic injection, Prednisolone, ComplianceAbstract
Background: Systemic and intratympanic steroids (ITS) are primary treatments for idiopathic sudden sensorineural hearing loss (SSNHL). While efficacy is known, real-world adherence to high-dose oral tapers and its impact on outcomes remains under-reported. We compared adherence rates between oral (OST) and ITS therapy and evaluated their correlation with hearing recovery.
Methods: This retrospective cohort study included 245 adults with unilateral SSNHL. Patients received a 14-day oral prednisolone taper (OST group) or four intratympanic Dexamethasone injections over two weeks (ITS group). OST adherence (defined as taking ≥80% of the prescribed dose) was assessed via refill records and patient diaries. ITS adherence required completing all injections. Multivariate logistic regression adjusted for baseline imbalances.
Results: Of the 245 patients, 138 received OST and 107 received ITS. The ITS group demonstrated significantly higher adherence (96.3%) versus the OST group (78.3%; p<0.001). OST non-adherence resulted mainly from hyperglycemia (30%), insomnia (25%), and gastrointestinal distress (20%). Adherent OST patients achieved a mean Pure Tone Average improvement of 24.5 dB, compared to 14.2 dB in non-adherent patients (p=0.004). Age >65 and diabetes history were independent predictors of poor OST adherence.
Conclusions: Adherence to high-dose oral steroids for SSNHL is suboptimal compared to intratympanic administration due to systemic side effects, significantly compromising hearing recovery. Intratympanic therapy may be the preferred primary modality for patients with non-adherence risk factors like diabetes or advanced age.
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