Topical steroid therapy using the Silverstein Microwick in sudden sensorineural hearing loss after failure of conventional treatment

CONCLUSIONS: Local administration of steroids to the inner ear through the round window route improves hearing in patients after failure of conventional therapy. OBJECTIVES: To determine if delivery of methylprednisolone to the round window can improve hearing after failure of conventional treatment for sudden sensorineural hearing loss (SSHL) administered for 10 days after the onset of the hearing loss. PATIENTS AND METHODS: A Silverstein microwick was placed in the round window niche under local anesthesia and endoscopic control, allowing self-administration of methylprednisolone twice a day for 3 weeks. Treated patients were compared to a control group composed of similar patients, treated with the same systemic regimen but who did not receive local therapy. RESULTS: Of the 12 patients enrolled in this nonrandomized prospective study, 8 patients showed an improvement of the pure tone average (PTA) and 4 remain stable. Of those who responded to perfusion, eight patients demonstrated a significant mean 24.5 +/- 12 dB improvement in PTA, and seven patients had a mean 17.5 +/- 18% improvement in discrimination, with five patients reaching 100% speech discrimination score (SDS). Patients in the control group did not show any improvement of the PTA.