Objectives: To evaluate the hearing outcomes of intratympanic steroid (ITS) treatment for patients with acute low-tone sensorineural hearing loss (ALHL) after failure of initial therapy and to investigate the recurrence and progression to definite Ménière's disease (MD) during a long-term follow-up. Methods: We retrospectively reviewed the medical records of 90 patients with refractory ALHL who were followed up for at least 1 year between January 2000 and April 2014. Patients who responded poorly to initial medical treatment received intratympanic dexamethasone injections (ITS group) or isosorbide administration for 4 weeks (diuretic group) as salvage treatment options according to their choice of management. The control group did not receive ITS or the diuretic, due to their refusal of both medical treatments. The hearing outcomes were evaluated 1 month, 1 year and 5 years after the completion of the second-line therapy, and the rates of recurrence and progression to MD were measured during a follow-up period of at least 1 year. Results: Twenty-seven patients in the ITS group, 39 patients in the diuretic group and 24 patients in the control group were enrolled. Of these, 12 patients in the ITS group, 15 patients in the diuretic group and 12 patients in the control group were followed up for over 5 years. We found that the recovery rates and the audiometric functional values after 1 month and 1 year in the ITS group were significantly higher than those in the diuretic and control groups. However, there were no significant differences in the recovery rates or the audiometric functional values after 5 years, or in the rates of recurrence and progression to MD between the groups. Conclusions: Salvage ITS therapy can provide a relatively good short-term hearing outcome for ALHL patients who have persistent hearing loss despite conventional treatment. However, both recurrence and progression to MD after treatment were observed in some patients during the long-term follow-up.

Barrs DM, Keyser JS, Stallworth C, McElveen JT Jr: Intratympanic steroid injections for intractable Ménière's disease. Laryngoscope 2001;111:2100-2104.
Chandrasekhar SS, Rubinstein RY, Kwartler JA, Gatz M, Connelly PE, Huang E, Baredes S: Dexamethasone pharmacokinetics in the inner ear: comparison of route of administration and use of facilitating agents. Otolaryngol Head Neck Surg 2000;122:521-528.
Fukushima M, Kitahara T, Fuse Y, Uno Y, Doi K, Kubo T: Changes in aquaporin expression in the inner ear of the rat after i.p. injection of steroids. Acta Otolaryngol Suppl 2004;553:13-18.
Fuse T, Aoyagi M, Funakubo T, Sakakibara A, Yoshida S: Short-term outcome and prognosis of acute low-tone sensorineural hearing loss by administration of steroid. ORL J Otorhinolaryngol Relat Spec 2002;64:6-10.
Fuse T, Hayashi T, Oota N, Fukase S, Asano S, Kato T, Aoyagi M: Immunological responses in acute low-tone sensorineural hearing loss and Ménière's disease. Acta Otolaryngol 2003;123:26-31.
Fushiki H, Junicho M, Aso S, Watanabe Y: Recurrence rate of idiopathic sudden low-tone sensorineural hearing loss without vertigo: a long-term follow-up study. Otol Neurotol 2009;30:295-298.
Govaerts PJ, Somers T, Offeciers FE: Box and whisker plots for graphic presentation of audiometric results of conductive hearing loss treatment. Otolaryngol Head Neck Surg 1998;118:892-895.
Imamura S, Nozawa I, Imamura M, Murakami Y: Clinical observations on acute low-tone sensorineural hearing loss. Survey and analysis of 137 patients. Ann Otol Rhinol Laryngol 1997;106:746-750.
Junicho M, Aso S, Fujisaka M, Watanabe Y: Prognosis of low-tone sudden deafness. Does it inevitably progress to Ménière's disease? Acta Otolaryngol 2008;128:304-308.
Li H, Feng G, Wang H, Feng Y: Intratympanic steroid therapy as a salvage treatment for sudden sensorineural hearing loss after failure of conventional therapy: a meta-analysis of randomized, controlled trials. Clin Ther 2015;37:178-187.
Martin-Sanz E, Esteban-Sanchez J, Rodrigañez-Riesco L, Sanz-Fernández R: Transitory effect on endolymphatic hydrops of the intratympanic steroids for Ménière's disease. Laryngoscope 2015;125:1183-1188.
McCabe BF: Autoimmune sensorineural hearing loss. Ann Otol Rhinol Laryngol 1979;88:585-590.
Monsell EM, Balkany TA, Gates GA, Goldenberg RA, Meyerhoff WL, House JW: Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Ménière's disease. Otolaryngol Head Neck Surg 1995;113:181-185.
Morita S, Suzuki M, Iizuka K: A comparison of the short-term outcome in patients with acute low-tone sensorineural hearing loss. ORL J Otorhinolaryngol Relat Spec 2010;72:295-299.
Noguchi Y, Nishida H, Tokano H, Kawashima Y, Kitamura K: Comparison of acute low-tone sensorineural hearing loss versus Ménière's disease by electrocochleography. Ann Otol Rhinol Laryngol 2004;113:194-199.
Nozawa I, Imamura S, Mizukoshi A, Honda H, Okamoto Y: Clinical study of acute low-tone sensorineural hearing loss: survey and analysis of glycerol test and orthostatic test. Ann Otol Rhinol Laryngol 2002;111:160-164.
Okada K, Ishimoto S, Fujimaki Y, Yamasoba T: Trial of Chinese medicine Wu-Ling-San for acute low-tone hearing loss. ORL J Otorhinolaryngol Relat Spec 2012;74:158-163.
Parnes LS, Sun AH, Freeman DJ: Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. Laryngoscope 1999;109:1-17.
Plontke SK, Siedow N, Wegener R, Zenner HP, Salt AN: Cochlear pharmacokinetics with local inner ear drug delivery using a three- dimensional finite-element computer model. Audiol Neurootol 2007;12:37-48.
Pondugula SR, Raveendran NN, Ergonul Z, Deng Y, Chen J, Sanneman JD, Palmer LG, Marcus DC: Glucocorticoid regulation of genes in the amiloride-sensitive sodium transport pathway by semicircular canal duct epithelium of neonatal rat. Physiol Genomics 2006;24:114-123.
Pondugula SR, Sanneman JD, Wangemann P, Milhaud PG, Marcus DC: Glucocorticoids stimulate cation absorption by semicircular canal duct epithelium via epithelial sodium channel. Am J Physiol Renal Physiol 2004;286:F1127-F1135.
Rutt AL, Hawkshaw MJ, Sataloff RT: Incidence of tympanic membrane perforation after intratympanic steroid treatment through myringotomy tubes. Ear Nose Throat J 2011;90:E21.
Salt AN: Dexamethasone concentration gradients along scala tympani after application to the round window membrane. Otol Neurotol 2008;29:401-406.
Selivanova OA, Gouveris H, Victor A, Amedee RG, Mann W: Intratympanic dexamethasone and hyaluronic acid in patients with low-frequency and Ménière's-associated sudden sensorineural hearing loss. Otol Neurotol 2005;26:890-895.
Shimono M, Teranishi M, Yoshida T, Kato M, Sano R, Otake H, Kato K, Sone M, Ohmiya N, Naganawa S, Nakashima T: Endolymphatic hydrops revealed by magnetic resonance imaging in patients with acute low-tone sensorineural hearing loss. Otol Neurotol 2013;34:1241-1246.
Shirwany A, Seidman MD, Tang W: Effect of transtympanic injection of steroids on cochlear blood flow, auditory sensitivity, and histology in the guinea pig. Am J Otol 1998;19:230-235.
Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, Brown SR, Fife TD, Ford P, Ganiats TG, Hollingsworth DB, Lewandowski CA, Montano JJ, Saunders JE, Tucci DL, Valente M, Warren BE, Yaremchuk KL, Robertson PJ; American Academy of Otolaryngology, Head and Neck Surgery: Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg 2012;146(suppl 3):S1-S35.
Trune DR, Kempton JB, Gross ND: Mineralocorticoid receptor mediates glucocorticoid treatment effects in the autoimmune mouse ear. Hear Res 2006;212:22-32.
Wang CT, Fang KM, Young YH, Cheng PW: Vestibular-evoked myogenic potential in the prediction of recovery from acute low-tone sensorineural hearing loss. Ear Hear 2010;31:289-295.
Yamasoba T, Kikuchi S, Sugasawa M, Yagi M, Harada T: Acute low-tone sensorineural hearing loss without vertigo. Arch Otolaryngol Head Neck Surg 1994;120:532-535.
Yamasoba T, Sugasawa M, Kikuchi S, Yagi M, Harada T: An electrocochleographic study of acute low-tone sensorineural hearing loss. Eur Arch Otorhinolaryngol 1993;250:418-422.
Yang J, Wu H, Zhang P, Hou DM, Chen J, Zhang SG: The pharmacokinetic profiles of dexamethasone and methylprednisolone concentration in perilymph and plasma following systemic and local administration. Acta Otolaryngol 2008;128:496-504.
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