Objective: The present trial is aimed to evaluate the effectiveness of early transtympanic steroid injection in patients with ‘poor prognosis’ idiopathic sensorineural sudden hearing loss (ISSHL). Methods: Seventy-six patients, diagnosed as having ISSHL with ‘poor prognosis’, were randomized into a transtympanic group and a control group. Thirty-nine patients received conventional steroid treatment and 37 patients received 4 courses of additional transtympanic injections of methylprednisolone 7 days after conventional steroid treatment. Results: In the transtympanic group 45.9% of the patients had at least 15 dB improvement in pure tone average compared with 20.5% of the patients in the control group at the 8-week follow-up audiogram. In the transtympanic group 43.2% of the patients had an improvement of ≧15% in speech discrimination, compared with 17.9% of the patients in the control group 8 weeks after the treatment. The differences between the 2 groups were statistically significantly. Conclusion: The outcome was better for the patients with ‘poor prognosis’ ISSHL if the transtympanic steroid therapy could be applied early.

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