Sudden sensorineural hearing loss (SSNHL) is defined as a rapid loss of ≥30 dB in three contiguous frequencies over 72 hours. The first-line treatment and the evidence basis for intratympanic steroid injection as salvage therapy are:

• A Oral acyclovir as first-line (viral aetiology confirmed); intratympanic steroids are contraindicated
• B Systemic corticosteroids (oral prednisolone 1 mg/kg/day × 10 days) as first-line; intratympanic dexamethasone/methylprednisolone is indicated as initial or salvage treatment especially when systemic steroids are contraindicated (diabetes, hypertension) ✓
• C Emergent MRI followed by surgical exploration of the cochlea
• D Hyperbaric oxygen is the only evidence-based treatment; systemic steroids have no role

Explanation

Systemic corticosteroids (oral prednisolone 60 mg/day tapered over 10–14 days) are the evidence-based first-line treatment for SSNHL, based on improved hearing recovery rates. Intratympanic steroid injection (dexamethasone 10 mg/mL or methylprednisolone 40 mg/mL via round window or transtympanic route) delivers high local concentrations to the cochlea and is used as: (1) primary treatment when systemic steroids are contraindicated, or (2) salvage therapy for inadequate response to systemic steroids at 2–4 weeks. The etiology of SSNHL is idiopathic in >80% of cases; viral, microvascular, and autoimmune mechanisms are proposed but unproven in most individuals.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.