Therapeutic Effect of Intratympanic Methylprednisolone in Sudden Sensorineural Hearing Loss: A Prospective Observational Study

Abstract

Introduction: Sudden sensorineural hearing loss (SSNHL) is an otological emergency requiring prompt treatment. Intratympanic steroid therapy delivers a high concentration of steroid directly into the inner ear while minimizing systemic adverse effects. Despite its routine use, outcomes of intratympanic methylprednisolone therapy have not been documented in our setting. This study evaluated its therapeutic effect in SSNHL patients treated in routine clinical practice. Methods: This hospital-based prospective observational analytical study was conducted in the Department of ENT at Lumbini Medical College from June 2025 to May 2026. Forty patients with SSNHL who received intratympanic methylprednisolone (40 mg in 1 mL) as part of routine care were included. Each received four injections over 15 days. Hearing thresholds were assessed using pure tone audiometry before treatment and at one month after treatment, using 3-frequency (500, 1000, 2000 Hz) and 4-frequency (500, 1000, 2000, 4000 Hz) averages. Improvement was defined as a hearing gain of ≥10 dB in the 3-frequency PTA. Results: Improvement was observed in 35 patients (87.5%). The mean 3-frequency PTA improved from 60.3 ± 6.6 dB to 49.8 ± 10.2 dB (mean gain 10.4 ± 7.8 dB; p < 0.001). The mean 4-frequency PTA improved from 62.0 ± 6.0 dB to 52.3 ± 9.9 dB (mean gain 9.7 ± 6.5 dB; p < 0.001). No vertigo, perforation, or infection occurred. Conclusions: Intratympanic methylprednisolone therapy resulted in significant hearing improvement in patients with SSNHL treated in routine clinical practice, with a favorable safety profile.