Factors Associated With the Benefits of Concurrent Administration of Intratympanic Steroid Injection With Oral Steroids in Patients With Acute Acoustic Trauma

Objective: To analyze the factors associated with the benefits of concurrent administration of intratympanic steroid injection (ITSI) and oral steroids in patients with acute acoustic trauma (AAT) incurred during military training. Study Design: Retrospective analysis. Patients: Nineteen patients eligible under the criteria established concerning treatment for AAT were retrospectively reviewed in this study. Interventions: ITSI treatments were administered simultaneously alongside oral prednisolone. Main Outcome Measures: Patients were categorized into two groups depending on the time elapsed between exposure to the noise and treatment initiation: 1) "Early Treatment initiation," defined as the treatment being initiated between 3 and 7 days; and 2) "Delayed treatment initiation," defined as the treatment being initiated in >7 days. Pure-tone air conduction threshold audiometry, to record the pure-tone average (PTA) at 2, 4, and 8 kHz, was conducted upon each patient's initial visit, and 1 month after starting treatment. The degree of hearing gain (hearing gain [dB] = [initial PTA] – [final PTA]) was calculated and used as the metric for determining the treatment's outcome. The initial PTA and treatment onset were adopted as possible associated factors. Results: The mean ages of each group were 22.00 ± 2.12 years and 22.83 ± 2.64 years, respectively (p = 0.28). The initial PTAs were 46.41 ± 12.73 dB and 47.22 ± 14.74 dB, respectively (p = 1.00). In the multivariable linear regression analysis, the initial PTA and the treatment initiation showed a significant association (R2 = 0.37). The unstandardized regression coefficient of the initial PTA was 0.37 (p = 0.04). Patients with early treatment initiation showed significant improvement in the degree of hearing gain compared with delayed treatment initiation (unstandardized regression coefficient = 12.63, p = 0.01). Conclusions: We demonstrated the importance of early treatment onset for maximizing the benefits of concurrent administration of ITSI with oral steroids in patients with AAT suffered during military training. Further evaluation is needed to confirm the factors associated with the efficacy of concurrent ITSI with oral steroids. Address correspondence and reprint requests to Young-Soo Chang, M.D., Department of Otorhinolaryngology, ROK Armed Forces Yangju Hospital, 1186 Eunhyeon-myeon, Hwahap-ro, Yangju-si, Gyeonggi-do 482-863, Republic of Korea; E-mail: yschang83@gmail.com The authors alone are responsible for the content and writing of this article. This work was supported by the Korean Military Medical Research Project which is funded by the ROK Ministry of National Defence (ROK-MND-2017-KMMRP-003). The authors disclose no conflicts of interest. Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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