What to Do for Sudden Sensorineural Hearing Loss When Initial Corticosteroid Therapy Fails to Improve Hearing
Sudden sensorineural hearing loss has a defined first-line treatment window. When that initial therapy does not produce meaningful hearing improvement — confirmed at reassessment 2 to 6 weeks after onset — a structured salvage approach is indicated. This protocol addresses that specific escalation.
Previous Treatment & Failure Condition
Prior therapy: Corticosteroids as initial treatment within 2 weeks of symptom onset — administered systemically or intratympanically, sometimes combined with hyperbaric oxygen therapy, or managed with watchful waiting as an alternative.
Goal not reached: Hearing improvement not confirmed on reassessment within 2 to 6 weeks of onset. This unmet goal is what triggers escalation to the salvage protocol described here.
Salvage Approach
For incomplete recovery assessed 2 to 6 weeks after onset, salvage therapy involves intratympanic steroid injections. In eligible patients, hyperbaric oxygen therapy combined with steroids may also be offered as a salvage option. The complete regimen, eligibility criteria, timing, and sequencing are specified in the full protocol.
Clinical Goal
The target of salvage therapy is hearing recovery.
References
DOI: 10.1177/0194599819859885
- Clinicians should offer, or refer to a clinician who can offer, IT steroid therapy when patients have incomplete recovery from SSNHL 2 to 6 weeks after onset of symptoms.
- Clinicians may offer, or refer to a clinician who can offer, hyperbaric oxygen therapy (HBOT) combined with steroid therapy as salvage within 1 month of onset of SSNHL.
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