Evaluation of Transtympanic Steroid Injection Dosage in Treatment of Sensorineural Hearing Loss: A Systematic Review

Objectives: In sensorineural hearing loss treatment, transtympanic membrane (TTM) steroid injections help in recovery. However, steroid dosage distribution and patient recovery rates remains underexplored. Our systematic review compiles steroid regimens and their hearing recovery rates.

Data Sources: PubMed, OVID, and Google Scholar.

Review Methods: Search terms included TTM steroid and hearing loss. Inclusion criteria were measurements for human hearing recovery, full-text articles, and studies published on or before 1/20/2025. Exclusion criteria included reviews. Primary outcomes were hearing and patient recovery rates. For analysis, we focused on dose levels and simultaneous systemic steroids, and employed descriptive and exploratory study-level analyses

Results: 29 articles were included. Of studies reporting gender, the distribution was 54.6% (635) male and 45.4% (528) female. 1,294 total patients received TTM steroids with distributions being: 26.0% (n=336) received 4 mg/mL dexamethasone, 25.2% (n=326) received 5 mg/mL dexamethasone, 2.7% (n=35) received 8 mg/mL dexamethasone, 3.5% (n=45) used 10 mg/mL dexamethasone, 3.1% (n=40) received 24 mg/mL dexamethasone, 31.8% (n=411) received 40 mg/mL methylprednisolone, 2.6% (n=34) received 62.5 mg/mL methylprednisolone, and 5.2% (n=67) received 125 mg/mL methylprednisolone.

Hearing recovery ranged from 6.4-41 decibels (dB). The exploratory analysis did not identify significant differences in hearing recovery; however, methodological variance limits direct cross-study comparison and limits dose equivalence.

Conclusion: Variability exists in regimen and outcomes reported. The findings of this study-level exploratory analysis should not be interpreted as evidence that a dose-response relationship does not exist. Therefore, this study provides a framework for researchers and clinicians to understand steroid regimens used to date.