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.

Critically appraise the current state of alternate temporal bone training techniques (virtual reality (VR) simulation, 3D-printed models, and mental practice (MP)) compared to traditional and cadaver methods. Databases Reviewed: PubMed, Cochrane, Web of Science.

Search terms utilized “temporal bone training”, “temporal bone surgical modalities”, and “training modalities temporal bone surgery” with “3D”, “rapid prototyp*”, “stereolithography”, “additive manufact*”, “plaster”, “VR”, “virtual reality”, “animal model”, “animal temporal bone”, and “synthetic” with “AND” for all literature. Exclusion criteria: non-ENT, non-English, and did not compare against alternative/traditional methods.

10 studies were included with 322 participants (83.9% ENT residents and 16.1% medical students). Costs include the FDM printer ($300), materials ($5/3D model), and <$5,000 for freeware simulator hardware. The Welling scale was used in 50% of studies. Alternate methods produced comparable or improved assessment scores to traditional and cadaver methods. Injuries were reported in three VR studies, with two reported significantly lower injury scores in the intervention groups. Time to completion was not significantly different in four VR studies, except for one finding that the time to visualize the incus was significantly lower in the intervention group. Performance after MP was not statistically different.

More data are needed to assess whether the alternate methods are comparable to cadaveric dissection in temporal bone training. 3D models and VR simulation demonstrate promising potential for novel trainees to acquire the basic skills and produce performance comparable to or significantly better than traditional methods of lectures, textbooks, CT images, and operative videos.