Irish Journal of Medical Science (1971 -)

https://doi.org/10.1007/s11845-021-02610-6

ORIGINAL ARTICLE

Postauricular injection of methylprednisolone sodium succinate

as a salvage treatment for refractory sudden sensorineural hearing
loss
Gang Ren1 · Jue Xu1 · Longjiang Lan1 · Bingliang Ma1 · Qi Zhang1

Received: 9 August 2020 / Accepted: 28 March 2021

© Royal Academy of Medicine in Ireland 2021

Abstract
Background Postauricular steroid administration has been popular for treating sudden sensorineural hearing loss. However,
there are few reports on its use in patients with refractory sudden sensorineural hearing loss (RSSNHL).
Aims The objective of this study was to investigate the therapeutic efficacy of postauricular steroid injection as a salvage
treatment for RSSNHL patients.
Methods This retrospective study enrolled 63 RSSNHL patients between January 2016 and January 2019. Thirty-three
patients of them who have been divided into the treatment group received postauricular methylprednisolone sodium suc-
cinate injection. The remaining 30 patients who formed the control group did not receive any steroid as a salvage therapy.
Improvements in hearing were evaluated between pre-salvage therapy and 3 months follow-up after salvage therapy.
Results The median hearing gain in PTA was 9.88 dB HL (quartile range 7.58, 18.65) in the treatment group and 0.90 dB
HL (quartile range 0.00, 4.90) in the control group (P<0.01). According to the criteria of Furuhashi, the total percentage for
effective prognosis was 48.48% (16/33) in the treatment group and 10.00% (3/30) in the control group (P<0.01). The time
interval from onset to study entry was significantly and independently associated with the prognosis for RSSNHL patients
(P< 0.01).
Conclusions The present findings suggest that postauricular corticosteroid administration as a salvage treatment demonstrated
better results than no treatment for RSSNHL patients. The time interval from onset to study entry was mainly the prognostic
factor for RSSNHL patients. It is therefore considered that postauricular corticosteroid administration may be used as a
salvage therapy for RSSNHL patients.

Keywords Methylprednisolone sodium succinate · Postauricular injection · Refractory sudden sensorineural hearing loss
(RSSNHL) · Salvage treatment

Introduction SSNHL remains unclear. Approximately 30–50% of patients

Although the treatment of sudden sensorineural hearing loss
(SSNHL) remains controversial, the systematic administra-
tion of steroids is commonly used as a standard therapy [1].
However, the value of systemic steroids in the treatment of
* Qi Zhang
383587773@qq.com
Gang Ren
176164137@qq.com
1 treatment of RSSNHL [5]. However, this may result into
Department of Otolaryngology, the First Affiliated Hospital
of Huzhou University, the First People’s Hospital of Huzhou,
Huzhou 313000, Zhejiang, China
do not show adequate response to initial systemic corticos-
teroid treatment over a 2-week period of time [2]. Therefore,
patients with SSNHL who do not respond or who respond
insufficiently to systemic steroids are typically considered
to have refractory sudden sensorineural hearing loss (RSS-
NHL) [3].
The mechanism of steroid action in the inner ear is still
unclear, but higher steroid concentration in the perilymph
of the inner ear is associated with greater hearing recovery
[4]. In order to achieve an adequate perilymphatic concentra-
tion, high-dose systemic steroids may be required for salvage
all kinds of adverse effects [1]. Therefore, new methods of

13
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steroid administration for RSSNHL are therefore of increas-
ing clinical interest.
Intratympanic administration of steroids into the inner ear
as a local delivery route can achieve higher perilymphatic
levels compared to the systemic route, and avoid systemic
side effects of steroids. In fact, many reports confirm that
intratympanic steroid administration has benefit in patients
with RSSNHL [6, 7]. However, intratympanic steroid treat-
ment can result in some potential complications [6]. There-
fore, other suitable routes for drug delivery to the inner ear
are needed. It has been reported that therapy of postauricu-
lar methylprednisolone injection can decrease the pure tone
threshold effectively and increase speech discrimination
with a sudden hearing loss [8]. In fact, postauricular steroid
injection is widely used as an initial treatment for SSNHL
patients in China. However, there are relatively few reports
on its use in patients with RSSNHL. Hence, this retrospec-
tive study was conducted to evaluate the therapeutic efficacy
of postauricular injection methylprednisolone sodium succi-
nate as a salvage treatment for RSSNHL patients. We found
that the median hearing gain was larger after postauricular
steroid administration than no treatment and the time inter-
val from onset to study entry was significantly and indepen-
dently associated with the prognosis for RSSNHL patients.
Subjects and methods
Subjects
The medical records of patients with SSNHL hospitalized
at the Department of Otorhinolaryngology of our hospital
between January 2016 and January 2019 were analyzed ret-
rospectively. The primary steroid therapy had been admin-
istration of intravenous dexamethasone which consisted of
16.0 mg per day for the beginning 3 days, 8.0 mg per day
for the next 3 days, and 4.0 mg per day for the last 3 days.
These patients that exhibited no response (less than 10 dB
HL mean hearing gain at 500, 1000, 2000, and 4000 Hz after
initial therapy) to the systemic steroid on the 14th day were
deemed to have RSSNHL [9].
The inclusion criteria for RSSNHL patients were as fol-
lows: (1) age of at least 18 years and including male and
female; (2) minimum 30 dB HL hearing loss at three or
more consecutive frequencies in unilateral hearing loss; (3)
occurred within 72 h and presented for less than 30 days;
(4) standardized treatment containing systemic steroid usage
for at least 14 days; (5) less than 10 dB HL mean hearing
gain after previous therapy; and (6) must have 50 dB HL or
higher pure tone average (PTA) for the affected ear before
salvage therapy which was calculated as the arithmetic mean
of the hearing thresholds at 500, 1000, 2000, and 4000 Hz.
13
Irish Journal of Medical Science (1971 -)
The exclusion criteria were defined as follows: (1) other
sensorineural hearing loss with identifiable etiology such
as Meniere’s disease, presbyacusia, and position-occupy-
ing lesion at the cochlear rear; (2) conductive or mixed
hearing loss such as inflammatory ear disease, otosclero-
sis, and cholesteatoma; (3) prior ear surgery of any kind
(except ventilating tubes) or bilateral hearing loss; (4) the
conditions that could reduce the dosage of steroids such as
uncontrolled diabetes, serious hypertension, and active gas-
trointestinal ulcer; and (5) the conditions that could affect
hearing recovery such as rheumatic disease, known human
immunodeficiency virus, liver or renal dysfunction, presence
of neoplasm, chemotherapy or radiation therapy, or other
immunosuppressive drugs.
A total of 63 RSSNHL patients were included in the
study. They were informed about the procedure and the pos-
sible benefits and risks such as pain, subcutaneous conges-
tion, a transient dizziness, and uncontrolled hyperglycemia
before salvage treatment. Thirty-three patients who provided
an informed consent form for postauricular steroid injec-
tion were divided into the treatment group. The remaining
30 patients who refused postauricular therapy formed the
control group. They all agreed to take part in the study and
signed an informed consent form for medical record use
which provided relevant data including age, sex, affected
ear, time of onset deafness, accompanying symptoms, and
hearing conditions. The Ethical Committee of our Hospital
approved the study protocol.
Salvage treatment
All RSSNHL patients received the same salvage treatment
protocol for 14 days, such as mecobalamin and ginkgo
biloba extract. At the same time, the treatment group
received methylprednisolone sodium succinate treatment
through the following procedures: draw 1 ml of 40 mg/ml
of methylprednisolone sodium succinate (Pfizer Inc., New
York, NY, USA) with a 1-ml syringe; inject the solution on
the surface of the cribriform area of the mastoid bone of
the post affected ear after strict disinfection; and compress
the injected site for 5 min with a cotton ball after injection.
The procedure was carried out at 8:00 a.m. and performed 5
times (once every 2 days). No steroid was used for salvage
therapy in the control group.
Outcome assessment
Auditory function was measured before initial and salvage
therapy as well as at the 3-month follow-up after salvage
therapy. PTA repressed the hearing level of the damaged ear
which was calculated as the arithmetic mean of the hearing
thresholds at 500, 1000, 2000, and 4000 Hz. The final mean
Irish Journal of Medical Science (1971 -)

hearing gain was defined as the mean changes of PTA between
pre-salvage therapy and at the 3-month follow-up after sal-
vage therapy. The hearing recovery was evaluated according
to the criteria used by Furuhashi [10]: (1) complete recovery:
PTA ≤ 25 dB HL or identical to the contralateral non-affected
ear; (2) marked improvement: PTA improvement > 30 dB HL;
(3) slight improvement: PTA improvement between 10 and
30 dB HL; and (4) non-recovery: PTA improvement < 10 dB
HL. Adverse events included untoward response caused by
injection, and side effects of glucocorticoids were assessed at
all patients according to the medical records. A positive result
about the event should be given to the patient as long as some
adverse event occurred only one time.
Statistical analysis
Statistical analyses were performed using the software pack-
age SPSS version 23.0 (SPSS Inc., Chicago, IL, USA). Data
about categorical variables were presented as count and per-
centages. The categorical variables were compared by the
Chi-square (x2) tests or Fisher’s exact test when the theo-
retical frequency was smaller than 5. The Shapiro-Wilk test
was used to assess whether the distributions of continuous
variables were normal. Normal distribution variables were
evaluated by two independent sample t tests between treat-
ment group and control group or between before and after
salvage treatment. Data were expressed as mean ± standard
deviation (SD). Skewed continuous variables were com-
pared by Mann-Whitney U tests between the two groups and
Kruskal-Wallis H tests among PTA of different frequency.
Data were showed by median and interquartile ranges. Mul-
tiple comparisons in Kruskal-Wallis H were made using
the Nemenyi test. The ordinal categorical variable about
the curative effect was analyzed by the Wilcoxon rank-sum
test. Because the variable (prognosis for RSSNHL patients
defined as effective or ineffective) was categorical variable,
Spearman rank correlation and multivariate logistic regres-
sion were used for analyzing correlations between prognosis
of RSSNHL patients and prognostic factors in the treatment
group. The following covariates were taken into account: age
(0/1: < 56 years/ ≥ 57 years), sex (0/1: male/female), affected
ear (0/1: left/right), time interval from onset to study entry
(0/1: < 24 days/ ≥ 25 days), pre-salvage PTA (0/1: < 76.82 dB
HL/ ≥ 76.82 dB HL), tinnitus (0/1: absent/present), and diz-
ziness (0/1: absent/present). The hearing gain was evaluated
using a 1-sided test, but the others used 2-sided. A differ-
ence was considered to be statistically significant when the
P value was less than 0.05.
Results
Study patients
A total of 63 patients who failed in the initial systemic
treatment were enrolled into this study. Table 1 presents the
demographic, clinical, and audiological characteristics for
the study patients. There were no statistically significant

Table 1  Demographic, clinical, and audiological features between treatment group and control group
Parameters Total (n = 63) Treatment group (n = 33) Control group (n = 30) t/Χ2/Z P value

Age (years)* 57.19 ± 8.84 56.42 ± 9.74 58.03 ± 7.80 −0.72 0.48
Sex (male/female) ** 33/30 18/15 15/15 0.13 0.72
Side of affected ear (left/right) ** 39/24 19/14 20/10 0.55 0.46
Time interval (days)
Study entry from onset of deafness*** 24.0 (19.0,26.0) 24.0 (19.0,26.0) 23.5 (19.0,26.0) −0.70 0.49
Study entry from end of prior therapy* 7.21 ± 3.19 6.85 ± 2.90 7.60 ± 3.50 −0.92 0.36
Accompanied symptoms**
Tinnitus 24 (38.1) 13 (39.4) 11 (36.7) 0.05 0.82
Dizziness 7 (11.1) 3 (9.1) 4 (13.3) − 0.70
PTAa for affected ear (dB HL)*, b
Initial PTA 80.81 ± 13.78 79.96 ± 14.02 81.74 ± 13.69 −0.52 0.61
Pre-salvage PTA 76.23 ± 13.48 76.82 ± 13.57 75.58 ± 13.58 0.36 0.72

PTA pure tone average

*
Statistical significance was determined using the t test. The results were showed by mean ± standard deviation; **Statistical significance was
determined using the Χ2 test or Fisher’s exact test when the theoretical frequency was smaller than 5. The results were showed by number (%);
***
Statistical significance was determined using the Mann-Whitney U test. The results were showed by median (quartile range). P value of < 0.05
was considered statistically significant
a
Pure tone average at 500, 1000, 2000, and 4000 Hz hearing thresholds
b
Statistically differences were not absence between initial PTA and pre-salvage PTA for each group

13

Fig. 1  Hearing gain profile (change in PTA) from pre-salvage ther-
apy to 3 months after salvage therapy. a Comparison of average PTA
between pre-salvage and 3 months later: The dates were calculated
by the two-sample group t test and presented by mean and standard
deviation. b Comparison of the hearing gain (improvement in PTA)
between treatment group and control group calculated by the Mann-
Whitney U test with a 1-sided test. The figures were presented by
median (quartile range). c Comparison of the hearing gain (improve-
ment in PTA) among different frequency calculated by the Mann-
Whitney U test, Kruskal-Wallis H tests, and Nemenyi test. The dates
were presented by median (quartile range). P value of < 0.05 was con-
sidered statistically significant. Abbreviations: PTA: pure tone aver-
age. *: P<0.05 vs. 8000 Hz. **: P<0.05 vs. 4000 Hz
differences with regard to age, sex, side of affected ear,
time from onset or prior therapy to study entry, initial PTA,
pre-salvage PTA, tinnitus, and dizziness between treatment
group and control group (P˃0.05). Statistically significant
differences were not detected between initial PTA and pre-
salvage PTA in the two groups, respectively (P˃0.05).
Hearing gain profile and curative effect
After salvage therapy, the final mean PTA after 3 months
were 63.43 ± 17.49 dB HL (mean ± SD) and 72.50 ± 15.84 dB
HL (mean ± SD) for the treatment group and control group,
respectively. A statistically significant difference was
detected in the treatment group (P<0.01) but was not found
Table 2  Curative effect between Groups Cases (n) Curative ­effecta n (%)
treatment and control group
from pre-salvage therapy to
3 months after salvage therapy
Treatment group 33
Control group 30
P value of < 0.05 was considered statistically significant
a
Statistical significance was determined using the Wilcoxon rank-sum test. Data were presented as count
and percentages
13
Irish Journal of Medical Science (1971 -)
in the control group (P = 0.42) compared with pre-salvage
PTA (Fig. 1a). The median hearing gain in PTA was 9.88 dB
HL (quartile range 7.58, 18.65) in the treatment group and
0.90 dB HL (quartile range: 0.00, 4.90) in the control group.
There was a significant difference in hearing gain between
the two groups (P<0.01, Fig. 1b). At the same time, there
were also significant differences in hearing gain at 250, 500,
1000, 2000, 4000, and 8000 Hz between treatment group and
control group (P<0.01, Fig. 1c). It is worthy of attention that
the hearing gains were decreased as the frequencies increased
in the treatment group by Kruskal-Wallis H tests (P<0.01,
Fig. 1c). The same results were discovered further by the
Nemenyi test. In contrast to 8000 Hz, the hearing gains were
significantly larger at 250, 500, 1000, and 2000 Hz (P<0.05,
Fig. 1c). Compared with 4000 Hz, the greater hearing gains
were shown at 250 and 500 Hz (P<0.05, Fig. 1c). No sig-
nificant differences were found among 250, 500, 1000, 2000,
4000, and 8000 Hz in the control group by Kruskal-Wallis H
tests (P>0.05, Fig. 1c).
According to the criteria of Furuhashi, the total per-
centage for effective prognosis was 48.48% (16/33) in the
treatment group and 10.00% (3/30) in the control group. A
total of 51.52% (17/33) patients in the treatment group and
90.00% (27/30) patients in the control group were resistant
to salvage therapy and were defined as non-recovery. There
were no patients who met the criteria for complete recov-
ery. Significant differences were detected between the two
groups by the Wilcoxon rank-sum test (P < 0.01, Table 2).
Prognostic factors for RSSNHL patients
in the treatment group
For the sake of clarifying whether the influence of clini-
cal and audiological features on prognosis of RSSNHL
patients, Spearman rank correlation and multivariate logis-
tic regression model were implemented. The prognosis
for RSSNHL patients was divided into effective and inef-
fective according to the curative effect in the treatment
group. There was a negative correlation between prog-
nosis and time interval from onset to study entry through
Spearman rank correlations (r = −0.60, P < 0.01, model 1
P value
2
Complete Marked Slight improvement Non-recovery Χ
recovery improve-
ment
0 6 (18.18) 10 (30.30) 17 (51.52) 11.93 0.002
0 0 3 (10.00) 27 (90.00)
Irish Journal of Medical Science (1971 -)

Table 3  Prognostic factors for RSSNHL patients in the treatment Table 4  Complications in treatment group
group
Adverse events (n = 33) Time’s of adverse Case’s of
variables Model ­1a, * Model ­2b, ** events reported (n) unique patients,
n (%)a
Univariate (r) P value Multi- P value
variate Injection pain 13 7 (21.21)
(OR)
Infection 0 0
Age 0.03 0.87 1.15 0.88 Bleeding 1 1 (3.03)
Sex 0.09 0.62 0.91 0.94 Subcutaneous congestion 2 2 (6.06)
Side of affected ear −0.10 0.59 0.42 0.40 Headache 3 2 (6.06)
Time interval from −0.60 <0.01 0.06 <0.01 A transient dizziness 2 2 (6.06)
onset to study Facioplegia 0 0
entry Blood glucose 3 3 (9.09)
Pre-salvage PTA −0.17 0.33 0.74 0.79 Blood pressure 2 2 (6.06)
Tinnitus 0.21 0.24 1.81 0.59 Sleep change 4 4 (12.12)
Dizziness 0.12 0.52 3.31 0.42 Appetite change 1 1 (3.03)
PTA pure tone average, RSSNHL refractory sudden sensorineural a
Percentages are the number of patients who experienced the adverse
hearing loss event at least once/number of randomized patients
*
Statistical significance was determined using Spearman rank corre-
lations; **Statistical significance was determined using multivariate
logistic regression 9.09% (3/33), 6.06% (2/33), 12.12% (4/33), and 3.03%
a
Model 1: unadjusted model (1/33), respectively. These side effects were gradually
b
Model 2: adjusted for age, sex, side of affected ear, pre-salvage PTA, improved when steroid was discontinued.
tinnitus, and dizziness

in Table 3). No other correlations were observed between
prognosis and the other factors which include age, sex,
side of affected ear, pre-salvage PTA, tinnitus, and dizzi-
ness (P>0.05). The time interval from onset to study entry
was significantly and independently associated with the
prognosis for RSSNHL patients after adjusting for age,
sex, side of affected ear, pre-salvage PTA, and presence
of tinnitus and dizziness (OR = 0.06, P < 0.01, model 2 in
Table 3).
Safety
The major adverse events in the treatment group which
included untoward effect caused by the injection and side
effects of glucocorticoids are listed in Table 4. Thirteen
times pains caused by the injection were frequently
presented in 21.21% (7/33) patients. At the same time,
there were 1 time bleeding, 2 times subcutaneous conges-
tion, 3 times headache, and 2 times transient dizziness
noticed in 3.03% (1/33), 6.06% (2/33), 6.06% (2/33), and
6.06% (2/33) patients, respectively. Most of them did not
require special treatment after proper rest. The infection
at the injection site and facioplegia did not appear in
treatment group. Some side effects of glucocorticoids
appeared in the treatment group which included the rise
of blood glucose and pressure and changes in sleep and
appetite. The incidence of these adverse reactions was
Discussion
Although the patients with RSSNHL have failed in the ini-
tial steroid treatment, salvage steroid therapy is still used as
standard for first-line treatment for them [1]. However, high-
dosage systemic administration of steroids may result in
many undesirable side effects [1]. To address this problem,
there are many delivery methods which have been devised
for the agent to perfuse via the round-window membrane
into the inner ear [7, 11]. These local administrations of
steroids into the inner ear via the round window would seem
preferable for achieving higher inner ear concentration and
avoiding the side effects associated with systemic adminis-
tration. Therefore, it is considered to be a more reasonable
alternative as a salvage treatment for RSSNHL patients.
Nevertheless, intratympanic steroid treatment also may
result in some potential complications [6]. Therefore, more
suitable routes for drug delivery to the inner ear are needed
for RSSNHL. The previous study has reported that there
is no statistical difference about the treatment efficiency
between the postauricular methylprednisolone injection
group and intratympanic dexamethasone injection group for
treating RSSNHL patients [12]. That is to say, postauricular
steroid injection may be a potential alternative drug delivery
route for treating RSSNHL patients.
Postauricular steroid administration, which can avoid
many side effects resulting from systemic steroids and be
characterized by reasonable therapeutic effects, minimal
invasiveness, and easy operation, has been popular for

13

treating SSNHL in China. Although these studies have
shown the therapeutic effect of postauricular administration
on SSNHL, the true delivery route and mechanism of drug
into the inner ear are unclear. Zou’s study has reported that
postaurical injection is a systemic administration, which is
similar to hypodermic injection, rather than a focal delivery
method [13]. Other studies have considered that the agent
can be delivered into the inner ear through a local deliv-
ery route based on supposed existence of a direct channel
and systemic delivery route which is based on the systemic
circulation to the inner ear [14, 15]. So far, the only reli-
able evidence of the local delivery route is that numerous
micro-channels present between the surface of the mastoid
bone and the middle ear in humans via micro-CT scan [16].
Further studies on the mechanism of postauricular drug
administration should be conducted in the future.
In this study, the therapeutic effect on RSSNHL patients
was researched between treatment group and control group.
First of all, the mean PTA at 3 months was significantly
improved compared to that before salvage treatment in the
treatment group but was not significantly changed in the con-
trol group. Consistent with our research, several studies have
shown that the mean PTA can remarkably decrease after
postauricular corticosteroid injection [17, 18]. Secondly,
the mean hearing gain in PTA was higher in the treatment
group compared to that in the control group. At the same
time, the higher total effective in the treatment group was
found contrast to that in the control group according to the
criteria of Furuhashi. That is to say, the therapeutic effect
of postauricular corticosteroid injection was better than
that of conventional treatment for RSSNHL patients. The
same results have been shown in the previous studies [17,
18]. However, there was no consensus about the influence
of postauricular treatment on the hearing gains of different
frequencies [17, 18]. In order to determine this problem,
the hearing gains were analyzed among different frequen-
cies. The hearing gains were decreased as the frequencies
increased in the treatment group, but no significant differ-
ences were found among different frequencies in the control
group. Therefore, we considered that the hearing of all fre-
quencies were improved after postauricular steroids therapy,
but the improvement of low-frequency hearing was more
significant compared with that of high-frequency hearing.
The mechanism of this phenomenon was unclear. Wang’s
study has shown that fluorescence was primarily present in
the organ of Corti and did not differ significantly between
the apical and basal portions after postauricular administra-
tion [15]. Their results indicate that postauricular admin-
istration is appropriate for inner ear diseases targeting the
organ of Corti regardless of apical or basal position [15]. It
may be used to explain that there were effects on hearing
all frequencies after postauricular therapy, but the reason
about better improvement at low-frequency hearing was not
13
Irish Journal of Medical Science (1971 -)
understood. The specific causes of this phenomenon still
required further study.
We evaluated the value of these prognostic factors for
RSSNHL patients in the treatment group. There was no sig-
nificant association between prognosis and age, sex, side of
affected ear, pre-salvage PTA, and presence of tinnitus and
dizziness in the present study. Consistent with our study,
Zhu et al. also have reported that the prognosis of RSSNHL
patients is not relevant to sex, side of affected ear, age, pres-
ence of vertigo or tinnitus, and initial hearing threshold [19].
This may be that subjects of our study were composed of
RSSNHL patients who were older and presented with severe
hearing loss compared to the patients who were sensitive to
initial steroid treatment.
The result of the study indicated that the time interval
from onset to study entry was negatively and independently
associated with the prognosis for RSSNHL patients. Zhu’s
study has shown the same result [19]. In other words, early
initiation of salvage treatment produced better outcome for
RSSNHL patients. However, there is no consensus on the
duration of time after which the initial treatment for SSNHL
is ineffective and interval of time for beginning salvage treat-
ment. Early treatment within 2 weeks to 3 months is more
beneficial than later treatment according to US guidelines
[1]. Therefore, a patient received systemic steroid treatment
at least 14 days and presented inadequate response to the
treatment may be considered as a RSSNHL in the study.
Nevertheless, further research was needed for determin-
ing the optimal timing of salvage treatment for RSSNHL
patients.
Most studies have shown that there was no significant
adverse reaction in SSNHL patients who received postau-
ricular steroids injection [18, 20]. In our study, there was
no infection and facioplegia presented in all of subjects. A
small number of patients suffered from blooding, subcutane-
ous congestion, headaches, and transient dizziness during
the treatment. However, a considerable number of patients
felt pain during postauricular injection. Although there were
some untoward effects which are caused by injection, they
do not require special treatment after proper rest. Some side
effects of glucocorticoids appeared in the treatment group
which included the rise of blood glucose and pressure and
changes in sleep and appetite. These effects could gradually
improve when steroid was discontinued. The delivery modes
of drug may include local and systemic mechanism after
postauricular administration [14, 15]. If it is true, the pres-
ence of some systemic effects of glucocorticoids was easy
understood in the treatment group. In contrast, there was no
complication was observed in the control group.
The present study has several limitations. First, it lacked
randomization and a control group, given its retrospective
design. Second, the case size of this study was limited.
Therefore, a multi-center, large sample, strict prospective
Irish Journal of Medical Science (1971 -)
randomized controlled study was required for further valida-
tion. In addition, the current study only presented the effect
of postauricular injection treatment on RSSNHL patients,
but the comparison of effect between postauricular treatment
and transtympanic treatment was unknown. A prospective
study should further fully understand the therapy efficacy
of postauricular and transtympanic injections in RSSNHL
patients.
To sum up, the results of our study suggested that postau-
ricular steroid administration as a salvage treatment demon-
strated better results than no salvage treatment in RSSNHL
patients. The time interval from onset to study entry was the
main prognostic factors of RSSNHL patients who received
the postauricular steroid injection. It is therefore considered
that postauricular corticosteroid treatment may be used as a
salvage treatment for RSSNHL patients.
Acknowledgements The authors would like to thank Mr. Jian-Bin Sun
(Hearing Testing Centre, the First People’s Hospital of Huzhou, Zhe-
jiang, China) for the technical assistance in auditory function testing.
Author contribution The medical records of patients were collated
by Jue XU. The postauricular injection was performed by Gang Ren.
The auditory function was measured by Longjiang Lan. Statistical
analyses were performed by Bingliang Ma. Qi Zhang was responsible
for designing the investigation and writing of the manuscript. All the
authors reviewed and proved the manuscript.
Availability of data and materials The data and material are available.
Declarations
Ethics approval All procedures performed in studies involving human
participants were in accordance with the 1964 Helsinki declaration and
its later amendments or comparable ethical standards. This article does
not contain any studies with animals performed by any of the authors.
Informed consent Informed consent about participating in the study
and publication of manuscript was obtained from all individual par-
ticipants included in the study.
Conflict of interest The authors declare no competing interests.
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