Foreign Body Complications in Ears due to Mishandled Hearing Aid Fitting and Proposed Clinical Guidelines to Address the Complications

Background@#South Korea has one of the world’s fastest aging populations and is witnessing increased age-related hearing impairment cases as well as an increase in the number of hearing aid users. The aim of this study was to analyze complications caused by hearing aid mold materials. In addition, we hope to raise awareness of the harm and danger that inexperienced hearing aid providers can cause to patients. @*Methods@#We retrospectively reviewed the medical records of 11 patients who were diagnosed with hearing aid mold material as a foreign body in the ear at a tertiary center between 2016 and 2020. The following data were analyzed: symptoms, endoscopic findings, audiometry, temporal bone CT images, treatment methods, and complications after removal. The currently available literature was also reviewed to develop clinical guidelines, to identify the systematic weaknesses in the South Korean hearing aid market, and to identify policies that warrant better quality control. @*Results@#Among the 11 cases, 9 were restricted to the external auditory canal, all of which were successfully removed under endoscopy with minor complications. Two cases with middle ear involvement resulted in infection and thus required surgical removal with mastoidectomy. The average age of these patients was 76.4, and all patients received their molding procedure at private hearing aid shops without an otolaryngologist’s examination. @*Conclusion@#Thorough patient history-taking and otologic examination must be performed to identify patients at higher risk of complications. Such patients should be referred to an otolaryngologist. If a patient exhibits alarming symptoms, early referral is critical since prompt surgery can minimize complications. A CT scan is highly recommended to determine an optimal approach for foreign body removal. Systematic and regulatory changes in hearing aid dispensers, such as requiring apprenticeship, raising the required level of education, and legally mandating referrals, can help reduce these complications.

Surgical Outcome of Revision Operation for Recurrent Aural Cholesteatoma / 대한이비인후과학회지

Background and Objectives@#To investigate surgical outcomes of revision operation for recurrent cholesteatoma.Subjects and Method From 1989 to 2018, 5245 cases of middle ear surgeries were performed at Kangdong and Hallym University Sacred Heart Hospital. A total of 138 clinical records of the subjects who underwent revision cholesteatoma surgery, and whose follow-up durations were more than 3 months, were reviewed. Hearing outcomes were analyzed in accordance with the 2005 Korean otology society guideline. Postoperative perforation was defined to be present if perforation exists after three months of surgery. Postoperative infection or recurrence was defined if patients were treated with intravenous antibiotics or underwent reoperation. @*Results@#Among 138 cases, surgical approaches used were canal wall up mastoidectomy in 38 (28%), canal wall down mastoidectomy in 89 (64%), and exploratory tympanotomy in 11 (8%). Air conduction and air bone gap showed statistically significant differences before and after the surgery. The number of patients who met at least 1 criteria was 70, accounting for 51%. Patients were classified into four groups according to the Postoperative ABG grade, where 43% of patients were included in “Excellent” or “Good” results group. When the results were compared according to the surgical method, canal wall up group showed significantly higher hearing success rate compared to CWDM group. Patients without postoperative perforation, infection or recurrence were considered successful and there were 122 such cases, accounting for 88%. @*Conclusion@#CWDM more frequently underwent revision than CWUM and ET, and showed worse hearing results than other groups. These analyses can be used for preoperative counseling.

Surgical Outcomes of Revision Operation for Non-Cholesteatomatous Chronic Otitis Media / 대한이비인후과학회지

Background and Objectives@#The aim of this study was to investigate the surgical outcomes of revision operation due to recurrence of non-cholesteatomatous chronic otitis media (COM) surgery cases.Subjects and Method From 1989 to 2018, 5197 cases of COM surgery were performed at Kangdong and Hallym University Sacred Heart Hospital. Among them, clinical data of 297 subjects who had undergone revision tympanoplasty and/or mastoidectomy for recurrent noncholesteatomatous COM were retrospectively collected from computerized database of middle ear surgery (Korean Otological Society program 2005). Each case was categorized by surgical approaches into canal wall down mastoidectomy (CWDM), canal wall up mastoidectomy (CWUM), or tympanoplasty only groups. @*Results@#Tympanoplasty only was performed in 170 cases, CWDM in 74 cases, and CMUM in 53 cases. Postoperative perforation occurred in 9.4% of total cases, and less frequently in CMDM compared with tympanoplasty only (p=0.023), and CMUM (p=0.049), respectively, whereas no differences between tympanoplasty only and CMUM (p=0.930) were found. Postoperative infection rate was 1.0% and did not show any differences among the groups. Postoperative successful hearing was obtained in 66.7% of total cases, and the success rate of tympanoplasty only was better than that of CMDM (p=0.001), and CMUM (p=0.011). And, that of CMUM was better than that of CMDM (p=0.011). @*Conclusion@#The results showed that postoperative perforation occurred less frequently in CMDM than in tympanoplasty only and in CWUM; successful hearing was achieved more frequently in tympanoplasty alone than in the other surgical approaches in recurrent non-cholesteatomatous COM.

Hearing Results After Type I Tympanoplasty With Versus Without Mastoidectomy / 대한이비인후과학회지

Background and Objectives@#The purpose of the mastoidectomy and tympanoplasty is to improve the hearing by removing the middle ear lesion and reconstructing the hearing mechanism. The purpose of this study is to verify whether several factors, including the presence of mastoidectomy can affect the hearing outcome of tympanoplasty patients.Subjects and Method From 1989 to 2018, 1260 patients with chronic otitis media who had been followed up for more than 6 months after type 1 tympanoplasty were selected. The each patient group was divided into 2 groups based on the last audiometry; Group A (post operative air-bone gap [ABG] ≤10 dB HL) and Group B (post operative ABG >10 dB HL). We analyzed the various factors including patency of E-tube or mastoid aeration for each group to figure out which factors affect the post operative hearing outcome. @*Results@#In conclusion, even with mastoidectomy, the final hearing after surgery was worse than that of the group who underwent tympanoplasty only (final ABG; tympanoplasty only vs. tympanoplasty with mastoidectomy; 6.59±9.09 vs. 9.71±8.94). In both with and without mastoidectomy group, the size of the perforation and external ear canal diameter before surgery did not affect the final hearing outcome. On the otherhand, in the group with mastoidectomy, mastoid pneumatization and E-tube patency affected the postoperative prognosis, but not in the case without mastoidectomy. @*Conclusion@#In this study, the factors affecting postoperative hearing success were analyzed. The results can be used to predict the postoperative hearing prognosis and to help select surgical treatment.

Atypical Hemolytic Uremic Syndrome Successfully Treated with Eculizumab / 대한내과학회지

Atypical hemolytic uremic syndrome (aHUS) is a rare syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury, which results from uncontrolled complement activation. Delayed diagnosis and treatment of aHUS may result in end-stage renal disease (ESRD) and an associated dependence on dialysis. In extreme cases, it may cause death due to multi-organ failure. Eculizumab, a humanized monoclonal antibody against C5, inhibits the formation of the terminal membrane attack complex and is used to treat aHUS. Here, we report a 46-year-old male patient who suffered from aHUS relapse, despite prior treatment with repeated plasma exchange and hemodialysis. Eculizumab therapy improved his hematologic findings without use of hemodialysis.

The Relationship between Serum Phosphorous Level and Arteriovenous Fistula Dysfunction in Maintenance Hemodialysis Patients / 대한내과학회지

Background/Aims@#Maintaining vascular access (VA) is very important in the management of hemodialysis (HD) patients. Therefore, the identification of risk factors for decreased vascular access flow has clinical relevance. The aim of the present study was to investigate the impact of serum phosphorus (P) on autologous arteriovenous fistula flow in HD patients. @*Methods@#Sixty-two maintenance HD patients who visited the dialysis unit of CHA Bundang Medical Center between November 2016 and December 2017 were included in the study. Serum P levels were obtained every month, and time-averaged serum P was calculated. All patients had left arm arteriovenous fistulas (AVF; side-to-side anastomosis). AVF flow was assessed by Transonic HD 03. Decreased AVF flow was defined as < 600 mL/min. @*Results@#Decreased AVF flow was observed in 14 of 62 patients. In univariate analysis and multivariable analysis, higher serum P had a significant independent association with decreased AVF flow. Advanced age, reduced ejection fraction, low blood flow rate in dialysis, and higher serum calcium were not associated with AVF flow. @*Conclusions@#The present study demonstrated that higher serum P was an independent risk factor for decreased autologous AVF flow in maintenance HD patients. Serial monitoring of serum P may be helpful in stratifying patients by risk of AVF dysfunction, and proper management of serum P levels may be helpful in maintaining flow through autologous AVFs.

Usefulness of a Novel Staging System for Congenital Cholesteatoma of the Middle Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Although there are number of studies on the risk factors of recidivism in the congenital middle ear cholesteatoma, few have focused on the staging system. In this study, we aimed to investigate the postoperative recurrence rate in surgical cases of congenital middle ear cholesteatoma, and compare the results of using the Potsic staging system with those of a novel Kim staging system. Additionally, we also studied to see if the Kim staging system could suggest an appropriate surgical approach for each stage.SUBJECTS AND METHOD: Surgical cases of the disease from January, 1989 to August, 2017 performed at Kangdong Sacred Heart or Hallym University Sacred Heart Hospital were included and those data were retrospectively reviewed. All the cases were pre-operatively assigned to the stages using both Potsic and Kim staging system, retrospectively. The post-operative recurrence rate was analyzed for each subject according to the findings of one year after surgery using both staging systems. Additionally, surgical approach performed in these cases, such as mastoidectomy and/or ossiculoplasty were analyzed and compared among the stage groups of Kim staging system.@*RESULTS@#The Potsic staging system showed that recurrence was significantly lower in the stage I than in the other stages, and the Kim staging system showed that recurrence was significantly higher in the revision R stage than in the primary A, P, and M stages. The Kim staging system showed that mastoidectomy was performed more frequently in the M stage, and ossiculoplasty was performed less frequently in the A stage than in the other stages.@*CONCLUSION@#Although Potsic and Kim staging systems were both useful for predicting prognosis, the Kim staging system can additionally provide a clue for an appropriate surgical approach for each stage.

Erratum: Relative Association of Overhydration and Muscle Wasting with Mortality in Hemodialysis Patients: Assessment by Bioelectrical Impedance Analysis / 대한내과학회지

The original article contained an error in Figure 1.

Hearing Outcome of Patients with Acute Noise-Induced Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Although poor hearing outcomes have been associated with acute noise-induced hearing loss (ANIHL), only limited studies exist on this issue. This study evaluated the prognosis of ANIHL in comparison to idiopathic sudden sensorineural hearing loss (ISSNHL) and investigated the types of noise causing these disorders.SUBJECTS AND METHOD: Patients with sudden sensorineural hearing loss due to noise exposure were included in the ANIHL group if the threshold shift was more than 30 dB in three or more consecutive frequencies within the study period (from January 2010 to December 2016). The ANIHL group included 19 patients. As a matched-control group, treated patients with ISSNHL (n=95) were selected as a way of controlling the known prognostic factors that were evenly distributed between groups. Selected prognostic variables used for matching included age, sex, the degree of initial hearing loss, the number of days before the start of treatment, and treatment method.@*RESULTS@#The overall hearing recovery rate of ANIHL was 11% and that of the control group was 80% (p<0.001). Noise exposure in military service (37%) and leisure activities (37%) was the most prominent cause of ANIHL.@*CONCLUSION@#The hearing outcome of ANIHL was worse than that of ISSNHL. It is thus necessary to establish national guidelines for environmental noise regulations and to raise awareness of hazardous noise exposure.

Change of Tympanogram after Chronic Otitis Media Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Pre-operative eustachian tube function (ETF) is an important factor for the postoperative success after tympanoplasty, though much debates have been reported. In this study, we investigated the tympanogram changes after tympanoplasty, indirectly checking up ETF, to find out the relationship between tympanogram changes and associated factors of tympanoplasty.SUBJECTS AND METHOD: Included in this study were 238 cases of tympanoplasty (canal wall up mastoidectomy with tympanoplasty type I or tympanoplasty type I only) performed by one surgeon for chronic otitis media from January, 2012 to June, 2017. In all cases, tympanometric tests were undertaken at one month, three month, six month, and one year post-operatively, and pure tone audiometry tests were taken at 1 year, post operatively.@*RESULTS@#The average hearing level and air-bone gap were 41.8±19.7 dB, and 17.1±9.3 dB, pre-operatively, and 29.9±21.1 dB, and 6.9±8.5 dB, 1 year post-operatively, respectively. Most of the cases showed improvement in hearing. The results of tympanometry showed that hearing improvement was greater for the A type than for the B or C type (p<0.001). The smaller the size of the tympanic membrane was, the higher, the type A tympanogram appeared to be (p=0.008).@*CONCLUSION@#The estimation of pre-operative ETF using post-operative tympanogram changes can give insight to the degree and process of recovery of the normal middle ear after tympanoplasty.

Erratum: Relative Association of Overhydration and Muscle Wasting with Mortality in Hemodialysis Patients: Assessment by Bioelectrical Impedance Analysis / 대한내과학회지

The original article contained an error in Figure 1.

Change of Tympanogram after Chronic Otitis Media Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pre-operative eustachian tube function (ETF) is an important factor for the postoperative success after tympanoplasty, though much debates have been reported. In this study, we investigated the tympanogram changes after tympanoplasty, indirectly checking up ETF, to find out the relationship between tympanogram changes and associated factors of tympanoplasty. SUBJECTS AND METHOD: Included in this study were 238 cases of tympanoplasty (canal wall up mastoidectomy with tympanoplasty type I or tympanoplasty type I only) performed by one surgeon for chronic otitis media from January, 2012 to June, 2017. In all cases, tympanometric tests were undertaken at one month, three month, six month, and one year post-operatively, and pure tone audiometry tests were taken at 1 year, post operatively. RESULTS: The average hearing level and air-bone gap were 41.8±19.7 dB, and 17.1±9.3 dB, pre-operatively, and 29.9±21.1 dB, and 6.9±8.5 dB, 1 year post-operatively, respectively. Most of the cases showed improvement in hearing. The results of tympanometry showed that hearing improvement was greater for the A type than for the B or C type (p<0.001). The smaller the size of the tympanic membrane was, the higher, the type A tympanogram appeared to be (p=0.008). CONCLUSION: The estimation of pre-operative ETF using post-operative tympanogram changes can give insight to the degree and process of recovery of the normal middle ear after tympanoplasty.

Hearing Outcome of Patients with Acute Noise-Induced Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although poor hearing outcomes have been associated with acute noise-induced hearing loss (ANIHL), only limited studies exist on this issue. This study evaluated the prognosis of ANIHL in comparison to idiopathic sudden sensorineural hearing loss (ISSNHL) and investigated the types of noise causing these disorders. SUBJECTS AND METHOD: Patients with sudden sensorineural hearing loss due to noise exposure were included in the ANIHL group if the threshold shift was more than 30 dB in three or more consecutive frequencies within the study period (from January 2010 to December 2016). The ANIHL group included 19 patients. As a matched-control group, treated patients with ISSNHL (n=95) were selected as a way of controlling the known prognostic factors that were evenly distributed between groups. Selected prognostic variables used for matching included age, sex, the degree of initial hearing loss, the number of days before the start of treatment, and treatment method. RESULTS: The overall hearing recovery rate of ANIHL was 11% and that of the control group was 80% (p<0.001). Noise exposure in military service (37%) and leisure activities (37%) was the most prominent cause of ANIHL. CONCLUSION: The hearing outcome of ANIHL was worse than that of ISSNHL. It is thus necessary to establish national guidelines for environmental noise regulations and to raise awareness of hazardous noise exposure.

Feasibility of Eye Tracking Assisted Vestibular Rehabilitation Strategy Using Immersive Virtual Reality

OBJECTIVES: Even though vestibular rehabilitation therapy (VRT) using head-mounted display (HMD) has been highlighted recently as a popular virtual reality platform, we should consider that HMD itself do not provide interactive environment for VRT. This study aimed to test the feasibility of interactive components using eye tracking assisted strategy through neurophysiologic evidence. METHODS: HMD implemented with an infrared-based eye tracker was used to generate a virtual environment for VRT. Eighteen healthy subjects participated in our experiment, wherein they performed a saccadic eye exercise (SEE) under two conditions of feedback-on (F-on, visualization of eye position) and feedback-off (F-off, non-visualization of eye position). Eye position was continuously monitored in real time on those two conditions, but this information was not provided to the participants. Electroencephalogram recordings were used to estimate neural dynamics and attention during SEE, in which only valid trials (correct responses) were included in electroencephalogram analysis. RESULTS: SEE accuracy was higher in the F-on than F-off condition (P=0.039). The power spectral density of beta band was higher in the F-on condition on the frontal (P=0.047), central (P=0.042), and occipital areas (P=0.045). Beta–event-related desynchronization was significantly more pronounced in the F-on (–0.19 on frontal and –0.22 on central clusters) than in the F-off condition (0.23 on frontal and 0.05 on central) on preparatory phase (P=0.005 for frontal and P=0.024 for central). In addition, more abundant functional connectivity was revealed under the F-on condition. CONCLUSION: Considering substantial gain may come from goal directed attention and activation of brain-network while performing VRT, our preclinical study from SEE suggests that eye tracking algorithms may work efficiently in vestibular rehabilitation using HMD.

Is the Auditory Brainstem Response Diagnostic for Vestibular Paroxysmia? / 대한평형의학회지

OBJECTIVES: Vestibular paroxysmia (VP) of the eighth cranial nerve is characterized by recurrent auditory and vestibular disturbances when a proximal part of the eighth cranial nerve is continuously pressed by a vessel. A detailed history and several ancillary diagnostic tools, such as tinnitogram, caloric test, auditory brainstem response (ABR) and magnetic resonance imaging, are used for diagnosis of VP. Among them, although Møller criteria using ABR is a simple method, the previous study is insufficient. Therefore, this study aimed to evaluate ABR's diagnostic value of VP. METHODS: ABR records of the 14 patients (patient group) who were diagnosed with VP and 45 patients (as control) who were diagnosed with only tinnitus were reviewed retrospectively. We analyzed the differences in Møller criteria between 2 groups. RESULTS: Mean age of the patient group was 52.9 years old and the control group was 55.4 years old. As compared with the control group, there were no significant differences of Møller 3 criteria contents (peak II wave amplitude < 33% [35.7% vs. 15.5%, p=0.133], interpeak latency I–III ≥2.3 msec [42.8% vs. 35.5%, p=0.622]), Contralateral interpeak latency III–V ≥2.2 msec (0% vs. 4.4%, p=1.000) in patient group. CONCLUSION: There was no significant difference of ABR parameters according to the Møller criteria between patient and control groups.

Relative Association of Overhydration and Muscle Wasting with Mortality in Hemodialysis Patients: Assessment by Bioelectrical Impedance Analysis / 대한내과학회지

BACKGROUND/AIMS: Assessment of fluid status in hemodialysis patents is very important. Overhydration in hemodialysis is associated with generalized edema, cardiovascular complications, and hypertension. The aim of this study was to determine the factors correlated with mortality of hemodialysis patients, assessing body muscle mass and fluid status using bioelectrical impedance analysis (BIA). METHODS: This study enrolled 93 patients who underwent hemodialysis between January 2010 and May 2015 at CHA Bundang Medical Center. Medical records of enrollees up to June 2017 were reviewed retrospectively. These included laboratory results (serum albumin, C-reactive protein [CRP], lipid profile, etc.) and BIA data (extracellular water, intracellular water, total body water, soft lean mass, fat free mass, skeletal muscle mass, etc.). RESULTS: Eleven of 93 patients had expired by May 2017. Among the surviving subjects, mean age was younger, CRP levels were lower, albumin levels were higher, and extracellular water/total body water (ECW/TBW) ratios were lower than in the expired patient group. Kaplan-Meier survival analysis revealed that overhydration (ECW/TBW > 0.4) was associated with higher mortality. CONCLUSIONS: In hemodialysis patients, overhydration is an important factor in mortality, and BIA could be a reliable modality in its assessment. We suggest that, for hemodialysis patients, overhydration is more of a risk factor for mortality than is muscle wasting.

Changes in geriatric nutritional risk index and risk of major adverse cardiac and cerebrovascular events in incident peritoneal dialysis patients

BACKGROUND: Geriatric nutritional risk index (GNRI) is a validated nutritional assessment method, and lower GNRI values are closely associated with adverse clinical outcomes in dialysis patients. This study investigated the impact of changes in GNRI during the first year of dialysis on cardiovascular outcomes in incident peritoneal dialysis (PD) patients. METHODS: We reviewed medical records in 133 incident PD patients to determine GNRI at the start of PD and after 12 months. Patients were categorized into improved (delta GNRI > 0) and worsening/stationary (delta GNRI ≤ 0) groups. The primary outcome was major adverse cardiac and cerebrovascular events (MACCEs). RESULTS: During a mean follow-up of 51.1 months, the primary outcome was observed in 42 patients (31.6%). The baseline GNRI at PD initiation was not significantly associated with MACCEs (log-rank test, P = 0.40). However, the cumulative event-free rate was significantly lower in the worsening or stationary GNRI group than in the improved group (log-rank test, P = 0.004). Multivariate Cox analysis revealed that a worsening or stationary GNRI was independently associated with higher risk for MACCEs (hazard ratio, 2.47; 95% confidence interval, 1.15–5.29; P = 0.02). In subgroup analysis, patients with worsening or stationary GNRI were at significantly greater risk for MACCEs in both the lower (P = 0.04) and higher (P = 0.01) baseline GNRI groups. CONCLUSION: Baseline GNRI was not associated with MACCEs, but patients with deteriorating or stationary nutritional status were at significantly greater risk for MACCEs, suggesting that serial monitoring of nutritional status is important to stratify cardiovascular risk in incident PD patients.

The pattern of choosing dialysis modality and related mortality outcomes in Korea: a national population-based study

BACKGROUND/AIMS: Since comorbidities are major determinants of modality choice, and also interact with dialysis modality on mortality outcomes, we examined the pattern of modality choice according to comorbidities and then evaluated how such choices affected mortality in incident dialysis patients. METHODS: We analyzed 32,280 incident dialysis patients in Korea. Patterns in initial dialysis choice were assessed by multivariate logistic regression analyses. Multivariate Poisson regression analyses were performed to evaluate the effects of interactions between comorbidities and dialysis modality on mortality and to quantify these interactions using the synergy factor. RESULTS: Prior histories of myocardial infarction (p = 0.031), diabetes (p = 0.001), and congestive heart failure (p = 0.003) were independent factors favoring the initiation with peritoneal dialysis (PD), but were associated with increased mortality with PD. In contrast, a history of cerebrovascular disease and 1-year increase in age favored initiation with hemodialysis (HD) and were related to a survival benefit with HD (p < 0.001, both). While favoring initiation with HD, having Medical Aid (p = 0.001) and male gender (p = 0.047) were related to increased mortality with HD. Furthermore, although the severity of comorbidities did not inf luence dialysis modality choice, mortality in incident PD patients was significantly higher compared to that in HD patients as the severity of comorbidities increased (p for trend < 0.001). CONCLUSIONS: Some comorbidities exerted independent effects on initial choice of dialysis modality, but this choice did not always lead to the best results. Further analyses of the pattern of choosing dialysis modality according to baseline comorbid conditions and related consequent mortality outcomes are needed.

Bilateral Sequential Pneumolabyrinth Resulting from Nose Blowing

Pneumolabyrinth describes a condition with entrapped air in the labyrinth and usually occurs in temporal bone fractures that involve the otic capsule. While sporadic cases of bilateral pneumolabyrinth have been reported, cases lacking head trauma are very rare. We report the case of a 43-year-old man who had sudden hearing loss bilaterally after blowing his nose at an interval of 1 year. Although conservative management for the right ear and exploratory tympanotomy with sealing of the possible site of perilymphatic leakage in the left ear were performed, hearing outcome was poor in both ears. To our knowledge, this is the first case of bilateral pneumolabyrinth occurring as a result of nose blowing.

Is Intratympanic Dexamathasone Injection Effective for the Treatment of Idiopathic Sudden Sensorineural Hearing Loss?

BACKGROUND AND OBJECTIVES: The purpose of this study is to identify the effectiveness of intratympanic (IT) steroids when used as an initial therapy in sudden sensorineural hearing loss (SSNHL), and when it is used as a salvage therapy in a refractory SSNHL. SUBJECTS AND METHODS: This retrospective study included 122 patients with SSNHL. First, patients were divided into three groups according to the initial treatment; IT steroid, systemic steroid and combined (systemic and IT steroid) groups. Second, patients were divided into two groups according to the salvage treatment in a refractory SSNHL; IT steroid and the control (non IT group). Fifty eight patients who did not respond to initial therapy were included in the second analysis. Hearing was assessed immediately before the treatment and 2 weeks, 4 weeks and 3 months after the treatments. Hearing recovery was defined as an improvement of >15 dB and the final hearing of 25-45 dB in the audiogram. RESULTS: When we analyzed the hearing recovery in initial treatment, the comparison of audiogram among three groups did not result in significantly different outcomes. There were no differences in the recovery rate in 2 and 4 weeks throughout all the frequencies. Also, the analysis of the salvage treatment demonstrated that neither IT steroid group nor control group was significantly effective in treating the refractory SSNHL. CONCLUSIONS: The results suggest that initial treatment of SSNHL with IT steroid alone is as effective as systemic steroid alone or a combination therapy. Also, salvage IT steroids for refractory SSNHL did not have any additional beneficial effects.