Sudden Hearing Loss Multicenter Treatment Trial
Overview
- Phase
- Phase 3
- Intervention
- prednisone
- Conditions
- Sudden Deafness
- Sponsor
- Massachusetts Eye and Ear Infirmary
- Enrollment
- 255
- Locations
- 14
- Primary Endpoint
- Hearing Improvement
- Status
- Completed
- Last Updated
- 9 years ago
Overview
Brief Summary
This trial aims to compare the efficacy of oral prednisone vs. methylprednisolone injected into the middle ear for the treatment of moderate-to-severe, sudden sensorineural hearing loss (inner ear hearing loss affecting one ear that occurs over less than 72 hours).
Detailed Description
Sudden deafness is believed to affect 1:5000 people yearly. The cause is unknown. Spontaneous improvement is seen in approximately 20% of subjects. Improvement is seen in approximately 60% of subjects treated promptly with oral corticosteroids. Anecdotal case reports and uncontrolled case series have suggested the intratympanic corticosteroids may work as well or better than oral treatment. The risks of oral prednisone are well-known. In theory, intratympanic treatment should achieve a higher drug concentration at the target (inner ear) with less risk of systemic side effects. This study is a head-to-head comparison of oral prednisone vs. intratympanic methylprednisolone for primary treatment of idiopathic sudden deafness. The study is designed as a non-inferiority trial testing that hypothesis that intratympanic methylprednisolone is not inferior to oral prednisone treatment. Subjects assigned to the oral treatment arm receive 14 days of high dose prednisone (60mg/day) followed by a 5-day taper. Subjects assigned to the intratympanic treatment arm receive 4 doses of methylprednisolone injected into the middle twice weekly for two weeks. The primary outcome measure is hearing as measured by pure tone audiometry. Secondary outcomes include word recognition hearing levels and safety issues of local vs. systemic steroid side-effects and pain.
Investigators
Steven Rauch, MD
Professor of Otology and Laryngology, Harvard Medical School
Massachusetts Eye and Ear Infirmary
Eligibility Criteria
Inclusion Criteria
- •Men/women 18 years and older in good health
- •Unilateral sensorineural hearing loss developing within 72 hours (SSNHL)
- •Pure Tone Average (PTA) (500, 1000, 2000, 4000 Hz) \>/= 50 dB in the affected ear, with the affected ear \>/= 30 dB worse than contralateral ear in at least one of the four frequencies
- •Symmetric hearing prior to onset of SSNHL
- •Hearing loss must be idiopathic
- •Hearing loss must have occurred within the past 14 days
- •Must be able to read or write English or Spanish
Exclusion Criteria
- •SYSTEMIC DISEASE
- •\>21 days prior oral steroid treatment within preceding 30 days
- •History of tuberculosis (TB) or positive PPD
- •Insulin-dependent diabetes mellitus
- •History of rheumatic disease, e.g., rheumatoid arthritis, scleroderma, lupus, etc.
- •Serious psychiatric disease or psychiatric reaction to corticosteroids
- •History of heart disease or transient ischemic attacks (TIAs)
- •Prior treatment with chemotherapeutic or immunosuppressive drugs
- •Pancreatitis
- •Active peptic ulcer disease or history of gastrointestinal bleeding
Arms & Interventions
1
Nineteen days of oral prednisone
Intervention: prednisone
2
Four doses of methylprednisolone sodium succinate delivered by injection to the middle ear over 2 weeks
Intervention: methylprednisolone sodium succinate
Outcomes
Primary Outcomes
Hearing Improvement
Time Frame: 2 months
Change from baseline to 2mos of 4-frequency (500, 1000, 2000, 4000Hz) pure tone average.