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High Dose Oral Steroids in Sudden Sensorineural Hearing Loss

Primary Purpose

Sudden Sensorineural Hearing Loss (SSNHL)

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Dexamethasone
Prednisone
Sponsored by
University of Colorado, Denver
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sudden Sensorineural Hearing Loss (SSNHL)

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Adults aged 18 to 80 years old
  • Present to the Otology or Otolaryngology Clinic at the University of Colorado Hospital with unilateral sudden sensorineural hearing loss (SSNHL)
  • Seen within six weeks of initial hearing loss
  • Unilateral hearing loss at screening as defined by:

    • Loss of 30 decibels (dB) HL or greater over 3 continuous frequencies with participants reporting that this hearing loss occurred within 3 days
  • Present with primary complaint of sensorineural hearing loss
  • Normal tympanometry (Type A)
  • Normal tympanic membrane

Exclusion Criteria:

  • Participants for whom high dose corticosteroids are a contraindicated due to:

    • Pregnancy
    • Known allergies to corticosteroids
    • Other concurrent medical conditions and or medications where high dose oral corticosteroids are not safe to use
  • Participants who have Type 1 or Type 2 diabetes
  • Participants who have previously received a course of oral steroids for this indication
  • Participants who have bilateral SSNHL
  • Participants with conductive hearing loss, mixed hearing loss (sensorineural and conductive), or any type of hearing loss that is not SSNHL (i.e. caused by acoustic or physical trauma to the ear)
  • Participants with the following conditions/situations will be excluded because the possibility that these could cause SSNHL:

    • History of previous/recurrent unilateral SSNHL
    • History of fluctuating hearing in either ear
    • History of Meniere's syndrome
    • History of chronic granulomatous or suppurative otitis media or cholesteatoma in either ear
    • History of otosclerosis in either ear
  • Participants with the following conditions/situations will be excluded due to risk of misclassification of diagnosis of idiopathic SSNHL or because these participants are at higher risk for potential steroid side effects due to other comorbidities. If the time line is not otherwise stated, then the participant will be excluded if they experienced these criteria at any point in their lifetime:

    • Received oral steroids (for any indication besides SSNHL) for greater than 21 days in the preceding 30 days
    • Systemic fungal infections in the last 6 months
    • History of tuberculosis or history of prophylactic tuberculosis treatment for positive skin test (PPD)
    • History of unstable angina, coronary artery stenting or bypass graft within 3 months
    • History of transient ischemic attacks, cardiac arrhythmia, or stroke in the last 4 weeks
    • Serious psychiatric disease or history of psychiatric reaction to corticosteroids, specifically bipolar, schizophrenia, episodes of mania or delirium
    • Prior treatment with chemotherapy agents, immunosuppressive drugs, cyclosporine, or interferon
    • Pancreatitis in the last year
    • Active peptic ulcer disease or history of gastrointestinal bleeding in the last year
    • History of known HIV, hepatitis C, or hepatitis B infection
    • Chronic renal insufficiency requiring dialysis
    • Active shingles (herpes zoster infection)
    • Advanced/severe osteoporosis or nonsurgical aseptic necrosis of the hip

Sites / Locations

  • University of Colorado Anschutz Medical Campus

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Dexamethasone

Prednisone

Arm Description

All subject identification (ID) numbers will be randomly assigned to the dexamethasone or the prednisone arm of the trial prior to the initiation of the study.

All subject ID numbers will be randomly assigned to the dexamethasone or the prednisone arm of the trial prior to the initiation of the study.

Outcomes

Primary Outcome Measures

Changes in Hearing Threshold (Hearing Improvement)
Pure tone averages (from pure tone audiometry) will be recorded for participants at each visit, and assessed for changes in pure tone average over time. Based on a change in pure tone average, participants will be categorized into the different groups.

Secondary Outcome Measures

Changes in Word Recognition Scores
Word recognition scores from speech audiometry tests will be summarized, by treatment arm, as a continuous variable using the mean, standard deviation, median, 25th percentile, 75th percentile, minimum and maximum.
Changes in Pure Tone Averages
Continuous pure tone averages calculated from pure tone audiometry will be summarized using the mean, standard deviation, median, 25th percentile, 75th percentile, minimum and maximum and will be presented by treatment arm.
Clinical Frequency Analysis Based on Hearing Improvement
The frequency of patients presenting in each clinical category of hearing improvement will be presented by treatment arm. Hypothesis testing will be performed, using a Mantel-Haenszel Chi-Square test, to test for the association between treatment group and the ordered levels of clinical category of hearing improvement.
Clinical Percentage Analysis Based on Hearing Improvement
The percentage of patients presenting in each clinical category of hearing improvement will be presented by treatment arm. Hypothesis testing will be performed, using a Mantel-Haenszel Chi-Square test, to test for the association between treatment group and the ordered levels of clinical category of hearing improvement.

Full Information

First Posted
August 16, 2017
Last Updated
March 14, 2023
Sponsor
University of Colorado, Denver
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1. Study Identification

Unique Protocol Identification Number
NCT03255473
Brief Title
High Dose Oral Steroids in Sudden Sensorineural Hearing Loss
Official Title
High Dose Oral Steroids in Sudden Sensorineural Hearing Loss
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
August 30, 2017 (Actual)
Primary Completion Date
August 1, 2022 (Actual)
Study Completion Date
March 13, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Colorado, Denver

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Compare hearing outcomes between treatment with dexamethasone versus prednisone in participants who have been diagnosed with unilateral SSNHL (sudden sensorineural hearing loss).
Detailed Description
Sudden sensorineural hearing loss (SSNHL) affects approximately 5 to 20 per 100,000 persons with spontaneous recovery seen in 32% to 65%. Many different treatments have been investigated in attempt to improve hearing outcomes, with oral corticosteroids having some success. Steroid regimens are highly variable, however, retrospective data has suggested greater improvement in hearing outcomes with the use of high dose oral steroids (dexamethasone) in the setting of unilateral sudden sensorineural hearing loss compared to traditional medical therapy with lower dose oral prednisone. The investigators hypothesize that patients with unilateral SSNHL who are randomized to treatment with high doses of oral dexamethasone will show better hearing outcomes than patients who are randomized to the more common standard clinical practice treatment with lower doses of oral prednisone.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sudden Sensorineural Hearing Loss (SSNHL)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Compare hearing outcomes between treatment with dexamethasone versus prednisone in participants who have been diagnosed with unilateral SSNHL within six weeks, and compare side effect profiles between the two treatment regimens of either dexamethasone or prednisone.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
4 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Dexamethasone
Arm Type
Active Comparator
Arm Description
All subject identification (ID) numbers will be randomly assigned to the dexamethasone or the prednisone arm of the trial prior to the initiation of the study.
Arm Title
Prednisone
Arm Type
Active Comparator
Arm Description
All subject ID numbers will be randomly assigned to the dexamethasone or the prednisone arm of the trial prior to the initiation of the study.
Intervention Type
Drug
Intervention Name(s)
Dexamethasone
Other Intervention Name(s)
dexamethasone sodium phosphate
Intervention Description
All subject ID numbers will be randomly assigned to the dexamethasone or the prednisone arm of the trial prior to the initiation of the study.
Intervention Type
Drug
Intervention Name(s)
Prednisone
Other Intervention Name(s)
Deltasone
Intervention Description
All subject ID numbers will be randomly assigned to the dexamethasone or the prednisone arm of the trial prior to the initiation of the study.
Primary Outcome Measure Information:
Title
Changes in Hearing Threshold (Hearing Improvement)
Description
Pure tone averages (from pure tone audiometry) will be recorded for participants at each visit, and assessed for changes in pure tone average over time. Based on a change in pure tone average, participants will be categorized into the different groups.
Time Frame
Baseline, 1 week, 1 month, 3 months
Secondary Outcome Measure Information:
Title
Changes in Word Recognition Scores
Description
Word recognition scores from speech audiometry tests will be summarized, by treatment arm, as a continuous variable using the mean, standard deviation, median, 25th percentile, 75th percentile, minimum and maximum.
Time Frame
1 week, 1 month, 3 months, and assessed for change from baseline score.
Title
Changes in Pure Tone Averages
Description
Continuous pure tone averages calculated from pure tone audiometry will be summarized using the mean, standard deviation, median, 25th percentile, 75th percentile, minimum and maximum and will be presented by treatment arm.
Time Frame
1 week, 1 month, 3 months, and assessed for change from baseline pure tone average..
Title
Clinical Frequency Analysis Based on Hearing Improvement
Description
The frequency of patients presenting in each clinical category of hearing improvement will be presented by treatment arm. Hypothesis testing will be performed, using a Mantel-Haenszel Chi-Square test, to test for the association between treatment group and the ordered levels of clinical category of hearing improvement.
Time Frame
Baseline, 1 week, 1 month, 3 months
Title
Clinical Percentage Analysis Based on Hearing Improvement
Description
The percentage of patients presenting in each clinical category of hearing improvement will be presented by treatment arm. Hypothesis testing will be performed, using a Mantel-Haenszel Chi-Square test, to test for the association between treatment group and the ordered levels of clinical category of hearing improvement.
Time Frame
Baseline, 1 week, 1 month, 3 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adults aged 18 to 80 years old Present to the Otology or Otolaryngology Clinic at the University of Colorado Hospital with unilateral sudden sensorineural hearing loss (SSNHL) Seen within six weeks of initial hearing loss Unilateral hearing loss at screening as defined by: Loss of 30 decibels (dB) HL or greater over 3 continuous frequencies with participants reporting that this hearing loss occurred within 3 days Present with primary complaint of sensorineural hearing loss Normal tympanometry (Type A) Normal tympanic membrane Exclusion Criteria: Participants for whom high dose corticosteroids are a contraindicated due to: Pregnancy Known allergies to corticosteroids Other concurrent medical conditions and or medications where high dose oral corticosteroids are not safe to use Participants who have Type 1 or Type 2 diabetes Participants who have previously received a course of oral steroids for this indication Participants who have bilateral SSNHL Participants with conductive hearing loss, mixed hearing loss (sensorineural and conductive), or any type of hearing loss that is not SSNHL (i.e. caused by acoustic or physical trauma to the ear) Participants with the following conditions/situations will be excluded because the possibility that these could cause SSNHL: History of previous/recurrent unilateral SSNHL History of fluctuating hearing in either ear History of Meniere's syndrome History of chronic granulomatous or suppurative otitis media or cholesteatoma in either ear History of otosclerosis in either ear Participants with the following conditions/situations will be excluded due to risk of misclassification of diagnosis of idiopathic SSNHL or because these participants are at higher risk for potential steroid side effects due to other comorbidities. If the time line is not otherwise stated, then the participant will be excluded if they experienced these criteria at any point in their lifetime: Received oral steroids (for any indication besides SSNHL) for greater than 21 days in the preceding 30 days Systemic fungal infections in the last 6 months History of tuberculosis or history of prophylactic tuberculosis treatment for positive skin test (PPD) History of unstable angina, coronary artery stenting or bypass graft within 3 months History of transient ischemic attacks, cardiac arrhythmia, or stroke in the last 4 weeks Serious psychiatric disease or history of psychiatric reaction to corticosteroids, specifically bipolar, schizophrenia, episodes of mania or delirium Prior treatment with chemotherapy agents, immunosuppressive drugs, cyclosporine, or interferon Pancreatitis in the last year Active peptic ulcer disease or history of gastrointestinal bleeding in the last year History of known HIV, hepatitis C, or hepatitis B infection Chronic renal insufficiency requiring dialysis Active shingles (herpes zoster infection) Advanced/severe osteoporosis or nonsurgical aseptic necrosis of the hip
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Stephen P Cass, MD
Organizational Affiliation
University of Colorado, Denver
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Colorado Anschutz Medical Campus
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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High Dose Oral Steroids in Sudden Sensorineural Hearing Loss

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