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Korean Journal of Otorhinolaryngology-Head and Neck Surgery > Volume 69(7); 2026 > Article
Korean Journal of Otorhinolaryngology-Head and Neck Surgery 2026;69(7): 301-309.
doi: https://doi.org/10.3342/kjorl-hns.2026.00234
Effect of Adding Metformin to Standard High Dose Systemic Steroid Therapy in Non-Diabetic Patients With Sudden Sensorineural Hearing Loss
Jae Won Jang , Hyeon Seok Goo , Joong Keun Kwon
Department of Otolaryngology-Head and Neck Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
비당뇨 돌발성감각신경성난청 환자에서 표준 고용량 전신 스테로이드 요법에 메트포르민을 병용 투여했을 때의 효과
장재원 , 구현석 , 권중근
울산대학교 의과대학 울산대학교병원 이비인후과학교실
Correspondence  Joong Keun Kwon ,Tel: +82-52-250-8807, Fax: +82-52-234-7182, Email: joongkeun@uuh.ulsan.kr
Received: 23 March 2026; Revised: May 11, 2026   Accepted: 19 May 2026.  Published online: 22 July 2026.
ABSTRACT
Background and Objectives
Sudden sensorineural hearing loss (SSNHL) is commonly treated with high-dose systemic corticosteroids, yet recovery remains incomplete in a substantial proportion of patients. Metformin has pleiotropic anti-inflammatory, immunomodulatory, and vascular-protective effects and may mitigate steroid-induced dysglycemia. This study evaluated whether adding metformin to the standard high-dose glucocorticoid therapy improves hearing outcomes in nondiabetic SSNHL.
Subjects and Method
This retrospective observational cohort study included patients treated for idiopathic SSNHL at a single tertiary center (July 2020-July 2025). All patients received oral methylprednisolone of 48 mg/day for 10 days followed by taper; non-responders received intratympanic dexamethasone (up to four injections). The metformin group additionally received metformin of 500 mg/day for 4 weeks. Variable ratio propensity score matching (caliper 0.2) was controlled for age, vertigo, onset-to-treatment interval, and baseline pure-tone average (PTA). Outcomes were changes in the PTA and word recognition score (WRS), and American Academy of Otolaryngology-Head and Neck Surgery Foundation recovery categories. Groupby-time interaction was tested using a linear mixed model.
Results
After matching, 68 patients were analyzed (control n=44; metformin n=24). Both groups showed significant improvement in PTA and WRS; however, between-group differences were not significant (PTA interaction p=0.779; WRS interaction p=0.965). Complete recovery occurred in 43.2% of controls and 33.3% of metformin patients.
Conclusion
In nondiabetic SSNHL, short-term low-dose metformin added to the standard high-dose steroid therapy did not provide additional hearing benefit.
Keywords: Glucocorticoids Hearing tests Metformin Propensity score Sudden hearing loss
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