Thank you for the invitation to respond to the very interesting letter to the editor written by Dong-Hee Le.

First issue/ethical aspect: Regarding the objection of ethical aspect of deciding to perform tympanotomy and sealing of the round window membrane in patients with acute unilateral sensorineural hearing loss after failure of conservative treatment, I would like to explain my point of view.

All patients were treated with cortisone and rheologic medication for the recommended time without improvement of hearing level. All patients were clarified of operation facts and possible side events and agreed. In any case of idiopathic hearing loss, time of spontaneous remission was awaited. None of the 60 operated patients had any complication.

The rationale for surgery was given for patients without response to conservative treatment, as recommended in patients with profound hearing loss by the German Society of Otorhinolaryngology. As the tympanotomy and sealing of the round window are interventions with a low rate of complications, it should be arguable in distinct cases.

Second issue/statistical analysis: Unfortunately, we did no statistical analyses. Regarding Table 3, we did not affirm that the outcome after identification of a leak was significantly better in patients presenting a leak. We simply argued that a leak in patients with barotraumas seemed to entail a better outcome, as these patients improved fast and some of them completely.

In patients with acoustic trauma, we only described the results but stated that we could not suggest any difference in patients presenting and not presenting any leak due to the very few cases.

Comparison to acute idiopathic hearing loss: We did not initiate another control group because there are published plenty of studies regarding the treatment of idiopathic hearing loss with observed rates of spontaneous remission from 28% to 68%.

Time point of surgery: The surgery was carried out after the expiration of the expected spontaneous remission. As remission cannot be expected after 10 to 14 days in cases of hearing loss of more than 70 dB (Mattox and Simmens 1977, Sano H et al 1998), these patients were operated in these defined time intervals. In addition, patients with lower graded hearing loss were delayed up to 60 days.

The article published by Maier et al was published after submission of this article in December 2007 and acceptation in June 2008. They performed surgery faster (within 7 days) and recommended a tympanotomy in any case that does not present any contraindications.

Of course, any treatment can be discussed; and every otologist has a distinct opinion. We did not misunderstand the tympanotomy with sealing of round window membrane as a principal treatment of acute sensorineural hearing loss. We only recommended the surgical option in cases of hearing loss after failure of conservative treatment, after expected spontaneous remission, and after agreement of the patient.