What is the recommended steroid dosing for sudden hearing loss?

From the Guidelines

The recommended steroid dosing for sudden hearing loss is oral prednisone at 1 mg/kg/day (usually 60 mg daily for adults) for 7-14 days, followed by a taper over an additional 5-7 days, as supported by the most recent guideline update 1.

Key Considerations

• The dose of prednisone should not be divided, and the treatment should start as soon as possible after symptom onset, ideally within 2 weeks, for better outcomes.
• Alternatively, intratympanic dexamethasone injections can be used, administered as 0.4-0.8 ml of 10-24 mg/ml solution into the middle ear, typically given 1-3 times weekly for 2-4 weeks.
• Patients with certain systemic medical conditions, such as insulin-dependent or poorly controlled diabetes, labile hypertension, glaucoma, tuberculosis, peptic ulcer disease, and prior psychiatric reactions to corticosteroids, may not be able to receive systemic corticosteroids, and intratympanic injections may be the primary approach.

Monitoring and Side Effects

• Patients should be monitored for common side effects of oral steroids, including insomnia, increased appetite, mood changes, and elevated blood glucose.
• Intratympanic injections may cause temporary dizziness, pain, or tympanic membrane perforation.
• Audiograms should be performed at completion of treatment course and at delayed intervals to assess hearing improvement.

Treatment Individualization

• Treatment is routinely individualized by provider and per patient, and the most important principles pertain to early institution of high-enough dosages of treatment.
• The lack of clear evidence supporting systemic steroids for SHL and the existence of potential adverse treatment effects support a large role for shared decision making with patients, as noted in the guideline update 1.

From the Research

Steroid Dosing for Sudden Hearing Loss

• The recommended steroid dosing for sudden hearing loss varies, but some studies suggest the following regimens:
  • High-dose intravenous prednisolone at 250 mg/d for 5 days 2
  • High-dose oral dexamethasone at 40 mg/d for 5 days 2
  • Oral prednisolone at 60 mg/d for 5 days, followed by 5 days of tapering doses 2
  • A 14-day course of 60 mg prednisone (with taper) for patients with unilateral idiopathic sudden hearing loss and additional symptoms (dizziness or tinnitus) 3
• Intratympanic steroid injection regimens have also been studied, including:
  • Intratympanic methylprednisolone injection at 40 mg, every other day for 4 times 4
  • Intratympanic dexamethasone injection at 4 mg/mL, two times a week for 2 weeks (four injections in total) 5
  • Intratympanic prednisolone at a dose of 62.5 mg/ml, once a day for 3 consecutive days 6

Comparison of Steroid Regimens

• Some studies have compared the effectiveness of different steroid regimens, including:
  • High-dose versus lower-dose systemic glucocorticoid therapy 2
  • Intratympanic methylprednisolone versus dexamethasone injection 5
  • Oral versus short-term intratympanic prednisolone therapy 6
• The results of these studies suggest that the choice of steroid regimen may not significantly affect the outcome of treatment for sudden sensorineural hearing loss 2, 4, 5

Adverse Events and Side Effects

• The use of high-dose steroid regimens has been associated with a higher risk of adverse events, including:
  • Hypertension 2
  • Insulin resistance 2
  • Transient discomfort 4
  • Persistent small perforations in patients with diabetes mellitus 4