From the Guidelines
The recommended dose of prednisone for treating sudden sensorineural hearing loss (SSNHL) is 1 mg/kg/d, with a usual maximum dose of 60 mg/d, for 7-14 days, as stated in the most recent guideline update 1. This high-dose oral steroid regimen should be started as soon as possible after symptom onset, ideally within the first 2 weeks, as earlier treatment is associated with better outcomes. The tapering schedule might involve reducing the dose by 10 mg every 1-2 days until discontinuation to prevent adrenal suppression. For patients who cannot tolerate oral steroids, intratympanic steroid injections (typically dexamethasone 10-24 mg/ml) directly into the middle ear may be used as an alternative or adjunctive therapy. Steroids work by reducing inflammation and swelling in the inner ear, potentially improving cochlear blood flow and reducing oxidative stress that can damage hair cells. Some key points to consider when treating SSNHL with steroids include:
- Starting treatment as soon as possible, ideally within the first 14 days of symptom onset, as recommended by the guidelines 1
- Using a high enough dose of steroids, such as prednisone 1 mg/kg/d, to maximize treatment outcomes
- Monitoring patients for potential side effects, including increased blood glucose, mood changes, insomnia, and gastric irritation
- Considering alternative treatment options, such as intratympanic steroid injections, for patients who cannot tolerate oral steroids
- Individualizing treatment based on patient-specific factors, such as medical history and comorbidities, as emphasized in the guidelines 1. The most recent guideline update 1 provides the best evidence for the recommended dose and treatment duration of prednisone for SSNHL, and should be prioritized when making treatment decisions.
From the Research
Recommended Dose of Steroids for Acute Hearing Loss
The recommended dose of steroids, specifically prednisone, for treating acute hearing loss, particularly sudden sensorineural (SSNHL) hearing loss, varies across studies.
- A study published in 2016 2 used a tapered course of oral prednisone over 14 days.
- Another study from 2010 3 used intratympanic prednisolone at a dose of 62.5 mg/ml performed every day for 3 consecutive days.
- A 2011 study 4 compared oral prednisone (60 mg/d for 14 days with a 5-day taper) to intratympanic methylprednisolone (40 mg/mL injected into the middle ear) and found both treatments to be effective.
- A 2012 study 5 used Prednisolone in tapering doses from 60 mg for 3 days and found no significant difference in hearing recovery compared to placebo.
- A 2013 study 6 used systemic high-dose dexamethasone therapy (40 mg daily for 3 days, followed by 10 mg daily for 3 days) and found it to be effective in improving hearing outcomes.
Key Findings
- The effectiveness of steroid treatment for SSNHL may depend on factors such as the severity of hearing loss, presence of vertigo, and timing of treatment initiation 2, 4, 5.
- High-dose dexamethasone therapy may be more effective than traditional prednisone treatment regimens 6.
- Intratympanic steroid administration may be a viable alternative to oral steroid treatment 3, 4.