From the Guidelines
For acute neurosensory deafness, the recommended dose of prednisone is 1 mg/kg/d, with a usual maximal dose of 60 mg/d, given as a single daily dose for 10 to 14 days. This dosage is based on the maximum adrenal output of hydrocortisone (cortisol) of 200 to 300 mg/d during stress, and considering that prednisone is 4 times more powerful than hydrocortisone 1. The treatment should be initiated as soon as possible, ideally within the first 14 days of symptom onset, to maximize the potential for hearing recovery.
The rationale behind this dosage is to ensure adequate anti-inflammatory effects in the inner ear structures, which may help restore hearing function. It's essential to note that underdosage is a possibility if attention is not given to the equivalent doses of different corticosteroids, such as methylprednisolone and dexamethasone 1.
Key points to consider in the management of acute neurosensory deafness with prednisone include:
- Initiating treatment as soon as possible, ideally within 14 days of symptom onset
- Using a dose of 1 mg/kg/d, up to a maximum of 60 mg/d, for 10 to 14 days
- Monitoring for potential adverse effects such as elevated blood glucose, mood changes, and increased susceptibility to infections
- Considering alternative administration routes, such as intratympanic steroid injections, for patients who cannot tolerate oral steroids or as salvage therapy for those who don't respond to oral treatment 1.
Given the importance of early treatment and the potential for significant hearing recovery, initiating prednisone at 1 mg/kg/d, up to 60 mg/d, as soon as possible after symptom onset is crucial. This approach is supported by the clinical practice guideline for sudden hearing loss, which emphasizes the importance of early institution of high enough dosages of treatment 1.
From the Research
Recommended Dose of Prednisone for Acute Neurosensory Deafness
- The recommended dose of prednisone for acute neurosensory deafness is not universally agreed upon, but several studies provide insight into common practices:
- A study published in 2009 2 used a dose of 60 mg/d of prednisone for the treatment of autoimmune inner ear disease, with a monitored 18-week prednisone taper resulting in an average dose of 30 mg per day.
- Another study from 2015 3 used tapering doses of prednisolone from 60 mg daily for the treatment of idiopathic sudden sensorineural hearing loss.
- A 2011 study 4 compared oral vs intratympanic corticosteroid therapy and used a dose of 60 mg/d of oral prednisone for 14 days with a 5-day taper.
- A 2016 study 5 used oral prednisone tapered over 14 days, but the initial dose was not specified.
- A 1998 study 6 used a high dose of 200 mg of prednisolone per day intravenously for severe sudden deafness.
Key Considerations
- The effectiveness of prednisone for acute neurosensory deafness may depend on factors such as the severity of hearing loss, age, presence of vertigo, and time to treatment initiation 3, 4, 6.
- High-dose corticosteroids are associated with known serious side effects, but prospective data suggest that with appropriate patient selection, monitoring, and education, they can be a safe and effective treatment for certain cases of neurosensory deafness 2.