Is prednisone (corticosteroid) effective for treating tinnitus?

Prednisone for Tinnitus

Prednisone is not recommended as a routine treatment for tinnitus alone, as there is insufficient evidence supporting its effectiveness and potential for significant adverse effects. 1

Evidence Assessment

Guidelines on Steroid Use for Tinnitus

The American Academy of Otolaryngology-Head and Neck Surgery guidelines strongly recommend against routinely prescribing corticosteroids for dysphonia or hoarseness prior to visualization of the larynx 1. While these guidelines don't specifically address tinnitus alone, they highlight the risks of empiric steroid use without confirmed diagnosis.

For sudden sensorineural hearing loss (SSNHL) with associated tinnitus, guidelines do recommend oral steroids as initial therapy within the first 14 days of symptom onset 1, 2. However, this recommendation is specific to SSNHL, not isolated tinnitus.

Research on Prednisone for Tinnitus

Recent research shows mixed results:

• A 2025 randomized controlled trial found that short-term oral prednisone plus Ginkgo biloba extract significantly reduced Tinnitus Handicap Inventory scores compared to Ginkgo biloba alone in patients with acute subjective tinnitus 3. This is the most recent high-quality evidence.

• A 2017 study found that circulating steroids negatively correlate with tinnitus intensity, suggesting a potential biological mechanism for steroid effectiveness 4.

• A 2009 comparative study found that intratympanic steroid injections had similar effects to oral carbamazepine for subjective tinnitus 5.

Treatment Algorithm for Tinnitus

1. Diagnostic Evaluation First

   • Audiometric testing to rule out hearing loss
   • Visualization of the ear and potentially larynx before considering steroids
   • MRI if indicated to rule out retrocochlear pathology

2. Treatment Decision Path

   • If tinnitus is associated with SSNHL:

     • Oral prednisone at 1 mg/kg/day (maximum 60 mg daily) for 10-14 days, followed by a taper over a similar period 1, 2
     • Treatment should start within 14 days of symptom onset

   • If tinnitus is isolated (without hearing loss):

     • Avoid routine use of prednisone due to risk-benefit concerns 1
     • Consider short-term prednisone (0.35 mg/kg daily) only for severe, disabling tinnitus that has failed other treatments 3, 6

Risks and Adverse Effects

Corticosteroid therapy carries significant risks that must be weighed against potential benefits:

• Common adverse events (>30% incidence): sleep disturbances, weight gain, hypertension 1
• Metabolic effects: hyperglycemia, insulin resistance, metabolic syndrome 1
• Bone health: increased risk of fractures, reduced bone mineral density 1
• Other risks: adrenal suppression, peptic ulcer, increased cardiovascular risks 1

Special Considerations

• Patients with diabetes, hypertension, glaucoma, tuberculosis, peptic ulcer disease, or prior psychiatric reactions to corticosteroids may not be candidates for systemic steroids 1, 2
• Intratympanic steroid injections may be considered as an alternative in these patients 1, 7
• The 2023 study showed that intratympanic steroids had a positive impact on tinnitus reduction in patients with SSNHL 7

Bottom Line

While the most recent evidence 3 suggests some benefit of prednisone for acute subjective tinnitus, the overall evidence is limited, and the risk of adverse effects is significant. Therefore, prednisone should not be routinely prescribed for tinnitus alone but may be considered in specific cases of severe, disabling tinnitus or when tinnitus is associated with sudden sensorineural hearing loss.