Is prednisone (corticosteroid) used in the treatment of tinnitus?

From the Guidelines

Prednisone is not a recommended treatment for chronic tinnitus, but it may be considered for sudden-onset tinnitus or tinnitus accompanied by sudden hearing loss, as stated in the 2019 clinical practice guideline update 1. The use of prednisone in treating tinnitus is generally reserved for cases where inflammation is suspected to be a contributing factor. According to the 2019 guideline update, corticosteroids like prednisone may be offered as initial therapy for sudden sensorineural hearing loss (SSNHL), which can be associated with tinnitus 1.

• Typical treatment regimens involve a short course of oral prednisone, often starting at 40-60mg daily and tapering over 10-14 days.
• The rationale for using prednisone is that it may reduce inflammation in the auditory system, potentially decreasing the perception of tinnitus.
• However, patients should be aware that prednisone has significant side effects, including mood changes, increased blood sugar, fluid retention, and increased susceptibility to infections, which is why it's only used for short periods.
• Long-term use is not recommended due to these side effects and limited evidence of sustained benefit.
• For chronic tinnitus, other approaches such as sound therapy, cognitive behavioral therapy, and hearing aids are generally more effective and safer options, as noted in the 2014 clinical practice guideline for tinnitus 1. The 2012 clinical practice guideline for sudden hearing loss also discusses the use of corticosteroids, including prednisone, but notes that the evidence is not strong enough to support their effectiveness in treating sudden hearing loss 1.
• A Cochrane review updated in 2013 found only 3 trials that met their inclusion criteria, and the results were contradictory, making the role of steroids unclear 1.
• Another systematic review noted that there was no statistically significant treatment effect with the same trials.
• In 2016, a group compared the addition of IV steroids to oral steroids and noted no difference in hearing outcomes with the addition of IV steroids. Overall, while prednisone may be considered for sudden-onset tinnitus or tinnitus accompanied by sudden hearing loss, its use should be carefully weighed against the potential risks and benefits, and other treatment options should be considered for chronic tinnitus.

From the Research

Treatment of Tinnitus with Prednisone

• There is limited direct evidence on the use of prednisone for the treatment of tinnitus specifically 2, 3, 4, 5, 6.
• However, prednisone has been used in the treatment of sudden sensorineural hearing loss, which can be associated with tinnitus 2, 3, 4, 5, 6.
• Studies have compared the effectiveness of oral and intratympanic corticosteroid therapy for sudden sensorineural hearing loss, with some suggesting that intratympanic therapy may be an alternative to systemic steroid therapy 3, 4, 6.
• A study found that immediate treatment of patients with unilateral idiopathic sudden hearing loss and additional symptoms (dizziness or tinnitus) with a 14-day course of 60 mg prednisone (with taper) is recommended 5.
• A systematic review found that intratympanic corticosteroids may have a small effect on the change in hearing threshold and may result in a higher proportion of participants whose hearing is improved, but the evidence is uncertain 6.

Adverse Effects of Prednisone

• The use of prednisone can be associated with adverse effects such as hyperglycemia, weight gain, and osteonecrosis 2.
• Intratympanic corticosteroid therapy can also be associated with adverse effects such as persistent tympanic membrane perforation, vertigo or dizziness, and ear pain 6.

Comparison of Treatment Options

• The evidence suggests that intratympanic corticosteroids may be an alternative to systemic steroid therapy for the treatment of sudden sensorineural hearing loss, but the effectiveness of prednisone specifically for the treatment of tinnitus is unclear 2, 3, 4, 5, 6.
• Further studies are needed to determine the effectiveness of prednisone for the treatment of tinnitus and to compare the adverse effects of different treatment options 6.