Is a shorter course of oral steroids, such as prednisone (corticosteroid), effective for treating sudden sensorineural hearing loss?

Oral Steroid Therapy for Sudden Sensorineural Hearing Loss

A short course of oral steroids (10-14 days) is effective for treating sudden sensorineural hearing loss when initiated within 14 days of symptom onset. 1

Recommended Steroid Regimen

The American Academy of Otolaryngology-Head and Neck Surgery recommends:

• Oral corticosteroid regimen:
  • Prednisone 1 mg/kg/day (maximum 60 mg daily)
  • Duration: 10-14 days
  • Followed by a taper over a similar period 1
  • Do not divide doses 2

Timing and Efficacy

• Treatment should be initiated as soon as possible, ideally within the first 14 days of symptom onset 2, 1
• Benefit has been reported up to 6 weeks following onset, but the greatest recovery typically occurs in the first 2 weeks 2
• Without treatment, spontaneous recovery occurs in 32-65% of cases 1
• Most recovery (78%) occurs within 1 month and by 3 months in 97% of patients 1

Alternative: Intratympanic Steroid Therapy

For patients who cannot tolerate oral steroids (diabetes, hypertension, glaucoma, tuberculosis, peptic ulcer disease, or prior psychiatric reactions), intratympanic (IT) steroids are an effective alternative:

• IT steroids show equivalent efficacy to oral steroids when properly administered 3
• IT steroid options:
  • Dexamethasone 24 mg/mL (compounded) or 10 mg/mL (stock) 2
  • Methylprednisolone 40 mg/mL or 30 mg/mL 2
• Administration: 0.4-0.8 mL injected into middle ear space, up to 4 injections over a 2-week period 2
• Patient should remain with affected ear up for 15-30 minutes after injection 2

Factors Affecting Prognosis

• Earlier treatment initiation correlates with better outcomes 1, 4
• Milder initial hearing loss has better prognosis 4
• Age and gender do not significantly influence treatment response 4
• Presence of vertigo may negatively affect outcomes 5

Adverse Effects of Steroid Therapy

• Most serious side effects occur with chronic use, not with the short 10-14 day course recommended for SSNHL 2
• Common adverse events include:
  • Sleep disturbances
  • Weight gain
  • Hypertension 1
• Patients should be monitored for:
  • Hyperglycemia (especially in diabetic patients)
  • Blood pressure changes in hypertensive patients 2

Follow-up and Monitoring

• Audiometric evaluation should be performed:
  • At completion of treatment course
  • Within 6 months of completing treatment 1
• For patients with residual hearing loss, consider audiologic rehabilitation options including hearing aids and assistive listening devices 1

Clinical Pitfalls to Avoid

1. Delayed treatment: Do not wait to initiate steroid therapy as early intervention (within 14 days) significantly improves outcomes
2. Inadequate dosing: Ensure full therapeutic doses are used (prednisone 1 mg/kg/day up to 60 mg)
3. Premature discontinuation: Complete the full 10-14 day course before tapering
4. Overlooking contraindications: Consider IT steroids for patients with contraindications to oral steroids
5. Insufficient follow-up: Ensure audiometric evaluation after treatment completion to assess recovery

The evidence strongly supports early intervention with a short course of high-dose oral steroids as the standard of care for sudden sensorineural hearing loss, with intratympanic steroids being an equally effective alternative for those who cannot tolerate oral therapy.