From the Guidelines
Prednisone is primarily used for sudden sensorineural hearing loss (SSHL), a type of hearing loss that occurs rapidly over a period of 72 hours or less due to damage to the inner ear or auditory nerve. The typical treatment regimen involves a high-dose course of oral prednisone, often starting at 60mg daily for 7-14 days, followed by a gradual taper over an additional 5-7 days, as recommended by the most recent guidelines 1. Some protocols may use different dosing, such as 1mg/kg/day.
Key Considerations
- Treatment should ideally begin within the first 2 weeks after onset of hearing loss, as earlier intervention is associated with better outcomes 1.
- For patients who cannot tolerate oral steroids, intratympanic steroid injections directly into the middle ear may be an alternative 1.
- Prednisone works by reducing inflammation and immune response in the inner ear, which may help restore hearing by decreasing swelling and improving blood flow to the cochlea.
Important Notes
- While prednisone is considered first-line therapy for SSHL, it is not typically effective for other types of hearing loss such as conductive hearing loss or age-related hearing loss 1.
- The lack of clear evidence supporting systemic steroids for SHL and the existence of potential adverse treatment effects support a large role for shared decision making with patients 1.
Treatment Details
- The dose of prednisone is typically 1 mg/kg/d, with a usual maximum dose of 60 mg/d, and the treatment duration is 10 to 14 days 1.
- The equivalent dose of prednisone 60 mg is 48 mg for methylprednisolone and 10 mg for dexamethasone 1.
Side Effects and Monitoring
- Side effects of prednisone treatment may include increased anxiety, pain, dizziness, elevated blood sugar, elevated blood pressure, depression, or insomnia 1.
- Patients should be monitored for hyperglycemia, hypertension, and other potential side effects, and the treatment should be adjusted accordingly 1.
From the Research
Type of Hearing Loss Treated with Prednisone
- Sudden sensorineural hearing loss (SSNHL) is the type of hearing loss treated with prednisone, as indicated in the studies 2, 3, 4, 5, 6.
- SSNHL is a condition characterized by a sudden loss of hearing in one or both ears, often due to unknown causes.
Efficacy of Prednisone in Treating SSNHL
- The efficacy of prednisone in treating SSNHL has been evaluated in several studies, with some showing significant improvement in hearing outcomes 2, 4, 6.
- A study published in 2016 found that oral prednisone treatment resulted in a significant improvement in hearing outcomes, with an average improvement of 18.24±8.72 dB 2.
- Another study published in 2010 found that intratympanic prednisolone therapy was effective in treating SSNHL, with 47% of patients experiencing complete recovery of hearing 4.
Comparison of High-Dose and Standard-Dose Prednisone
- A systematic review published in 2024 compared the effectiveness of high-dose and standard-dose corticosteroids in treating SSNHL, and found that the reported outcomes were mixed, with some studies suggesting a greater degree of hearing recovery with high-dose regimes, while others found no difference 3.
- A randomized controlled trial published in 2024 found that high-dose systemic glucocorticoid therapy was not superior to a lower-dose regimen in patients with SSNHL, and was associated with a higher risk of side effects 5.