Prednisone Dosage for Adults with Severe Ear Pain and Pressure
For adults with severe ear pain and pressure, prednisone should be administered at 1 mg/kg/day (maximum 60 mg daily) as a single morning dose for 7-14 days, followed by a gradual taper over a similar time period. 1
Dosing Recommendations
- Initial dose should be 1 mg/kg/day (maximum 60 mg daily) given as a single morning dose, not divided doses 1
- The full dose should be maintained for 7-14 days before beginning a taper 1
- One recommended tapering regimen is to maintain the maximum dose for 4 days, then taper by 10 mg every 2 days 1
- Treatment should be initiated as soon as possible, ideally within the first 14 days of symptom onset 1
- Take medication in the morning before 9 am to minimize adrenal suppression 2
- Take with food or milk to reduce gastric irritation 2
Evidence Basis and Rationale
- The American Academy of Otolaryngology-Head and Neck Surgery guidelines specifically recommend this dosing regimen for sudden sensorineural hearing loss, which often presents with ear pain and pressure 1
- The recommended dose is based on the maximum adrenal output of hydrocortisone (cortisol) of 200-300 mg/day during stress 1
- Prednisone is 4 times more potent than hydrocortisone, making 60 mg the appropriate maximum dose 1
- Early treatment is critical for maximum effectiveness, with greatest recovery typically occurring within the first 2 weeks 1
Important Considerations and Cautions
- Common side effects include hyperglycemia and weight gain, but these are usually manageable with the short course recommended 1, 3
- More serious side effects like osteonecrosis and fractures are rare with short-term therapy but more common in patients with pre-existing bone or joint problems 1
- Underdosing is a common pitfall - standard methylprednisolone dose packs (4 mg tablets) provide insufficient total steroid exposure compared to the recommended regimen 1
- The medication should be tapered rather than abruptly discontinued to avoid withdrawal symptoms 2
- Intratympanic steroid injection is an alternative treatment option with equivalent effectiveness to oral prednisone for sudden hearing loss 1, 4
Special Situations
- For patients with diabetes, hypertension, glaucoma, or other conditions that might be exacerbated by steroids, consider starting at the lower end of the dosing range (0.5 mg/kg/day) 1
- For patients with very severe symptoms or who have failed to respond to initial therapy, some clinicians use higher doses, though evidence for increased efficacy is limited 1
- Shared decision-making is important given the potential for adverse effects, particularly in patients with comorbidities 1