Pediatric Corticosteroid Dosing for Sudden Sensorineural Hearing Loss
For pediatric patients with sudden sensorineural hearing loss, administer oral prednisone at 1 mg/kg/day as a single daily dose (maximum 60 mg/day) for 7-14 days, followed by a taper over a similar time period. 1
Dosing Regimen
Initial Treatment Phase
- Prednisone: 1 mg/kg/day given as a single morning dose (not divided), with usual maximum of 60 mg daily 1
- Administer for 10-14 days at full dose 1
- Give in the morning prior to 9 am to align with natural cortisol rhythm and minimize adrenal suppression 2
Tapering Phase
- After full-dose treatment, taper over a similar time period (7-14 days) 1
- One representative regimen: maximum dose for 4 days, followed by 10-mg taper every 2 days 1
- Never stop abruptly—gradual withdrawal is essential 2
Alternative Equivalent Dosing
If prednisone is unavailable, equivalent doses include: 1
- Methylprednisolone: 48 mg/day (5x more potent than hydrocortisone)
- Dexamethasone: 10 mg/day (25x more potent than hydrocortisone)
Timing Considerations
Treatment must begin immediately, ideally within the first 14 days of symptom onset. 1 The evidence shows:
- Greatest spontaneous improvement and treatment benefit occur in the first 2 weeks 1
- Some benefit reported up to 6 weeks following onset, but efficacy diminishes significantly after 2 weeks 1
- Late recovery beyond 6 weeks is rare 1
Pediatric-Specific Evidence
A retrospective study of 14 pediatric patients used intravenous prednisolone at 3 mg/kg/day initially, reduced by half every second day for maximum 14 days, achieving complete recovery in 57% and partial recovery in 36%. 3 However, the standard guideline-recommended oral dosing of 1 mg/kg/day remains the primary recommendation for practical outpatient management. 1
Prognostic Factors in Children
- Initial hearing loss ≥50 dB predicts poor outcome in pediatric patients (p=0.028) 3
- Presence of tinnitus does not affect outcome 3
- Association with vertigo may worsen outcomes 4
Intratympanic Steroids as Alternative
For children who cannot tolerate systemic steroids (e.g., uncontrolled diabetes), intratympanic dexamethasone is an alternative: 1
- Dexamethasone 24 mg/mL, 16 mg/mL, or 10 mg/mL (higher concentrations show better outcomes) 1
- Methylprednisolone 40 mg/mL or 30 mg/mL 1
- Administered via anterosuperior myringotomy after topical anesthetic 1
A pediatric study comparing combined intratympanic dexamethasone plus oral methylprednisolone versus oral steroids alone found no significant difference in outcomes (31.69 dB vs 20.00 dB gain, p=0.132), suggesting systemic therapy alone is sufficient. 5
Recent High-Quality Evidence
A 2024 randomized controlled trial in adults demonstrated that high-dose glucocorticoids (250 mg/day IV prednisolone or 40 mg/day oral dexamethasone) were NOT superior to standard-dose oral prednisolone (60 mg/day) and caused more adverse events. 6 This supports using the standard 1 mg/kg/day dosing in pediatrics rather than escalating to higher doses.
Monitoring and Administration
- Administer with food or milk to reduce gastric irritation 2
- Consider antacids between meals for peptic ulcer prevention with large doses 2
- Obtain audiogram before treatment, at completion, and at delayed intervals 1
- Monitor for hyperglycemia, especially in at-risk patients 1, 7
- Most serious side effects occur with chronic use; short 10-14 day courses have acceptable safety profiles 1
Common Pitfalls to Avoid
- Underdosing: Ensure full 1 mg/kg/day is given, not lower "cautious" doses that compromise efficacy 1
- Delayed treatment: Every day matters—initiate treatment immediately upon diagnosis 1
- Abrupt discontinuation: Always taper to prevent adrenal insufficiency 2
- Divided dosing: Give as single morning dose, not split throughout day, to minimize HPA axis suppression 1, 2