From the Guidelines
The treatment for sensorineural hearing loss associated with shingles should involve prompt initiation of corticosteroids, such as prednisone, within 2 weeks of symptom onset, as recommended by the clinical practice guideline for sudden hearing loss 1.
Key Considerations
- The guideline strongly recommends distinguishing sensorineural hearing loss from conductive hearing loss and assessing patients for bilateral hearing loss, recurrent episodes, and focal neurologic findings 1.
- Corticosteroids may be offered as initial therapy within 2 weeks of symptom onset, with the option of adding hyperbaric oxygen therapy combined with steroid therapy within 2 weeks of onset or as salvage therapy within 1 month of onset 1.
- Intratympanic steroid therapy is recommended for patients with incomplete recovery from sensorineural hearing loss 2 to 6 weeks after onset of symptoms 1.
- Patient education on the natural history of the condition, benefits and risks of medical interventions, and limitations of existing evidence is strongly recommended 1.
Treatment Approach
- The treatment approach should prioritize reducing inflammation and swelling of the auditory nerve, controlling viral replication, and managing pain and potential balance issues.
- Audiometric confirmation of sensorineural hearing loss should be obtained as soon as possible, within 14 days of symptom onset, to confirm the diagnosis 1.
- Follow-up audiometric evaluation should be conducted at the conclusion of treatment and within 6 months of completion of treatment to assess outcomes 1.
- Patients with residual hearing loss and/or tinnitus should be counseled on the possible benefits of audiologic rehabilitation and other supportive measures 1.
From the Research
Treatment for Sensorineural Hearing Loss in Shingle Infection
- The treatment for sensorineural hearing loss in shingle infection is not directly addressed in the provided studies, as they focus on idiopathic sudden sensorineural hearing loss (ISSHL) and its treatment with antiviral therapy and corticosteroids 2, 3, 4, 5, 6.
- However, some studies suggest that antiviral agents, such as acyclovir, may be used in combination with corticosteroids to treat sensorineural hearing loss, although the evidence of their effectiveness is weak 3, 6.
- A study published in 2012 found that combination therapy with systemic steroids, an antiviral agent, anticoagulants, and stellate ganglion block resulted in a higher hearing improvement rate compared to treatment with systemic steroids alone 3.
- Another study published in 2003 found that the addition of acyclovir to hydrocortisone did not show any statistically significant difference in hearing improvement compared to hydrocortisone alone 5.
- A review of four randomized controlled trials found no statistically significant advantage in the use of antivirals in the treatment of ISSHL, and concluded that there is currently no evidence to support the use of antiviral drugs in the treatment of ISSHL 4.
Antiviral Treatment
- Acyclovir is an antiviral agent that has been studied as a potential treatment for ISSHL, but its effectiveness is still unclear 2, 5, 6.
- A study published in 1999 found that combination treatment with prednisolone and acyclovir resulted in earlier hearing recovery and less extensive cochlear destruction in an experimental model of HSV-1 viral labyrinthitis 6.
- However, other studies have found no significant benefit from the addition of acyclovir to corticosteroids in the treatment of ISSHL 2, 5.
Corticosteroid Treatment
- Corticosteroids, such as prednisolone and hydrocortisone, are commonly used to treat ISSHL, and have been shown to improve hearing recovery in some patients 2, 3, 5, 6.
- A study published in 2003 found that the overall improvement in hearing was 78% in patients treated with hydrocortisone alone 5.
- However, the effectiveness of corticosteroids in treating sensorineural hearing loss in shingle infection is not directly addressed in the provided studies.