Steroids for Tinnitus: Limited Evidence and Specific Indications Only
Steroids are NOT recommended as a general treatment for tinnitus, as there is insufficient evidence to support their routine use for this indication. The available evidence for steroids in tinnitus is limited to specific contexts: sudden sensorineural hearing loss (SSNHL) with associated tinnitus, or highly selected cases of temporomandibular joint dysfunction 1, 2.
When Steroids May Be Considered
Tinnitus Associated with Sudden Sensorineural Hearing Loss
If tinnitus occurs in the context of SSNHL, steroids are indicated for treating the underlying hearing loss, which may secondarily improve tinnitus symptoms 3, 4.
- Oral corticosteroids: Prednisone 1 mg/kg/day (maximum 60 mg/day) for 7-14 days followed by taper should be initiated within 14 days of symptom onset 3, 5
- Intratympanic steroids: Can be offered as initial therapy when systemic steroids are contraindicated, using dexamethasone 24 mg/mL or methylprednisolone 40 mg/mL 3
- The American Academy of Otolaryngology-Head and Neck Surgery notes that decreasing tinnitus correlates with hearing recovery and suggests ongoing resolution of cochlear inflammation 4
Isolated Tinnitus Without Hearing Loss
For isolated tinnitus without SSNHL, the evidence for steroid efficacy is weak and inconsistent 1, 2.
- A 2014 systematic review concluded there are no consistent results in studies with intratympanic steroids for tinnitus, and their use is not well supported by prospective, randomized, placebo-controlled trials 1
- One small 2009 trial found intratympanic steroids (prednisolone or dexamethasone) had similar modest effects to oral carbamazepine, with no statistical differences in effectiveness 2
- A 2023 study showed 45% improvement with intratympanic dexamethasone versus 12.5% with oral medications, but this was a small uncontrolled study with significant methodological limitations 6
Highly Specific Exception: Temporomandibular Joint Dysfunction
Intra-articular temporomandibular joint steroid injections may benefit a very select subset of patients with unilateral tinnitus and cervical pain 7.
- Only 20% of unselected tinnitus patients responded to temporomandibular steroids at 7 weeks 7
- However, 53% of patients with both unilateral tinnitus and cervical pain showed reduction in tinnitus, with 40% experiencing ≥50% reduction 7
- Critical caveat: 11% of patients experienced worsening of tinnitus as an adverse effect, highlighting the importance of proper patient selection 7
Evidence Quality and Limitations
The evidence base for steroids in isolated tinnitus is fundamentally weak:
- Most studies are retrospective, uncontrolled, or have small sample sizes 1, 2
- A 2017 study found that circulating steroid levels negatively correlate with tinnitus severity, suggesting that adding exogenous steroids may not address the underlying pathophysiology 8
- The American Academy of Otolaryngology-Head and Neck Surgery guidelines address steroids only in the context of SSNHL, not isolated tinnitus 3
Practical Algorithm for Clinical Decision-Making
Step 1: Determine if tinnitus is associated with SSNHL (documented hearing loss ≥30 dB in three contiguous frequencies)
- Yes: Treat according to SSNHL guidelines with systemic or intratympanic steroids 3, 5
- No: Proceed to Step 2
Step 2: Assess for temporomandibular joint dysfunction
- Unilateral tinnitus + cervical pain present: Consider temporomandibular joint steroid injection after informed consent about 11% risk of worsening 7
- Absent or bilateral tinnitus: Do NOT use steroids; consider alternative tinnitus management strategies 1, 7
Side Effects to Discuss
Short-term systemic steroid courses (10-14 days) typically cause manageable adverse events including hyperglycemia, weight gain, insomnia, hypertension, increased appetite, mood swings, and gastric irritation 3. Intratympanic steroids may cause transient pain, dizziness, infection, or persistent tympanic membrane perforation 3.