From the Guidelines
Steroids are recommended as first-line treatment for acute sensorineural hearing loss (ASNHL), with oral prednisone at 1 mg/kg/day (maximum 60 mg daily) for 10-14 days, followed by a 5-7 day taper, being the standard regimen. Alternatively, intratympanic steroid injections can be used, typically with dexamethasone 10-24 mg/mL administered through the tympanic membrane into the middle ear, repeated 3-4 times over 1-2 weeks 1. This approach may be preferred for patients with contraindications to systemic steroids such as uncontrolled diabetes, tuberculosis, or peptic ulcer disease. Combined therapy (oral plus intratympanic) may offer better outcomes in severe cases. Treatment should begin as soon as possible after symptom onset, ideally within 2 weeks, as efficacy decreases significantly after this window 1. Steroids work by reducing inflammation and edema in the inner ear, protecting hair cells, and improving cochlear blood flow. They may also regulate ion and fluid balance in the inner ear. Patients should be monitored for improvement with audiometric testing and should understand that complete recovery is not guaranteed, with approximately 50-70% of patients showing some degree of hearing improvement with prompt steroid treatment.
Some key points to consider when using steroids for ASNHL include:
- The importance of early treatment, with the best outcomes seen when treatment is started within 2 weeks of symptom onset 1
- The use of intratympanic steroid injections as a salvage therapy for patients who have not responded to initial treatment with oral steroids 1
- The potential benefits and risks of steroid treatment, including the risk of adverse effects such as insomnia, hyperglycemia, and hypertension 1
- The importance of shared decision making with patients, taking into account their individual preferences and values 1
Overall, the use of steroids for ASNHL is supported by a strong evidence base, with multiple studies demonstrating their effectiveness in improving hearing outcomes 1. However, it is essential to carefully consider the potential benefits and risks of treatment and to involve patients in the decision-making process.
From the Research
Steroids for Acute Sensorineural Hearing Loss
- The use of steroids for acute sensorineural hearing loss has been studied in various clinical trials and reviews 2, 3, 4, 5, 6.
- A randomized trial compared the effectiveness of oral vs intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss, and found that intratympanic treatment was not inferior to oral prednisone treatment 2.
- A systematic review of 30 studies found that intratympanic corticosteroids may have little or no effect compared with systemic corticosteroids as primary therapy, but may have a small effect on the change in hearing threshold as secondary therapy 3.
- Trends in the use and timing of intratympanic corticosteroid injections for sudden sensorineural hearing loss have been investigated, and it was found that the use of oral corticosteroids alone decreased, while the use of intratympanic corticosteroids alone and combination intratympanic-oral corticosteroids increased between 2007 and 2016 4.
- A retrospective chart review compared the effects of two different intratympanic methylprednisolone injection schedules in combination with intravenous dexamethasone for unilateral sudden sensorineural hearing loss, and found that the different timing of initiation of intratympanic methylprednisolone injection does not significantly affect the outcome of the treatment 5.
- A literature review provides an updated summary of the initial evaluation, treatment, and follow-up of sudden sensorineural hearing loss, and notes that corticotherapy remains widely accepted, but controversy exists regarding optimal management due to frequent spontaneous recovery 6.
Treatment Options
- Oral corticosteroids are a common treatment for idiopathic sudden sensorineural hearing loss 2, 3, 4, 6.
- Intratympanic corticosteroids have become increasingly common in the treatment of sudden sensorineural hearing loss, and may be used as an alternative or adjunctive therapy to oral corticosteroids 2, 3, 4, 5.
- Combination therapy with intratympanic and oral corticosteroids may have a small effect on the change in hearing threshold, but the evidence is uncertain 3.