From the Guidelines
Treating an inner ear infection with corticosteroids based on clinical exam alone is not recommended without further diagnostic evaluation. According to the 2019 clinical practice guideline on sudden hearing loss 1, the cause of sudden sensorineural hearing loss (SSNHL) is often not readily apparent and thus called idiopathic. The guideline suggests that a comprehensive history, physical exam, and hearing test (audiogram) should be done to evaluate SSNHL.
Key Considerations
- The guideline recommends that clinicians may offer corticosteroids as initial therapy for SSNHL, but this should be based on a thorough evaluation, not just a clinical exam alone 1.
- The benefits of corticosteroid therapy may include more prompt and complete recovery of hearing, but there are also side effects that must be considered when choosing among the available options, such as increased anxiety, pain, dizziness, elevated blood sugar, elevated blood pressure, depression, or insomnia 1.
- A Cochrane review updated in 2013 found that the role of steroids remained unclear due to contradictory outcomes and small number of patients in the trials reviewed 1.
Diagnostic Evaluation
- A hearing test (audiogram) should be done to evaluate SSNHL 1.
- Magnetic resonance imaging (MRI) may be ordered to screen for benign tumors of the vestibular nerve, such as vestibular schwannomas, which can lead to progressive hearing loss, balance problems, and in some cases compression of the brainstem with severe neurologic symptoms 1.
- Additional testing, such as auditory brainstem response (ABR), may be considered, but MRI is the most sensitive test 1.
Treatment Approach
- Corticosteroids may be beneficial when started early in the treatment of SSNHL, but accurate diagnosis is crucial before initiating treatment.
- Consultation with an otolaryngologist or other specialist is advisable before starting corticosteroid therapy for suspected inner ear infections.
- Symptoms that might seem like inner ear infection could represent more serious conditions like Meniere's disease, BPPV, or even stroke, which require different management approaches.
From the Research
Treatment of Inner Ear Infections with Corticosteroids
- The use of corticosteroids for inner ear infections is a common practice, but the decision to treat should be based on a thorough clinical exam and diagnosis 2, 3.
- A clinical exam alone may not be sufficient to determine the effectiveness of corticosteroids, as the diagnosis of inner ear disorders requires a targeted physical examination, audiometry, and electronystagmography (ENG) 4.
- Studies have shown that corticosteroids can be effective in treating inner ear disorders such as Meniere's disease, sudden sensorineural hearing loss, and vestibular neuritis 2, 3, 5.
- However, the effectiveness of corticosteroids can vary depending on the specific condition and the individual patient, and other treatment options such as gentamicin and vestibular rehabilitation may also be considered 3, 5.
Diagnosis and Treatment Options
- The diagnosis of inner ear disorders begins with a targeted physical examination, and may include additional tests such as audiometry and electronystagmography (ENG) 4.
- Treatment options for inner ear disorders may include corticosteroids, gentamicin, and vestibular rehabilitation, and the choice of treatment will depend on the specific condition and the individual patient 2, 3, 5.
- In some cases, intratympanic corticosteroid injections may be considered as an adjunct to traditional treatments 5.
Considerations for Treatment
- The use of corticosteroids for inner ear infections should be based on a thorough clinical exam and diagnosis, and should take into account the potential benefits and risks of treatment 2, 3, 5.
- The effectiveness of corticosteroids can vary depending on the specific condition and the individual patient, and other treatment options may also be considered 3, 5.