From the Guidelines
Corticosteroids should be initiated immediately, ideally within the first 14 days of symptom onset, for optimal recovery of nerve function in idiopathic sudden sensorineural hearing loss (ISSNHL). The recommended regimen is prednisone 1 mg/kg/d, with a usual maximal dose of 60 mg/d, for 10 to 14 days 1. Early administration is critical as studies show significantly better outcomes when steroids are started within the first two weeks, with diminishing benefits after this window. The mechanism involves reduction of inflammation and edema around the nerve, preventing compression within bony canals and subsequent ischemia. This allows for faster remyelination and axonal regeneration.
Key Considerations
- The dose of prednisone should be given in a single (not divided) dose, with the usual maximum dose of 60 mg daily 1.
- The equivalent dose of prednisone 60 mg is 48 mg for methylprednisolone and 10 mg for dexamethasone 1.
- Patients should be monitored for steroid side effects including hyperglycemia, mood changes, and insomnia, with appropriate precautions for those with diabetes, hypertension, or peptic ulcer disease.
Treatment Duration and Tapering
- The full dose should be given for 7 to 14 days, then tapered over a similar time period 1.
- The lack of clear evidence supporting this treatment, as well as the existence of potential adverse treatment effects, supports a large role for shared decision making with patients 1.
Alternative Treatment Options
- Intratympanic corticosteroids, such as methylprednisolone or dexamethasone, may be considered for patients who do not respond to oral corticosteroids or have contraindications to oral therapy 1.
From the Research
Steroid and Return of Nerve Function Timing
- There are no direct studies on steroid and return of nerve function timing among the provided evidence.
- However, the studies discuss the management and treatment of nerve injuries and neuropathic pain, which may be related to the return of nerve function timing.
- According to 2, changes in the nerve, neuromuscular junction, and muscle can become irreversible approximately 18 to 24 months following denervation, emphasizing the importance of early treatment.
- The use of pharmacological therapies such as pregabalin and gabapentin is discussed in 3, 4, and 5 as a treatment for neuropathic pain, but their effect on the return of nerve function timing is not explicitly mentioned.
- The studies suggest that early multidisciplinary approaches to nerve injuries and the use of various therapeutic strategies can improve outcomes, but the specific relationship between steroid use and return of nerve function timing is not addressed.