Visit one of Our Convenient Locations

1160 Park Ave W. Suite 4 S. Highland Park IL 60035 (847) 737-4270

Route 83 & Robert Parker Coffin Rd, Suite 103 Long Grove, IL 60047

Phone: (847) 737-7544

Website: www. NSAVL.com

Call Us: (847) 737-4270

Treatment of Sudden Sensorineural Hearing Loss with Steroids

Treatment options for SSNHL seem to be limited due to the lack of understanding; however, literature suggests that

steroids (glucocorticoids) taken orally may increase benefit in

the patient’s hearing recovery. Before providing specific empirical data illustrating the effectiveness of steroids, the

proposed glucocorticoid mechanism, dosage pattern, and possible side effects should be understood.

The steroids (glucocorticoids) basically have an anti-inflammatory effect on the

cytokines produced by the cochlea in response to a viral infection. The introduction of steroids into the system will inhibit the synthesis of the pro-inflammatory cytokines and

allow the ions to flow freely into the sensory epithelia (Devillier, 2001). Devillier (2003) explains that the steroid’s anti-inflammatory properties are brought about when the

glucocorticoid binds to the cytoplasmic receptor cell and migrates into the nucleus. The

activated receptor then acts on the transcription factors to inhibit the synthesis of the cytokines (Devillier, 2001). This specific anti-inflammatory mechanism involved in

SSNHL is complicated and may be incompletely understood (Mycel et al, 2000).

There is no conclusive data reported in the literature concerning an optimal dosage of steroids in the treatment for SSNHL. In a randomized clinical trial, Wilson et al (1980)

compared two different doses of oral steroids for treatment of SSNHL. One group was administered a 16-mg and taper dose of dexamethasone and the other group was

administered a 48 mg and taper dose of methylprednisolone. Unfortunately, for Wilson and his colleagues, their sample size happened to be too small in both groups to

distinguish a significant beneficial difference between the two different dosages (Wilson

et al, 1980). It has also been noted that optimal length of treatment has not been established (Slattery et al, 2005); however, it seems that most literature suggests

utilizing a high does and taper administration may be the most beneficial to the patients. A high dose or “blast” and taper method is administered with an initial high dose of

steroids, for example 60 mg of the glucocorticoid Prednisone six times per day for a few days, then the dosage is systematically tapered off as the treatment continues. This

Visit one of Our Convenient Locations

1160 Park Ave W. Suite 4 S. Highland Park IL 60035 (847) 737-4270

Route 83 & Robert Parker Coffin Rd, Suite 103 Long Grove, IL 60047

Phone: (847) 737-7544

Website: www. NSAVL.com

Call Us: (847) 737-4270

method is used because it seems to minimize the possible chance of systemic side effects (Mycek et al, 2003).

A minimal dosage of glucocorticoid is generally suggested because they have an ample

list of undesirable side effects. Glucocorticoids may increase brain excitation and provoke episode of psychosis and/or depression. These drugs also increase appetite and

may exacerbate weight gain. Glucocorticoids are known to retain sodium and water in the body while promoting the elimination of potassium and calcium and decreasing the

absorption of these minerals. In response to a decrease in calcium absorption, glucocorticoids may stunt the growth of children. Glucocorticoids may also cause poor

wound healing and other skin manifestations due to compromised protein content in skin and blood vessels. These drugs may cause hyperglycemia in individuals with diabetes.

Finally, literature also suggests that chronic use of glucocorticoids may induce renal

suppression (Mandermott & Deglin 1994).

A small number of empirical studies suggest that oral steroid treatment may be beneficial to the recovery of SSNHL (Chen et al 2003, Slattery et al 2005, & Wilson et al

1983). It should be noted; however, that patients who present with a moderate to severe loss benefit more from steroid treatment than do patients with milder losses

(Chen et al, 2003). It is also interesting that literature reports a consistent spontaneous recovery rate of approximately 31% of patients who go untreated (Chen et al, 2003;

Slattery et al, 2005: & Wilson et al, 1980). These findings suggest a need for more type I empirical studies in the treatment of SSNHL.

It seems there is an increasing amount of research concerning intratympanic steroid injections as a treatment for SSNHL. The medical and allied health community may find

this as a better mode of steroid administration because it lessens the chances of systemic side effects and it provides the proposed site of lesion with a more

concentrated dose of the drug. As research and administration of intratympanic steroid injections increases it seems treatment of SSNHL via oral steroids may wane and

eventually be inadequate.