Steroids for Sudden Hearing Loss
Source: Alexiou C, et al. Sudden sensorineural hearing loss: Does application of glucocorticoids make sense? Arch Otolaryngol Head Neck Surg. 2001;127:253-258.
Sudden Sensorineural Hearing Loss (SSNHL), though infrequently seen by neurologists, is a common disorder, with an incidence of 1 in 3000. Suspected etiologies include viral infection, microvascular occlusion, and autoimmune disorders. Treatment guidelines do not exist although rheotherapy, antiviral agents, nonsteroidal anti-inflammatory drugs, and corticosteroids are often administered.
Retrospective analysis of audiograms of 603 SSNHL patients was undertaken to assess the efficacy of glucocorticoids for SSNHL. Patients had received intravenous (IV) pentoxifylline (a blood flow-promoting agent, Trental, 100 mg) without (n = 301) or with (n = 302) IV prednisolone (500 to 1000 mg for 3 days). IV prednisolone was followed by oral prednisone (100 mg taper over 16 days) if the former did not produce improvement.
Glucocorticoid-treated patients with low and middle frequency SSNHL demonstrated significantly better recovery of hearing compared to the nonsteroid treated group. Similarly, SSNHL patients at all frequencies demonstrated significantly better recovery with glucocorticoids plus pentoxifylline, compared to the pentoxifylline-only treated group. The recommendation is clear: glucocorticoids are advocated for patients with SSNHL. Add pentoxifylline for good measure. —Michael Rubin