Treatment of Sudden Sensorineural Hearing Loss with Steroids
Call North Shore Audio-Vetibular Lab 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 (847) 737-7544 Website: www. NSAVL.com 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.
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 Route 83 & Robert Parker Coffin Rd, Suite 103 S. Highland Park IL 60035 Long Grove, IL 60047 (847) 737-4270 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. Visit one of Our Convenient Locations 1160 Park Ave W. Suite 4 Route 83 & Robert Parker Coffin Rd, Suite 103 S. Highland Park IL 60035 Long Grove, IL 60047 (847) 737-4270 Phone: (847) 737-7544 Website: www. NSAVL.com