Treatment of Sudden Sensorineural Hearing Loss with Steroids

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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

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                                                                        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