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Steroids for Treatment of Sudden Hearing Loss

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Sudden sensorineural hearing loss () can occur suddenly in one ear, and generally within three days, causing a 30+ hearing loss at three consecutive frequencies. The cause for this disorder is unclear, but research has indicated that viral infection, vascular compromise, and immunologic diseases could be key reasons for this hearing disorder. Treatment of SSNHL remains controversial. Different ap­proaches such as steroids, vasodilator, antiviral agents, diuretics, and low-salt diets have been suggested. Nevertheless, spontaneous recovery rate without treatment ranges from 30 to 60%, most resolving within two weeks after onset.
As a result of its anti-inflammatory effect, high-dosage systemic steroid therapy is currently the mainstay of the treatment for SSNHL. Despite oral or intravenous steroid therapy for 2 weeks, approximately 30-50% of patients show no response. Animal studies have found that intratympanic steroid injections—introducing steroids through the tympanic membrane—results in reduced systemic steroid toxicity and higher perilymph steroid level selectively.
A new study evaluates the effect of intratympanic steroid injections in patients with SSNHL after failure to respond to systemic steroid treatment. Patients who refused this regimen were used as controls in this research. The authors of “Intratympanic Steroids for Treatment of Sudden Hearing Loss After Failure of Intravenous Therapy,” are Guillermo Plaza, MD, PhD, from the Otolaryngology Department, Hospital de Fuenlabrada, and Carlos Herráiz, MD, PhD, with the Otolaryngology Department, Fundación Hospital Alcorcón, both in Madrid, Spain. Their findings were presented at the 110th Annual Meeting and OTO EXPO of the American Academy of Otolaryngology—Head and Neck Surgery Foundation, held September 17-20, 2006, in Toronto.

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I had sudden hearing loss. I wear hearing aids but they were doing no good. I went to an within a week and I took steroids. I’m not sure if my hearing is any better but I went to see the man who sold me the hearing aids. He was able to turn the left one up but now it seems I can hear a little but not understand what they are saying. Some people I have no trouble hearing and others I can’t hear. Is there any hope for me? My e-mail is sunnybrook2002@hotmail.com. Thank you

i lost most of my hearing to antibiotics used to treat meningitis when i was an infant, but a few years ago (i’m 32 now), i woke up with pressure and fullness in my ears. it felt like ear wax or maybe like my ears wouldn’t pop after a change in altitude. this went on for a few days before i saw a serious of that had no idea what was going on. hearing tests revealed that i had lost some hearing, but it was not as dramatic a drop as i thought it would be; nevertheless, i couldn’t hear as well and the fullness/pressure sensation was annoying. i was just about to give up when a friend’s father happened to mention my situation to a colleague who specialized in my disorder. he said it was endolymphatic hydrops and needed to start steroids immediately. he referred me to dr. derald brackmann at the house ear clinic in LA and i flew down to see him days later. he started me on prednisone, a steroid, for 60mg for 30 days. he also put me on HCTZ + potassium pills to lower the sodium content in the inner ear (the theoretical cause of the pressure and fullness). a few months later, the pressure disappeared and i got my hearing back, but i didn’t get all of what i had back. nevertheless, i adjusted.

the doctor kept me on the HCTZ and potassium pills indefinitely. i’d been doing fine this way for a few years, but earlier this week the fullness and pressure came back for seemingly no reason. i was put on steroids and they seem to be helping again.

this problem is similar to meniere’s disease, but commonly misdiagnosed if you don’t have vertigo (a common giveaway for meniere’s). most ENTs know what endolymphatic hydrops is…but i’d recommend seeing someone who is comfortable treating it.

@damaja said:

i lost most of my hearing to antibiotics used to treat meningitis when i was an infant, but a few years ago (i’m 32 now), i woke up with pressure and fullness in my ears. it felt like ear wax or maybe like my ears wouldn’t pop after a change in altitude. this went on for a few days before i saw a serious of ENTs that had no idea what was going on. hearing tests revealed that i had lost some hearing, but it was not as dramatic a drop as i thought it would be; nevertheless, i couldn’t hear as well and the fullness/pressure sensation was annoying. i was just about to give up when a friend’s father happened to mention my situation to a colleague who specialized in my disorder. he said it was endolymphatic hydrops and needed to start steroids immediately. he referred me to dr. derald brackmann at the house ear clinic in LA and i flew down to see him days later. he started me on prednisone, a steroid, for 60mg for 30 days. he also put me on HCTZ + potassium pills to lower the sodium content in the inner ear (the theoretical cause of the pressure and fullness). a few months later, the pressure disappeared and i got my hearing back, but i didn’t get all of what i had back. nevertheless, i adjusted.

the doctor kept me on the HCTZ and potassium pills indefinitely. i’d been doing fine this way for a few years, but earlier this week the fullness and pressure came back for seemingly no reason. i was put on steroids and they seem to be helping again.

this problem is similar to meniere’s disease, but commonly misdiagnosed if you don’t have vertigo (a common giveaway for meniere’s). most ENTs know what endolymphatic hydrops is…but i’d recommend seeing someone who is comfortable treating it.

Unfortunately Meniere’s disease is really more of a syndrome. It is very difficult for anyone who has it and unfortunately has no real “cure.” Hopefully in the near future there will be a cure. Perhaps just as bad is that the symptoms are very spontaneous and don’t occur in cycles. It would be wise to see both an audiologist and an for advice on how to cope with this. Best of luck to you Damaja.

Dunshaw

Thanks for shairng:A new study evaluates the effect of intratympanic steroid injections in patients with after failure to respond to systemic steroid treatment. Patients who refused this regimen were used as controls in this research. The authors of “Intratympanic Steroids for Treatment of Sudden Hearing Loss After Failure of Intravenous Therapy,” are Guillermo Plaza, MD, PhD, from the Otolaryngology Department, Hospital de Fuenlabrada, and Carlos Herráiz, MD, PhD, with the Otolaryngology Department, Fundación Hospital Alcorcón, both in Madrid, Spain. Their findings were presented at the 110th Annual Meeting and OTO EXPO of the American Academy of Otolaryngology—Head and Neck Surgery Foundation, held September 17-20, 2006, in Toronto.

Sudden sensorineural hearing loss is a confusing and controversial issue in otolaryngology that most of us will encounter in our practice. The impact of the loss of hearing on the patient can be catastrophic and most physicians consider it a medical emergency. On the other hand, it usually becomes frustrating for the physician, as the cause is most often not obvious and the treatment empiric and poorly understood.

I, too, was diagnosed with hydrops. I was given HCTZ and it seemed to work fine and I felt like I got my hearing back, unfortunately, the HCTZ triggered another auto-immune response and I developed Type 1 diabetes. Perhaps due to my genetic makeup, I cannot tolerate HCTZ. Genetic tests also discovered that Methotrexate, another treatment for hydrops or autoimmune inner ear disease, is very toxic for me. I’m glad I never tried that fix. My hearing loss is considered mild to moderate but my single syllable word recognition score is a mere 20% on good days. I also feel hopeless on anything helping me.

My wife recently had exactly the same thing happen and was prescribed steroids. Unfortunately, they were prescribed too late and therefore not allowed - I understand that may be helpful if taken early, then good luck. A quick question, you manage to get any benefit from homeopathy or other medical interventions.

Detection of this situation is easy and you will be able to notice when you hear your ears or phone when voice and with a pop can can. Sudden hearing loss is an emergency situation and you immediately should contact your doctor.

@Admin1 said:

Sudden sensorineural hearing loss (SSNHL) can occur suddenly in one ear, and generally within three days, causing a 30+ dB hearing loss at three consecutive frequencies. The cause for this disorder is unclear, but research has indicated that viral infection, vascular compromise, and immunologic diseases could be key reasons for this hearing disorder. Treatment of SSNHL remains controversial. Different ap­proaches such as steroids, vasodilator, antiviral agents, diuretics, and low-salt diets have been suggested. Nevertheless, spontaneous recovery rate without treatment ranges from 30 to 60%, most resolving within two weeks after onset.
As a result of its anti-inflammatory effect, high-dosage systemic steroid therapy is currently the mainstay of the treatment for SSNHL. Despite oral or intravenous steroid therapy for 2 weeks, approximately 30-50% of patients show no response. Animal studies have found that intratympanic steroid injections—introducing steroids through the tympanic membrane—results in reduced systemic steroid toxicity and higher perilymph steroid level selectively.
A new study evaluates the effect of intratympanic steroid injections in patients with SSNHL after failure to respond to systemic steroid treatment. Patients who refused this regimen were used as controls in this research. The authors of “Intratympanic Steroids for Treatment of Sudden Hearing Loss After Failure of Intravenous Therapy,” are Guillermo Plaza, MD, PhD, from the Otolaryngology Department, Hospital de Fuenlabrada, and Carlos Herráiz, MD, PhD, with the Otolaryngology Department, Fundación Hospital Alcorcón, both in Madrid, Spain. Their findings were presented at the 110th Annual Meeting and OTO EXPO of the American Academy of Otolaryngology—Head and Neck Surgery Foundation, held September 17-20, 2006, in Toronto.

Just knowing this could happen gives me a serious case of the screaming fantods. It’s bad enough having a serious hearing loss at a relatively young age, but having it decompensate thirty decibels over a few days has got to be scary. Y’all have my sympathy.

In reply to @dunshawhearing

@dunshawhearing said:

Unfortunately Meniere’s disease is really more of a syndrome. It is very difficult for anyone who has it and unfortunately has no real “cure.” Hopefully in the near future there will be a cure. Perhaps just as bad is that the symptoms are very spontaneous and don’t occur in cycles. It would be wise to see both an audiologist and an ENT for advice on how to cope with this. Best of luck to you Damaja.

Dunshaw

No, Menieres is no longer categorized as a syndrome. You are spot on with your statements however. For years it was considered a syndorme as it is idiopathic (no known cause and no known cure) but the syndrome category has been removed as 20 million or more Americans have it, many, never even being treated for it, sadly.

Thankfully, there are doctors that can treat it and make ones life bearable though they are often hard to locate. You are blessed if you live near one who is knowledgeable, capable and compassionate. Good luck to all who suffer from it. I feel blessed that I found just that kind of physician.

Steve

In reply to @davidfussion

I am living and working in Japan (or trying to keep working). About 13 days ago, I had sudden deafness in my right ear. It went from a moderately severe hearing loss to a profound loss, average 30 db loss, in an afternoon. I went to the hospital a few days later and was prescribed predinsone in pill form 30 mg for 3 days, then tapering to 20 mg for 2 days and 10 mg for 2 days. There weren’t any results from the treatment.

I went back today and they wanted to hospitalize me for a week to ten days. Being severely hard of hearing leaves my communication sorely lacking, let alone that the communication is in Japanese which I’m quite poor at. So I’m not sure what they wanted to do to me in there, but part of it was to administer a steroid IV. drip, and probably some oxygen treatments, but I’ve just returned to work after a medical leave (for a related but different condition) and it would look very bad to admit my big new problem, take ten lays leave, and probably not be fixed in the end. Hospitals here tend to hospitalize for many procedures that would be done on an outpatient basis in America (can’t speak for other countries on this). So I sought a second opinion.

I found another who agreed to give me an injection every day for a week at his clinic and I can still go to work in the afternoons. “Great” I thought, “Now were getting somewhere, doing something a little different.” Only one of the days he’s closed and another I have to be at work too early to stop by his clinic, so he prescribed pills for those days and when I got to the pharmacy I realized that they are the same steroid in the same low dosage that I took last week without effect. So that’s my story thus far and here are my questions:

Is taking 30 mg of predinsone by injection any more effective than taking 30 mg of predinsone by pill?

If my hearing didn’t come back after the first couple days of treatment (a critical window as I understand it) is prolonging the treatment advisable?

Is taking 60 mg of predinsone (which seems to be the standard treatment administered to many others on this forum by American doctors) likely to be more effective?

Does it seem this ENT is just trying to milk a little money out of me?

Please offer me some suggestions, advice, knowledge if you can. Everything is greatly appreciated as I’m having a really tough time dealing with this. Thanks.

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