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Steroids for the treatment of sudden hearing loss with unknown cause | Cochrane.
We considered trials including the use of steroids in combination with another treatment if the comparison control group also received the same other treatment. The two authors reviewed the full-text articles of all the retrieved trials of possible relevance and applied the inclusion criteria independently.
We graded trials for risk of bias using the Cochrane approach. The data extraction was performed in a standardised manner by one author and rechecked by the other author.
Where necessary we contacted investigators to obtain the missing information. Meta-analysis was neither possible nor considered appropriate because of the heterogeneity of the populations studied and the differences in steroid formulations, dosages and duration of treatment.
We analysed and reported the quality of the results of each study individually. A narrative overview of the results is presented.
The test should be done on an empty stomach, and after discontinuing Antivert, antihistamines and sedatives for two weeks these drugs may alter the results of the test. It may make the patient somewhat dizzy or nauseated. The test tells whether the inner ears are weak. ECOG : A test specific for distortion of the nerve-containing membranes of the inner ear, presumably due to pressure fluctuations of the perilymph.
It is most accurate when Meniere's is active. ABR : A test to see if there is anything that slows the transmission of sound impulses to the brain along the hearing nerve. MRI Scan : Brain scan that looks for abnormal masses or abnormal anatomy.
Please note tumors are rarely found but very important to rule out. How is it treated? In an acute attack, we use medications that dull the sensation of vertigo using: Antivert: 1 tablet every 8 hours or as needed.
Droperidol: drops under the tongue during severe attacks. If the patient has nausea or vomiting we can try antiemetics Compazine: 10 mg orally or rectal suppository for nausea use when too sick for pills. Phernagan: 25 mg orally or by rectal suppository Caution: Do not drive or operate heavy machinery while dizzy or taking above medication as they may impair your judgement and reflexes.
Medrol Dose pack: take as directed, 6 tabs day 1, 5 tabs day 2 until the pack is gone. Prednisone: 10 mg tablets in an as directed manner. Dexamethasone: 4 mg daily for 2 weeks, then. Steven Rauch of Harvard Medical School and the Massachusetts Eye and Ear Infirmary led a team of investigators from 16 medical centers nationwide in a clinical trial involving more than patients.
The results were published in the May 25, , issue of the Journal of the American Medical Association. The study tested the treatments as they are usually given in the clinic. For oral steroid therapy, patients received 60 milligrams of prednisone for 14 days, followed by a tapering-off period of 5 days. The other group was given 40 milligrams of methylprednisolone injected directly through the eardrum 4 times over the course of 2 weeks.
The study followed the recovery of these patients for 6 months, measuring the success of the treatments based on hearing tests at the first and second weeks, and months 2 and 6. The gradual decrease in the amount of steroids each day is called a "taper". The reason to do this is to allow the patient's adrenal glands, which are usually suppressed by the steroids, to gradually return to supplying steroids to the patient on their own.
Medrol is slightly stronger than prednsone, so to convert this into "prednisone", when using the 4 mg dose-pack, one just has to multiple by 5. In other words, the medrol dose pack is the equivalent of 30 mg of prednisone, tapering down to 0 over a week. For persons in whom a larger amount of steroids is indicated a longer protocol and more intense protocol is selected.
Longer pulses require longer tapers. Checking the blood pressure to make sure it is not dropping too low and follow up visits during the taper period are often required. Some patients are "steroid dependent".
For example, whenever the steroid dose is decreased below a threshold, hearing starts to deteriorate again. In patients like this, an attempt is made to find a steroid sparing replacement drug such as methotrexate or Enbrel , but in the meantime, the steroids are reduced to as low an amount as is practical.
Common examples of corticosteroids include: Prednisolone e. Sensorineural hearing loss new onset or sudden deterioration of pre-existing SNHL should be confirmed with an Audiogram prior to commencing CT. Therapeutic recommendations Corticosteroid Therapy is most beneficial the sooner it is started after symptoms onset.
For Sudden Sensorineural Hearing Loss, corticosteroid use should start ideally within 72 hours of deafness onset 1 , and can be offered within 2 weeks of symptom onset as a primary treatment. Salvage treatment, which is given to patients who did not receive or did not respond to primary treatment, is typically delivered weeks after the onset of symptoms.
Often it is given in three doses that are weeks apart. Initial administration route is systemic oral with topic therapy Trans-Tympanic used as salvage.
Timothy C. Steroids are commonly prescribed for sudden hearing loss as well as for autoimmune inner ear disease and vestibular neuritis.
The purpose of this page is to outline the usual methodology. We do not discuss their effectiveness or the validity of their indications. There is very little difference with respect to the ultimate results with these drugs and side effects, but they differ in potency and duration of action, and for this reason, the dose must be adjusted.
Oral decadron would seem to us to be a poor choice for a condition in which rapid effects are desirable such as acute hearing loss or vestibular neuritis, as due to it's long half life, it takes 20 days to reach steady state. Of course, one can adjust one's protocol to give more drug at the beginning, as is the case for the "medrol dose pack".
The most common method of administration is by mouth. We will not discuss intravenous administration faster and stronger, sometimes used for situations where symptoms are very severe such as bilateral deafness associated with autoimmune inner ear disease.
Administration through the ear-drum is discussed elsewhere. This method has the advantage of much less side effects, but the disadvantages of higher expense and the need for a subspecialty visit for injection through the ear drum. For the oral method, there are four common protocols that we use in our clinic :. The easiest, safest, and most convenient method of trying steroids is to use a medrol methylprednisolone dose pack.
This is a card that contains 6 days of steroids, with less provided each day. The gradual decrease in the amount of steroids each day is called a "taper". The reason to do this is to allow the patient's adrenal glands, which are usually suppressed by the steroids, to gradually return to supplying steroids to the patient on their own.
Medrol is slightly stronger than prednsone, so to convert this into "prednisone", when using the 4 mg dose-pack, one just has to multiple by 5. In other words, the medrol dose pack is the equivalent of 30 mg of prednisone, tapering down to 0 over a week. For persons in whom a larger amount of steroids is indicated a longer protocol and more intense protocol is selected.
Longer pulses require longer tapers. Checking the blood pressure to make sure it is not dropping too low and follow up visits during the taper period are often required. Some patients are "steroid dependent". For example, whenever the steroid dose is decreased below a threshold, hearing starts to deteriorate again.
In patients like this, an attempt is made to find a steroid sparing replacement drug such as methotrexate or Enbrelbut in the meantime, the steroids are reduced to as low an amount as is practical.
Steroids have many side effects, that are more common with longer administration. Common ones in the short run i. Problems that can occur after longer administration, besides the ones that may appear above, include.
The drugs that are most commonly used include: Drug Equivalent mg Half life Usual starting dose dexamethasone decadron 0. Deterioration or temporary induction of diabetes, high blood sugar Sleeplessness, mood swings Problems that can occur after longer administration, besides the ones that may appear above, include Weight gain with swelling in ankles and fat accumulation around center of body, moon face. Weakness in legs steroid myopathy Cataracts Increased risk of infections Suppression of adrenal glands, low blood pressure and other problems during taper.
Bruising, thin skin. Byl FM. Sprague MS. Lesion-induced plasticity in rat vestibular nucleus neurones dependent on glucocorticoid receptor activation. J Physiol ; Pt 1 Kitahara T. Kondoh K. Morihana T. Neurol Res ;25 3 Ohbayashi S. Oda M. Yamamoto M. Recovery of the vestibular function after vestibular neuronitis.
Acta Otolaryngol. Corticosteroids effect on vestibular neuritis symptom relief. Issa A. Golz A. Prednisone treatment for vestibular neuritis. Otol Neurotol. Zingler VC. Arbusow V. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med.
It often arises without an obvious cause and occurs in one ear all at once or over a period of up to 3 days. Oral steroids, such as prednisone. The glucocorticoids, prednisolone and dexamethasone, were the most effective in our study in reducing middle ear inflammation in response to bacterial challenge. of ear fullness and dizziness. In many instances medical specialists are able to find the cause and treat the hearing impairment. The tube function to equalize the pressure between the ear and the surrounding Topical nasal steroids (fluticasone, plus many others) and oral. This tube is important for pressure equalization into the middle ear. Allergy treatment (link to allergy page); Decongestants; Nasal steroids. The study tested the treatments as they are usually given in the clinic. Search Health Topics. Steroids for the treatment of sudden hearing loss with unknown cause A sudden onset of hearing loss due to disease of the hearing organs is a medical emergency and requires prompt recognition and treatment. We considered trials including the use of steroids in combination with another treatment if the comparison control group also received the same other treatment. Have a question? However, due to side-effects, we do not use it long term.Meniere's syndrome and endolymphatic hydrops both refer to a condition of excess pressure accumulation in the inner ear. Symptoms include:. E-Medicine article on Medical Treatment. E-Medicine article on Surgical Treatment.
There are two fluids that fill the chambers of the inner ear. Too much pressure from these fluids will stretch these nerve-filled membranes and may cause hearing disturbance, ringing in the ears, vertigo, imbalance and a pressure sensation in the ear. Inner ear inflammation or infections: Autoimmune disease, Lupus, Rheumatoid dz , Syphilis, Allergy, High Cholesterol or Triglyceride in the blood stream, Thyroid hormone disease Diabetes. Dietary Management - i. We usually start with a dietary protocol which involves reduction of: Salt, caffeine, chocolate, red wine and refined sugars, artificial or otherwise.
Next, we will move onto medications. In an acute attack, we use medications that dull the sensation of vertigo using:. If the patient has nausea or vomiting we can try antiemetics. Caution: Do not drive or operate heavy machinery while dizzy or taking above medication as they may impair your judgement and reflexes.
Prevention of attacks may be achieved by reducing inner ear pressure. This can sometimes be done using diuretics, aka "water pills". Caution: Do not take Dyazide or other water pills if you have low blood pressure or are already taking antihypertensive medication.
If in doubt, ask your family physician. Steroids can be used to reduce inner ear inflammation and settle down hydrops in acute situations. It can be dramatically effective for the immediate problem. However, due to side-effects, we do not use it long term. Caution: Steroids can have, but are not limited to the following side effects: GI upset, gastritis, ulcers take with meals insomnia and irritability and mood changes.
Prolonged use may cause weight gain, rounded face, body changes, adrenal suppression and possible hip problems. Vestibular Rehabilitation balance retraining is important for many reasons. Improved preparedness for impending attacks. Improved tolerances of attacks Overcoming damage to the inner ear system after attacks. Electrical Stimulation for Meniere's. A certain subset of tinnitus patients have Meniere's syndrome.
These patients, in an on going study done by Dr. Li, have shown some success in reducing: Tinnitus, Aural fullness, and Vertigo with interesting improvement rates! Meniett Device : Use of this device requires a tube to be placed in the ear drum. The device pumps air into the middle ear to and fro in a specific "micropressure" pulse pattern. Somehow, in some patients, this serves to reduce or eliminate symptoms of Meniere's disease. Patients use it for a few minutes each day.
Unfortunately we have not been overwhelmed by the results. All Rights Reserved. Symptoms include: Fluctuating hearing loss hearing that is good sometimes and bad sometimes Occasional vertigo usually a spinning sensation, sometimes violent Tinnitus or ringing in the ears usually low tone roaring Aural fullness pressure sensation in the ears See E-Medicine Chapters on Meniere's written by Dr.
What is Happening? How is it diagnosed? The following tests may be required. Hearing test : to document the patient's present hearing acuity and subsequent fluctuations. Sometimes the patient does not notice a loss in the high frequencies. Allergy testing: This is usually done by blood test initially, and the confirmed by skin testing. ENG : Test of the inner ear functions - particularly the semicircular canals.
The ENG measures their response to warm and cold water. The test should be done on an empty stomach, and after discontinuing Antivert, antihistamines and sedatives for two weeks these drugs may alter the results of the test.
It may make the patient somewhat dizzy or nauseated. The test tells whether the inner ears are weak. ECOG : A test specific for distortion of the nerve-containing membranes of the inner ear, presumably due to pressure fluctuations of the perilymph.
It is most accurate when Meniere's is active. ABR : A test to see if there is anything that slows the transmission of sound impulses to the brain along the hearing nerve. MRI Scan : Brain scan that looks for abnormal masses or abnormal anatomy.
Please note tumors are rarely found but very important to rule out. How is it treated? In an acute attack, we use medications that dull the sensation of vertigo using: Antivert: 1 tablet every 8 hours or as needed.
Droperidol: drops under the tongue during severe attacks. If the patient has nausea or vomiting we can try antiemetics Compazine: 10 mg orally or rectal suppository for nausea use when too sick for pills. Phernagan: 25 mg orally or by rectal suppository Caution: Do not drive or operate heavy machinery while dizzy or taking above medication as they may impair your judgement and reflexes.
Medrol Dose pack: take as directed, 6 tabs day 1, 5 tabs day 2 until the pack is gone. Prednisone: 10 mg tablets in an as directed manner. Dexamethasone: 4 mg daily for 2 weeks, then. Dexamethasone Perfusion : It would seem to make sense that if oral steroids work, they may work even better through the inner ear. This is done via the same method as Streptomycin Perfusion but using steroids instead.
Streptomycin Perfusion: An antibiotic that specifically affects the balance nerve is placed through a small puncture in the eardrum. A small amount is also given intravenously. Endolymphatic Sac Decompression : Decreases the pressure build up of the endolymph by removing bone that encases the endolymph reservoir sac. This allows the sac to expand more freely and allows the pressure to dissipate. It is a relatively low risk procedure that can preserve hearing. Vestibular Nerve Section : For patients with useful hearing in both ears, cutting the diseased balance nerve can often cure the symptoms.
The surgery involves both an otologist and a neurosurgeon and is more complex than the endolymphatic sac decompression. It involves removal of the diseased inner ear organs but does not require entry into the cranial cavity and is thus less complex than the vestibular nerve section.
Other Options Fluctuating hearing loss hearing that is good sometimes and bad sometimes. Occasional vertigo usually a spinning sensation, sometimes violent. Tinnitus or ringing in the ears usually low tone roaring. Aural fullness pressure sensation in the ears. Type of employment - Roofer vs.
Antivert: 1 tablet every 8 hours or as needed. Compazine: 10 mg orally or rectal suppository for nausea use when too sick for pills.
Phernagan: 25 mg orally or by rectal suppository. Neptazane: reduces fluid pressure in the CSF give as mg 3 times a day. Transtympanic Medications : See linked page.
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