Steroids in sudden sensorineural hearing loss
Date First Published:
September 9, 2000
Last Updated:
July 20, 2005
Report by:
Angaj Ghosh, Registrar in Emergency Medicine (Manchester Royal Infirmary)
Search checked by:
Rupert Jackson, Manchester Royal Infirmary
Three-Part Question:
In [an adult with sudden idiopathic hearing loss] is [early steroid therapy better than no steroids] at improving [time to recovery and outcome]?
Clinical Scenario:
A 35 year old man presents to the emergency department with an 18 hour history of a right sided sudden hearing loss. Examination does not reveal a cause. A diagnosis of idiopathic sensorineural deafness is made. Your consultant suggests that a course of prednisolone might be of benefit. You discuss this with the registrar in audiological medicine who does not support this approach. You wonder who is right.
Search Strategy:
Medline OVID 1966-June week 4 2005.
Embase OVID 1980- 2005 week 27
Cochrane Library Issue 2 2005.
Embase OVID 1980- 2005 week 27
Cochrane Library Issue 2 2005.
Search Details:
Medline: [{exp hearing loss, sudden/ OR sudden$ adj deaf$.mp. OR sudden adj hearing adj loss.mp.}] AND [{exp steroids/ OR steroid$.mp. OR exp glucosteroids/ OR glucosteroid$.mp. OR corticosteroid$.mp }]. LIMIT to human, English language and all adult.
Embase: [{exp sudden deafness/ OR sudden$ adj deaf$.mp. OR sudden adj hearing adj loss.mp] AND [{exp steroid/ OR steroid$.mp OR exp glucocortcoide/ OR glucosteroid$.mp. OR exp corticosteroid/ OR corticosteroid$.mp.}] LIMIT to human, English language and adult <18 to 64 years> or aged <65+ years>)
Cochrane: Steroids [MeSH all fields] AND hearing loss, sudden [Mesh all fields]
Embase: [{exp sudden deafness/ OR sudden$ adj deaf$.mp. OR sudden adj hearing adj loss.mp] AND [{exp steroid/ OR steroid$.mp OR exp glucocortcoide/ OR glucosteroid$.mp. OR exp corticosteroid/ OR corticosteroid$.mp.}] LIMIT to human, English language and adult <18 to 64 years> or aged <65+ years>)
Cochrane: Steroids [MeSH all fields] AND hearing loss, sudden [Mesh all fields]
Outcome:
175 unique papers were found papers were found of which 5 directly answered the question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double blind clinical study. Wilson WR, Byl FM, Laird N. 1980, USA | Patients attending within 10 days of a 30 decibel sudden sensorineural hearing loss in at least 3 contiguous frequencies for whom no cause could be found. | Prospective double-blind trial, combining the results from two centres | Recovery of 50% of the original hearing loss | 20/33 (61%) in steroid group and 11/34 (32%) in placebo group: significant 0.01<p<.025 | Not randomised Poor design Not analysed with intention to treat Short follow-up Different steroids used |
| Steroid use in idiopathic sudden sensorineural hearing loss. Moskowitz D, Lee KJ, Smith HW. 1984, USA | Patients attending a private ENT clinic over a 10 year period with idiopathic sensorineural hearing loss (n=36) | Prospective cohort | Recovery of 50% of the original hearing loss | 24/27 (89%) with steroids and 4/9 (44%) without: statistically significant 0.005<p<0.01 | Not randomised No power study Sample size not calculated Not blinded Small numbers |
| Steroids, carboden or placebo for sudden hearing loss: a prospective double-blind study. Cinamon U, bendet E, Kronenberg J. 2001, Israel | 41 patients with unilateral sensorineural hearing loss. Randomised to prednisoloneo placebo tablets, carbogen inhalation or room air |
PRCT | Early audiometric outcome | No difference | |
| Late audiometric outcome | No difference | ||||
| Is corticosteroid therapy effective for sudden-onset sensorineural hearing loss al lower frequencies. Kitajiri S, Tabuchi K, Hiraumi H et al. 2002, Japan | 78 patients with sudden sensiorineural hearing loss. Normal therapy vs normal therapy plus steroids |
Controlled trial | Recovery rate | 81% vs 79% | Non randomised before and after design |
| Time from start of therapy to improvement | 3.9 days vs 3.7 days | ||||
| Oral steroid treatment of sudden onset sensorineural hearing loss: a ten tear retrospective analysis. Chen CY, Halpin C, Rauch SD. 2003, Taiwan | 318 patients presenting with sudden unilateral sensorineural hearing loss over ten years Steroid therapy vs none (patients who refused) |
Observational study | Recovery of hearing (pure tone average) in severe cases | Better in those on steroids | Non randomised study describing outcomes in a centre committed to steroid therapy |
| Recovery of hearing (pure tone average) in milder cases | No difference |
Author Commentary:
Idiopathic sudden sensorineural hearing loss has a high (50-70%) spontaneous partial or complete recovery rate. Therefore for a given treatment to be considered effective a very high success rate must be demonstrated. The studies shown are all small and offer no convincing evidence of recovery rates above those expected.
Bottom Line:
Current evidence does not support the early use of high dose steroids in idiopathic sensorineural hearing loss.
References:
- Wilson WR, Byl FM, Laird N.. The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double blind clinical study.
- Moskowitz D, Lee KJ, Smith HW.. Steroid use in idiopathic sudden sensorineural hearing loss.
- Cinamon U, bendet E, Kronenberg J.. Steroids, carboden or placebo for sudden hearing loss: a prospective double-blind study.
- Kitajiri S, Tabuchi K, Hiraumi H et al.. Is corticosteroid therapy effective for sudden-onset sensorineural hearing loss al lower frequencies.
- Chen CY, Halpin C, Rauch SD.. Oral steroid treatment of sudden onset sensorineural hearing loss: a ten tear retrospective analysis.