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June 6, 2011
Steroid Treatments Equally Effective Against Sudden Deafness
Injecting steroids into the middle ear works just as well as taking them orally when it comes to restoring hearing for sudden deafness patients. This finding, the result of a large clinical trial comparing the therapies, will help doctors choose the best treatment for patients with this condition.
Sudden deafness, also called sudden sensorineural hearing loss, is an emergency medical condition that affects several thousand people annually, usually between the ages of 40 and 60. 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, are usually prescribed over the course of 2 weeks to restore hearing. There is only a 2- to 4-week window of time for treatment before hearing loss becomes permanent.
Recently, doctors have started injecting steroids directly into the middle ear — a procedure called intratympanic treatment. This technique is thought to deliver more of the drug to the ear and to avoid some of the side effects that can come along with oral steroids. The side effects of oral therapy can be mild, like weight gain, mood changes and sleep disruption, or more serious, like high blood pressure and elevated blood sugar. Side effects of injected steroids are usually local, such as ear infection and vertigo. However, up until now, no study had compared the 2 treatments to see whether direct injection worked as well as oral steroids.
To investigate, Dr. 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 250 patients. The trial was funded by NIH’s National Institute on Deafness and Other Communication Disorders (NIDCD).The results were published in the May 25, 2011, 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.
Under both regimens, patients recovered their hearing to about the same extent at 2 and 6 months. The oral steroid patients experienced typical symptoms, such as sleep, mood and appetite changes. The injected steroid patients had pain at the injection site and vertigo; a few had ear infections and a perforated eardrum. Most symptoms cleared up by 6 months. Nevertheless, the difference showed that while the treatments were equally effective, they might not be equally appropriate for every patient.
“The comfort, cost and convenience of oral steroid treatment are preferable to intratympanic treatment,” says Dr. Rauch, “but injected steroids are an equally effective alternative for people who, for medical reasons, can’t take the oral steroids. People with sudden deafness should discuss the risks and benefits of both treatments with their doctor.”