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Steroids in sudden sensorineural hearing loss
  1. Angaj Ghosh, Registrar,
  2. Rupert Jackson, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A shortcut review was carried out to establish whether steroids are of benefit in sudden onset sensorineural deafness. Altogether 175 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated (table 4). It is concluded that there is insufficient good evidence to recommend early steroid treatment in this condition.

    • deafness
    • hearing loss
    • sensorineural
    • steroids

    Statistics from Altmetric.com

    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.

    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]?

    Search strategy

    Medline OVID 1966 to week 4 June 2005. [{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 OVID 1980 to week 27 2005. [{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 Library Issue 2 2005. Steroids [MeSH all fields] AND hearing loss, sudden [Mesh all fields]

    Search outcome

    Altogether 175 unique papers were found of which five directly answered the question.

    Comments

    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.

    CLINICAL BOTTOM LINE

    Current evidence does not support the early use of high dose steroids in idiopathic sensorineural hearing loss.

    Table 4

    References

    View Abstract

    Footnotes

    • Report by Angaj Ghosh, RegistrarSearch checked by Rupert Jackson, Consultant

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