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High-Dose Glucocorticoids No Better Than Low-Dose for Sudden Hearing Loss

Medically reviewed by Carmen Pope, BPharm. Last updated on Jan 10, 2024.

By Elana Gotkine HealthDay Reporter

WEDNESDAY, Jan. 10, 2024 -- For patients with idiopathic sudden sensorineural hearing loss (ISSNHL), systemic high-dose glucocorticoid therapy is no better than a lower-dose regimen, according to a study published online Dec. 26 in NEJM Evidence.

Stefan K. Plontke, M.D., from the University Medicine Halle in Germany, and colleagues randomly assigned 325 patients with sudden hearing loss of ≥50 dB within seven days of onset to five days of high-dose intravenous prednisolone at 250 mg/day (HD-Pred), high-dose oral dexamethasone (40 mg/d [HD-Dex]), or oral prednisolone (60 mg/day [Pred-Control]) followed by five days of tapering doses.

The researchers found the mean change in the difference in hearing threshold for the three most affected contiguous frequencies from baseline to 30 days was 34.2, 41.4, and 41.0 dB in the HD-Pred, HD-Dex, and Pred-Control groups, respectively. More adverse events related to trial medication were seen in the HD-Pred and HD-Dex than the Pred-Control groups (73 and 76, respectively, versus 46).

"Therapy with systemic high-dose glucocorticoids did not show benefits for patients with sudden sensorineural hearing loss compared with standard lower doses of glucocorticoids but increased the risk of side effects," the authors write. "Further trials are needed to compare glucocorticoid therapy with placebo or -- if this is not feasible -- with further dose de-escalation."

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Posted January 2024

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