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Steroids in sudden sensorineural hearing loss

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.
Medline: [{exp hearing loss, sudden/ OR sudden$ adj deaf$.mp. OR sudden adj hearing adj}] AND [{exp steroids/ OR steroid$.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$.mp. OR sudden adj hearing adj] AND [{exp steroid/ OR steroid$.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]

Search Outcome

175 unique papers were found papers were found of which 5 directly answered the question.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Wilson WR and Byl FM,
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 centresRecovery of 50% of the original hearing loss20/33 (61%) in steroid group and 11/34 (32%) in placebo group: significant 0.01Not randomised Poor design Not analysed with intention to treat Short follow-up Different steroids used
Moskowitz D et al,
Patients attending a private ENT clinic over a 10 year period with idiopathic sensorineural hearing loss (n=36)Prospective cohortRecovery of 50% of the original hearing loss24/27 (89%) with steroids and 4/9 (44%) without: statistically significant 0.005Not randomised No power study Sample size not calculated Not blinded Small numbers
Cinamon U et al,
41 patients with unilateral sensorineural hearing loss. Randomised to prednisoloneo placebo tablets, carbogen inhalation or room airPRCTEarly audiometric outcomeNo difference
Late audiometric outcomeNo difference
Kitajiri S et al,
78 patients with sudden sensiorineural hearing loss. Normal therapy vs normal therapy plus steroidsControlled trialRecovery rate81% vs 79%Non randomised before and after design
Time from start of therapy to improvement3.9 days vs 3.7 days
Chen CY et al,
318 patients presenting with sudden unilateral sensorineural hearing loss over ten years Steroid therapy vs none (patients who refused)Observational studyRecovery of hearing (pure tone average) in severe casesBetter in those on steroidsNon randomised study describing outcomes in a centre committed to steroid therapy
Recovery of hearing (pure tone average) in milder casesNo difference


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.


  1. Wilson WR, Byl FM, Laird N. The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double blind clinical study. Arch Otolaryngol 1980:106(12);772-776.
  2. Moskowitz D, Lee KJ, Smith HW. Steroid use in idiopathic sudden sensorineural hearing loss. Laryngoscope 1984:94(5Pt1);664-6.
  3. Cinamon U, bendet E, Kronenberg J. Steroids, carboden or placebo for sudden hearing loss: a prospective double-blind study. European Arch Oto-Rhino-Laryngol 2001;258:477-80.
  4. Kitajiri S, Tabuchi K, Hiraumi H et al. Is corticosteroid therapy effective for sudden-onset sensorineural hearing loss al lower frequencies. Arch Otolaryngol Head Neck Surg 2002;128:365-7.
  5. Chen CY, Halpin C, Rauch SD. Oral steroid treatment of sudden onset sensorineural hearing loss: a ten tear retrospective analysis. Otology and Neurotology 2003;24:728-33.