11
Table 6. General Guidelines for Corticosteroid Therapy for
SSNHL
a
Systemic Corticosteroids Intratympanic Corticosteroids
Timing of
Treatment
Immediate, ideally within
first 14 days. Benefit has been
reported up to six weeks post
onset of SSNHL.
1. Immediate
2. Salvage (rescue) aer initial
treatment fails or aer 2 weeks
from symptom onset
Dose Prednisone 1 mg/kg/day (usual
maximal dose is 60 mg/day)
or
Methylprednisolone 48 mg/day
or
Dexamethasone 10 mg/day
Dexamethasone
24 mg/mL (compounded), or
10 mg/mL (stock) if compounded
concentration unavailable
or
Methylprednisolone
40 mg/mL or 30 mg/mL
Duration /
Frequency
Full dose for seven to 14 days,
then taper over similar time
period.
Inject 0.4 to 0.8 mL into middle ear
space up to four injections over a
two-week period
Technique Do not divide doses. 1. Fill the middle ear with steroid
solution
2. Keep head in otologic position
(one side down, affected ear up)
for 15–30 minutes
Monitoring Audiogram at completion
of treatment course and at
delayed intervals.
Audiogram at completion of
treatment course and at delayed
intervals. Interval audiograms
between injections may help direct
early termination of therapy if
hearing loss resolves.
Inspect tympanic membrane to
ensure healing at completion of
treatment course, and at a delayed
interval.
Modifications Medically treat significant
adverse drug reactions, such as
insomnia.
Monitor for hyperglycemia,
hypertension in susceptible
patients.
May insert pressure-equalizing tube
if planning multiple injections,
but this increases risk of tympanic
membrane perforation.
a
is table is designed to provide guidance for systemic and intratympanic steroid treatment for
SSNHL and is based on the literature as well as expert input from the members of the GUG.
Treatment is routinely individualized by provider and per patient. e most important principles
pertain to early institution of high enough dosages of treatment.
Treatment
