BALTIMORE--The established treatment for sudden hearing loss has long been a course of oral steroids. However, a study headed by researchers from Johns Hopkins University and reported in the May 25 Journal of the American Medical Association (JAMA) suggests that steroid injections may be equally effective (or ineffective) in restoring hearing in patients who experience this mysterious and traumatic condition.
In the alternative treatment, steroids are delivered via a series of injections through the eardrum and into the middle ear. The theory is that this method can deliver a heavier dose of steroids directly to the source of the problem.
Researchers tested the two therapies at 16 academic medical centers across the United States. The subjects were 250 patients who had all suffered 50-dB or greater hearing loss in one of their ears. They were randomly assigned to receive either a two-week course of oral steroids or four steroid injections spaced over two weeks.
When the patients were tested two months after the treatment, those who had received the traditional oral steroid treatment had a mean improvement of 30.7 dB in the affected ear. Those who had been given injections had a mean improvement of 28.7 dB. While the results of the treatments were comparable for most patients, those with the most severe hearing loss (greater than 90 dB) had significantly better results with oral steroids.
Both treatments have advantages and disadvantages. Oral treatment is less expensive and can be done at home. However, the steroids can cause insomnia, weight gain, and increased blood sugar. Injections don’t have those side effects, but they cost more, can be painful, and are given in a medical office.
The cause of sudden dramatic loss in hearing is usually unknown. The condition, which affects about 20,000 Americans a year, typically occurs in one ear in less than 72 hours. In about a third of cases, the person regains some hearing without treatment. But most suffer permanent loss. Treatment, which should be given as soon as possible after the condition occurs, usually restores some of the lost hearing. However, for most patients, there is no complete cure.
