Corticosteroid Therapy for Hearing and Balance Disorders

Abstract

This review addresses the current status of steroid therapies for hearing and vestibular disorders and how certain misconceptions may be undermining the efficacy in restoring normal ear function, both experimentally and clinically. Specific misconceptions addressed are that steroid therapy is not effective, steroid-responsive hearing loss proves an underlying inflammatory problem in the ear, and steroids only have application to the hearing disorders listed below. Glucocorticoid therapy for hearing and balance disorders has been employed for over 60 years. It is recommended in cases of sudden hearing loss, Meniére’s disease, immune-mediated hearing loss, and any vestibular dysfunction suspected of having an inflammatory etiology. The predominant steroids employed today are dexamethasone, prednisone, prednisolone, and methyl-prednisolone. In spite of years of use, little is known of the steroid responsive mechanisms in the ear that are influenced by glucocorticoid therapy. Furthermore, meta-analyses and clinical study reviews occasionally question whether steroids offer any benefit at all. Foremost in the minds of clinicians is the immune suppression and antiinflammatory functions of steroids because of their efficacy for autoimmune hearing loss. However, glucocorticoids have a strong binding affinity for the mineralocorticoid (aldosterone) and glucocorticoid receptors, both of which are prominent in the ear. Because the auditory and vestibular end organs require tightly regulated endolymph and perilymph fluids, this ion homeostasis role of the mineralocorticoid receptor cannot be overlooked in both normal and pathologic functions of the ear. The function of the glucocorticoid receptor is to provide anti-inflammatory and anti-apoptotic signals by mediating survival factors.

A single dose of dexamethasone encapsulated in polyethylene glycol-coated polylactic acid nanoparticles attenuates cisplatin-induced hearing loss following round window membrane administration

“…7 To date, the results obtained for the intratympanic delivery of glucocorticoids varied, highly depending on the dose, frequency, intensity of the cisplatin injection, and the animal models used in the experiments. 18 In addition, frequent daily drug administration is required considering the loss of the drug down the Eustachian tube. The high frequency and high dose administration of intratympanic drugs would not only increase the cost of therapy, but also increase the incidence of tympanic membrane perforations 19 and cause undesired infection during the procedure.…”

Symptomatic sensorineural hearing loss in patients with ulcerative colitis

“…The hearing level in affected patients is unstable, with periods of exacerbation alternating with periods of partial or complete remission [12]. To date, the treatment of autoimmune ear disease relies mainly on steroids and, more recently, on the use of biological agents [21,22].…”

A Comparison of Two Vasoactive/Vasodilative Agents in Combination with Corticosteroid for Treatment of Sudden Sensorineural Hearing Loss

“…Standard treatment of ISSNHL usually involves steroids, although the results of efficacy are opposing [10] . Different ways of application of steroids are under investigation, with some promising results of intratympanic application of steroids, especially as addition to systemic steroid therapy [24,25] . Treatment delay time was found to be statistically significant (p=0.050).…”