Roid Rage: Historical Perspective on the Emergence of Oral Steroids as a Treatment of Idiopathic Sudden Sensorineural Hearing Loss

Abstract

ObjectivesTo review the historical circumstances that led to the emergence of corticosteroid therapy for idiopathic sudden sensorineural hearing loss (ISSNHL) and to discuss how this history has influenced current perspectives on the condition.MethodsPubMed and Google scholar were used to identify articles of ISSNHL and oral corticoid steroid use. Historical articles accessed through our institutional medical library were also reviewed.ResultsThe use oral corticosteroids as a treatment for ISSNHL was seemingly influenced by three key historical circumstances that, together, provided the substrate for the treatment’s use in ISSNHL. First, ISSNHL was a frustrating condition with uncertainty regarding its etiology and few reliable treatment options. Second, the discovery of corticosteroids was awarded the Nobel Prize in 1950, which led to widespread application of this therapy. Third historical circumstance was the evolution and emergence of more rigorous methodological study designs in clinical research. In 1980, these events culminated in a double-blind study evaluating the effectiveness of oral steroids for treatment of ISSNHL. Interestingly, this study is often misrepresented as a randomized controlled trial, which ultimately contributed to adoption of a new standard for treatment in ISSNHL. Research subsequent to these historical events has challenged the notion of corticosteroids as a gold standard but has not altered the historically established paradigm of corticosteroid treatment.ConclusionsThe use of steroids as a treatment for ISSNHL evolved from our specialty’s need to address a complex condition, a novel therapeutic discovery, and a landmark study that met emerging methodological standards. Despite these strong historical foundations, ISSNHL remains a condition with an unknown etiology and the therapeutic value of corticosteroids remains unpredictable despite their gold standard label.

Bilateral Sudden Sensorineural Hearing Loss

“…Historically, the management includes the use of steroids as standard therapy, which can be administered orally, intravenously, or via Intratympanic Injections. However, the therapeutic value of corticosteroids remains unpredictable [28].…”

Is Corticosteroid Treatment Beneficial in Sudden Sensorineural Hearing Loss? A Large Retrospective Study

“…This treatment gained validity in a randomized double-blind placebo control study by Wilson et al in 1980, in which 61% of patients treated with OCSs experienced a significant improvement in hearing, compared to only 32% of patients in the placebo group [14]. However, this study had several biases, which raised many questions and doubts about its conclusions and implications [15,16].…”