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School of Medicine
HeadWay - Treating Sudden Hearing Loss Without Side Effects
HeadWay Winter 2014
Treating Sudden Hearing Loss Without Side Effects
Date: December 2, 2013
John Carey and his colleagues recently showed that injectable steroids are as effective as oral steroids in treating most cases of sudden hearing loss.
Decreased hearing in one ear over the course of 72 hours or less is relatively rare. But for the one in 20,000 individuals who experiences this sudden hearing loss each year, it can be a terrifying experience.
“A lot of people just wake up with it,” says John Carey, new director of the Division of Otology, Neurotology and Skull Base Surgery. “They roll over in bed and realize that they suddenly can’t hear on one side.”
About a third of patients recover spontaneously, many before they even see a doctor. For others, multiple trials have suggested that treating with a course of steroids improves the chance of recovery by as much as 70 percent. However, oral steroids—the tried and true method for treating sudden hearing loss—come with a host of undesirable side effects, including wakefulness and elevated blood pressure and blood sugar.
Seeking a better treatment without these side effects, Carey and his colleagues at Johns Hopkins and elsewhere have long offered some patients the option of steroids injected into the middle ear. From there, the drugs diffuse through the round window membrane, entering the inner ear at concentrations over 1,000 times higher than would reach this area with oral steroids, potentially maximizing results without inducing as many off-target effects.
However, even though this treatment modality has become standard at Johns Hopkins and other medical centers, researchers had never put it to the test by directly comparing outcomes with oral steroids. A recent national study, with Carey leading the work at Johns Hopkins, assigned 255 patients with sudden hearing loss to receive either oral or middle ear injection of steroids over two weeks. Their findings suggest that the two treatments have comparable outcomes, at least for patients with hearing loss less than 90 decibels. For those with very severe loss, 90 decibels or above, oral steroids proved to be a better treatment. The study, published in the Journal of the American Medical Association in 2011, is one of the largest and most comprehensive on sudden hearing loss, and the largest number of patients were enrolled at Johns Hopkins.
“We’re showing that in most cases, injected steroids are as effective as oral steroids,” Carey says. “It’s given us confidence that the treatment we’d been offering is an appropriate one.”
Carey notes that the injected drug used in the study, methylprednisone, can be painful. However, he and his colleagues believe that other steroids, such as dexamethasone, will deliver the same benefits without as much discomfort.
For any of these therapies to have maximum benefit, he adds, patients need to receive treatment quickly after hearing loss onset. “Multiple studies suggest that the sooner you treat with steroids,” Carey says, “the likelier you are to get hearing recovery.” The call center at Johns Hopkins has a protocol to place patients under the care of an otologist for treatment within a week at several different locations, including The Johns Hopkins Hospital, Green Spring Station and Suburban Hospital. For patients whose hearing doesn’t return after steroids, Carey and other Johns Hopkins otologists offer other treatments to functionally restore hearing, including bone-anchored hearing aids.
“We have several different tools,” Carey says, “to help patients regain what they’ve lost.”
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