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Corticosteroid (systemic — SSNHL treatment) Pregnancy: Use with caution in pregnancy. Lowest effective dose for shortest duration.

Prednisolone (Sudden Sensorineural Hearing Loss)

Brand names: Prednisolone

Adult dose

Dose: 1 mg/kg/day (max 60 mg/day) for 10–14 days, then taper
Route: Oral
Frequency: Once daily (morning)
Max: 60 mg/day
Sudden Sensorineural Hearing Loss (SSNHL): 60 mg/day (or 1 mg/kg/day) for 10–14 days, taper over following 5–7 days. Start within 2 weeks of onset for best outcome. Intratympanic steroid injection (dexamethasone 4–24 mg/mL) may be used if oral contraindicated or as salvage. ENT/audiology urgent referral.

Paediatric dose

Dose: 1 mg/kg
Route: Oral
Frequency: Once daily
Max: 40 mg/day
Children (paediatric ENT specialist): 1 mg/kg/day (max 40 mg/day) for 10–14 days. SSNHL in children is rare and warrants urgent specialist assessment.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Use with caution; reduced conversion to active form in severe liver disease.

Paediatric weight-based calculator

Children (paediatric ENT specialist): 1 mg/kg/day (max 40 mg/day) for 10–14 days. SSNHL in children is rare and warrants urgent specialist assessment.

Clinical pearls

  • Time-critical: start within 2 weeks for best hearing recovery outcome
  • ~50–80% spontaneous recovery rate — steroids improve outcomes further
  • Intratympanic dexamethasone: rescue option if oral steroid fails or contraindicated
  • Exclude glomus tumour, acoustic neuroma, viral labyrinthitis urgently
  • Cover with PPI during short steroid course

Contraindications

  • Systemic infection (without antimicrobial cover)
  • Peptic ulceration (relative — use PPI)
  • Uncontrolled diabetes (relative)

Side effects

  • Hyperglycaemia
  • Insomnia
  • Mood changes
  • GI upset
  • Fluid retention
  • HPA axis suppression (prolonged use)

Interactions

  • NSAIDs — increased GI bleeding risk
  • Antidiabetics — antagonised glucose-lowering

Monitoring

  • Audiometry (pure tone audiogram at baseline and after treatment)
  • Blood glucose
  • Blood pressure

Reference: BNFc; BNF; NICE CG138; AAO-HNS SSNHL Clinical Practice Guideline. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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