Prednisolone (Sudden Sensorineural Hearing Loss)

How it works

As a systemic glucocorticoid, prednisolone is thought to reduce inflammation and oedema within the cochlea and to modulate immune-mediated cochlear injury, supporting recovery of sensorineural function.

Prescribing in practice

• SSNHL is a medical emergency where outcome depends on prompt treatment, so start the steroid course as early as possible after excluding other causes and audiometric confirmation.
• Weigh the short high-dose course against systemic risks — hyperglycaemia (close monitoring in diabetes), mood disturbance, gastric irritation and blood pressure rise — and taper rather than stop abruptly.
• Intratympanic steroid administration is an alternative or adjunct, particularly where systemic steroids are contraindicated or recovery is incomplete.

Monitoring

Monitor capillary glucose (especially in diabetes), blood pressure and mood during the course, and reassess hearing with audiometry to gauge recovery and the need for salvage intratympanic therapy.

Counselling the patient

• Start the tablets as soon as possible, as early treatment gives the best chance of hearing recovery.
• Take them with food, watch for raised blood sugar if you are diabetic, and do not stop the course abruptly.
• Attend your follow-up hearing test and report mood changes or stomach pain.

Evidence & guidelines

Oral corticosteroids are the established first-line treatment for idiopathic SSNHL in UK ENT practice, with intratympanic steroids supported as salvage therapy.