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What Causes Hearing Loss And Balance Issues While Prednisone?

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Posted on Fri, 1 Jul 2016
Question: 3 was ago I woke up and had no hearing in right ear - 9 days later I took 60mg prednisone for 7 days MRI was clear but I'm having a balancing issue whic actually started the day before I started on steroids - what do you suggest? I do not like this feeling
doctor
Answered by Dr. Sumit Bhatti (7 hours later)
Brief Answer:
Labyrinthitis or ISSNHL.

Detailed Answer:
Hi,

Thank you for your query.

1. This is either Labyrinthitis or ISSNHL (Idiopathic Sudden SendsoriNeural Hearing Loss). Either way, this requires urgent treatment. If your PTA (Pure Tone Audiogram) shows more than 20-30 dB hearing loss in three contiguous frequencies then it is defined as Sudden Sensori-Neural Hearing Loss (SSNHL). SSNHL is a medical emergency. In your case it may have been Labyrinthitis since you also had vertigo.

2. Your treatment is on the right track. However, you may consider the regimen mentioned below. It is good to hear that your MRI is normal. Other blood tests include:
a. Coagulogram
b. Homocysteine levels
c. VDRL
d. RF (Rheumatoid Factor), Auto-immune panel
e. HIV, Hepatitis panel
f. Lipid Profile (high triglycerides).

3. In the first 4-6 weeks of a SSNHL, there is a good possibility of recovery with aggressive treatment with intravenous steroids, anti-virals, blood thinners, vasodilators, neuroprotective drugs, anti-oxidants, multi-vitamins and carbogen therapy. Up to 3 months there may be excellent results with trans-tympanic steroid injections and with Hyper Baric Oxygen Therapy (HBOT).
(Assuming that you do not have diabetes):
a. IV Methylprednisolone (steroid): 1 gm/day x 3-5 days, then oral 1 mg/kg/day x 4 weeks, (tapered) followed by 6 bi-weekly steroid ear injections (dexamethasone).
b. Acyclovir 800 mg 5 x / day (anti-viral)
c. IV Lomodex 12 hrly (blood thinning agent)
d. Tab Trental (Pentoxyfyiline) 400 mg OD (rheologic or blood flow improvement)
e. Tab Nootropil (Piracteam) 400 mg OD (neural tonic)
f. Cap Palsinuron (empirical ayurvedic)
g. Tab Omeprazole (anti acidity & reflux)
h. Carbogen (vasodialtor)
i. Hyperbaric Oxygen Therapy (HBOT), if available.
j. IV antibiotics if labyrinthitis is suspected.
k. Tinnitus may be treated later with (Tinnex) Caroverine Injection and Capsules.

4. Spontaneous recovery occurs in 65% cases within 20dB or greater than 50% of total loss.If the hearing does not return after three months, it is unlikely to recover on its own.

5. Rehabilitation includes the option of no treatment.
a. Hearing aids are difficult to use in Single Sided Deafness (SSD) as one ear is normal and the other has profound hearing loss if the condition is permanent. CROS (Contralateral Routing of Signals) hearing aids may help.
b. Bone anchored hearing aids (BAHA) is an option. Traditional BAHA devices use an external Titanium Abutment or Magnetic Implant . These include Cochlear, Oticon and Medtronic (Sophono / Otomag).

6. You may follow up with your reports.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2685 Questions

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What Causes Hearing Loss And Balance Issues While Prednisone?

Brief Answer: Labyrinthitis or ISSNHL. Detailed Answer: Hi, Thank you for your query. 1. This is either Labyrinthitis or ISSNHL (Idiopathic Sudden SendsoriNeural Hearing Loss). Either way, this requires urgent treatment. If your PTA (Pure Tone Audiogram) shows more than 20-30 dB hearing loss in three contiguous frequencies then it is defined as Sudden Sensori-Neural Hearing Loss (SSNHL). SSNHL is a medical emergency. In your case it may have been Labyrinthitis since you also had vertigo. 2. Your treatment is on the right track. However, you may consider the regimen mentioned below. It is good to hear that your MRI is normal. Other blood tests include: a. Coagulogram b. Homocysteine levels c. VDRL d. RF (Rheumatoid Factor), Auto-immune panel e. HIV, Hepatitis panel f. Lipid Profile (high triglycerides). 3. In the first 4-6 weeks of a SSNHL, there is a good possibility of recovery with aggressive treatment with intravenous steroids, anti-virals, blood thinners, vasodilators, neuroprotective drugs, anti-oxidants, multi-vitamins and carbogen therapy. Up to 3 months there may be excellent results with trans-tympanic steroid injections and with Hyper Baric Oxygen Therapy (HBOT). (Assuming that you do not have diabetes): a. IV Methylprednisolone (steroid): 1 gm/day x 3-5 days, then oral 1 mg/kg/day x 4 weeks, (tapered) followed by 6 bi-weekly steroid ear injections (dexamethasone). b. Acyclovir 800 mg 5 x / day (anti-viral) c. IV Lomodex 12 hrly (blood thinning agent) d. Tab Trental (Pentoxyfyiline) 400 mg OD (rheologic or blood flow improvement) e. Tab Nootropil (Piracteam) 400 mg OD (neural tonic) f. Cap Palsinuron (empirical ayurvedic) g. Tab Omeprazole (anti acidity & reflux) h. Carbogen (vasodialtor) i. Hyperbaric Oxygen Therapy (HBOT), if available. j. IV antibiotics if labyrinthitis is suspected. k. Tinnitus may be treated later with (Tinnex) Caroverine Injection and Capsules. 4. Spontaneous recovery occurs in 65% cases within 20dB or greater than 50% of total loss.If the hearing does not return after three months, it is unlikely to recover on its own. 5. Rehabilitation includes the option of no treatment. a. Hearing aids are difficult to use in Single Sided Deafness (SSD) as one ear is normal and the other has profound hearing loss if the condition is permanent. CROS (Contralateral Routing of Signals) hearing aids may help. b. Bone anchored hearing aids (BAHA) is an option. Traditional BAHA devices use an external Titanium Abutment or Magnetic Implant . These include Cochlear, Oticon and Medtronic (Sophono / Otomag). 6. You may follow up with your reports. I hope that I have answered your queries. If you have any further questions, I will be available to answer them. Regards.