Cortisone therapy for a sudden hearing loss

introduction

The reason for a sudden hearing loss is often not known. Many different treatment strategies have been tried over the past few decades. So far, no therapy has a scientifically proven advantage over the other therapies. The assumption that hearing loss is caused by an inflammatory process led to the development of cortisone therapy in the 1970s. Glucocorticoid therapy (cortisone) was introduced in the USA at that time and has since established itself in the treatment of acute hearing loss. The glucocorticoids are administered as an infusion or in tablet form.

Indications for therapy with cortisone for sudden hearing loss

A sudden hearing loss can occur spontaneously. Suddenly the listening experience is very dull, as if you were under an invisible bell. A noise in the ear or, in extreme cases, severe dizziness may also occur. Since the sudden hearing loss can be caused by various causes, treatment is difficult. Disturbances of the blood circulation, bleeding, inflammatory processes or infections are discussed as causes. None of the reasons are really proven.

The indication for cortisone therapy is an inflammatory process in connection with a sudden hearing loss. Swelling, which can cause sudden hearing loss, is also reduced with the help of cortisone. However, since a sudden hearing loss disappears by itself in about half of all cases, it is often advisable to wait and see first.

In very severe and acute cases of sudden hearing loss, however, treatment should be given soon. If there is no improvement by waiting, high-dose cortisone therapy is used in accordance with guidelines.

If there is still no improvement after treatment with cortisone tablets or infusions, cortisone can also be injected directly into the middle ear.

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Effect of cortisone on hearing loss

The glucocorticoids that are administered are similar to the human hormone cortisol.

More precisely, drugs containing cortisone are taken and converted to cortisol in the liver. Cortisol is normally produced in the adrenal cortex and has various effects on the human organism. It can be seen as a stress hormone, which acts similarly to the catecholamines adrenaline and noradrenaline. For one thing, cortisol has an impact on carbohydrate and fat metabolism. In this way, more sugar is formed and fatty tissue is broken down more. In addition, cortisol has anti-inflammatory and immunosuppressive effects.This means that the immune system is suppressed and the activity of the white blood cells (Leukocytes) decreased.

This reduced immune response can be used in inflammation that is not caused by bacteria. For example, in autoimmune diseases (diseases in which the immune system attacks cells in your own body), the immune system is suppressed to such an extent that the symptoms regress.

The same principle applies to the treatment of sudden hearing loss. It is assumed that an inflammation in the ear triggers the sudden hearing loss. Glucocorticoids such as Prednisolone, thereby trying to suppress the inflammation. If the inflammation is gone, the sudden hearing loss should also decrease.

Side effects of cortisone therapy for sudden hearing loss

The side effects of glucocorticoids, like the effects, are unfortunately very broad. Since the glucocorticoids are (more frequently) absorbed via tablets or infusions, they have a systemic effect. This means that they are absorbed by the lining of the digestive tract into the bloodstream and thus act throughout the body.

With an infusion, the cortisone is directly in the bloodstream. This has the positive effect that the ear is also reached and the inflammation or swelling is combated there.

On the other hand, however, it also means that many undesirable side effects can occur all over the body.

On the one hand, blood sugar can rise through the formation of new sugar. This can be particularly problematic for diabetics. An increase in the fat level in the blood can also be observed. In addition, there may be swelling due to water accumulation in the tissue (so-called Edema). Long-term use of cortisone can lead to a so-called "full moon face", which is expressed in a rounded face shape with puffy cheeks.

In addition to the metabolic processes, the skin and muscles are also affected. The muscles are broken down by the altered protein metabolism and the skin becomes thinner. The circulation and the psyche can also be influenced. Ultimately, a decrease in immune activity is accompanied by a higher susceptibility to infections.

The desired effect can also have its downsides. For this reason, it is also recommended to wait for any improvement before cortisone therapy and to take glucocorticoids only if there is no improvement. With a cortisone injection, which only works locally in the middle ear, the systemic side effects are not to be feared.

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Interactions of Cortisone

In addition to the numerous side effects, cortisone therapy also has various interactions. For example, when treating acute viral or bacterial infections, the use of cortisone should be avoided. With severe diabetes mellitus or high blood pressure, the glucocorticoids should be taken with particular caution. Cortisone therapy should also be avoided in connection with vaccinations.

In any case, current illnesses and the use of other medications in connection with cortisone therapy should be discussed with the attending physician!

Further accompanying therapy for sudden hearing loss

In addition to cortisone therapy, there are various accompanying therapy approaches that can be tried out. One example is oxygen pressure therapy.

The patient is in a hyperbaric chamber and inhales pure oxygen. The theory behind this is that the hair cells of the inner ear are better supplied with oxygen via the increased oxygen concentration in the blood. However, studies have shown that it is less effective than therapy with glucocorticoids.

Alternatively, there are treatment methods that focus on blood flow to the ear. A new and so far rarely used method is "blood purification". This involves taking the blood from the vein through a small tube using a dialysis process, cleaning it in a machine and putting it back into the vein. The cleaning primarily includes the removal of fats (LDL cholesterol, lipoprotein a) and coagulation factors (e.g. fibrinogen). Cleansing is said to help blood flow better and improve blood flow to the inner ear. However, this form of therapy is not covered by the health insurance and is particularly recommended for increased fibrinogen levels.

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Dosage of cortisone in the therapy of acute hearing loss

The dosage of cortisone in the event of sudden hearing loss is very important for the success of the treatment. Recent studies have shown that low-dose cortisone treatment is not very effective. For this reason, a high dose of cortisone is usually used in the event of sudden hearing loss.

This is a dose of 200-250 milligrams per injection. Treatment is usually given within three to five days, with the dose given intravenously (injected into a vein) every day.

A cortisone regimen in tablet form (10 pieces) can then be taken. This scheme has a descending structure, which means that the dose is reduced per tablet. The dose goes down from around 100 milligrams per day at the beginning to 50 milligrams on the last day. However, taking the tablets is not mandatory.

How expensive is cortisone therapy for hearing loss?

The problem with cortisone therapy for a hearing loss is that the costs are currently not covered by health insurances.

The treatment is a so-called "off-label use". This means that the drug was not originally intended to be used to treat the disease. The cost of the infusion is around € 20.

3 ampoules, each containing 250mg prednisolone (cortisone), can be purchased for 50-60 €. If you still use the pill scheme, you have to pay an additional 15 €.

Cortisone and alcohol - are they compatible?

As with all substances, the amount matters a lot. If very little alcohol is consumed during cortisone therapy for a sudden hearing loss, this is usually not a problem.

If alcohol is consumed in large quantities, undesirable consequences can quickly arise. Above all, the side effects of cortisone can be increased by alcohol. Both alcohol and cortisol (the active form of cortisone) are broken down in the liver. Because the breakdown of alcohol requires certain enzymes, these enzymes can no longer be used to breakdown cortisol.

Conversely, the alcohol is also broken down more slowly, so that the effect of the alcohol lasts longer. In addition, gastric mucosal damage can occur more quickly, since both cortisone and alcohol damage the gastric mucosa.

Ultimately, the electrolyte balance (minerals in the blood) is also affected, as the absorption of potassium into the bloodstream can be disrupted. A low concentration of potassium can adversely affect nerve and muscle function.

Read more on the topic: Cortisone and alcohol - are they compatible?

Can you do sports while taking cortisone?

In principle, it is believed that sport and physical activity actually reduce the side effects of cortisone. For this reason, the combination of sport and cortisone therapy is not in itself problematic. The question here is rather whether the patient who has suffered a sudden hearing loss feels fit and safe enough to do sports.