Treatment of Ear and Hearing Disorders

Medication Dosage

• The American Academy of Otolaryngology-Head and Neck Surgery recommends that Dexamethasone 10 mg/Day is equivalent to 48 mg/Day Methylprednisolone or 60 mg/Day Prednisolone in patients with ear and hearing disorders 1
• Typical adult doses for dexamethasone range from 16-40 mg daily for 1-4 days, while prednisone is typically dosed at 40-60 mg daily for 5-7 days with or without tapering 2
• The potency and duration of action of different corticosteroids can be compared using the following table:

Note: Fludrocortisone also has significant mineralocorticoid activity at doses of 0.05-0.1 mg/day 3

Chronic Inflammatory Diseases

• For Chronic Arthritis, a maintenance dose of Prednisolone 10-15 mg/Day is recommended, as suggested by the European League Against Rheumatism 4
• In Adult-onset Still's Disease, most patients require Prednisolone, with 46% needing maintenance therapy, according to the European League Against Rheumatism 4
• The American Society of Hematology (ASH) suggests either prednisone (0.5-2.0 mg/kg/day) or dexamethasone (40 mg/day for 4 days) as initial therapy for certain conditions, with dexamethasone showing increased platelet count response at 7 days (RR 1.31; 95% CI 1.11-1.54) 2
• Condition-specific dosing regimens are recommended, including:

Patient Selection and Adherence

• Patients with poor medication adherence may benefit from dexamethasone due to its shorter course 2
• Patients with severe liver disease may benefit from dexamethasone, as it does not require hepatic activation 2
• Patients with a history of steroid-induced insomnia may prefer prednisone 2
• Patients with a history of infections may prefer dexamethasone 2
• Prednisone requires hepatic conversion to prednisolone to become active, and may have decreased effectiveness in patients with severe liver disease, with an initial dose of 12.5-25 mg daily 12

Side Effects and Tapering

• Both dexamethasone and prednisone have similar short-term side effects, including insomnia, mood changes, increased appetite, and hyperglycemia, although dexamethasone users reported significantly more insomnia 2
• Dexamethasone has a higher risk of HPA axis suppression due to its longer half-life 2
• Common side effects of corticosteroid therapy include hypertension, glucose intolerance, weight gain, decreased bone density, adrenal suppression, and emotional lability, affecting most patients 8
• Severe complications such as osteoporosis, vertebral compression, diabetes, cataracts, hypertension, and psychosis typically develop after 18 months of continuous therapy at doses exceeding 10 mg daily, as reported by the American Association for the Study of Liver Diseases 8
• Both medications require gradual tapering to avoid adrenal insufficiency, typically reducing by 5 mg weekly until reaching 10 mg/day, then reducing by 2.5 mg weekly until reaching 5 mg/day, as recommended by the American Gastroenterological Association and other societies 10, 1
• The total tapering period is suggested to be 6 months after achieving remission in many conditions, according to the National Kidney Foundation and other organizations 5, 10
• For patients on chronic corticosteroid therapy undergoing surgery, stress doses are recommended, including hydrocortisone 100 mg IV at induction, followed by continuous infusion of 200 mg/24h for major surgery, as advised by the American Society of Anesthesiologists 13