Pediatric Corticosteroid Dosing for Sudden Sensorineural Hearing Loss
Dosing Regimen
- The American Academy of Otolaryngology-Head and Neck Surgery recommends administering oral prednisone at 1 mg/kg/day as a single daily dose for 7-14 days, followed by a taper over a similar time period 1, 2
- Prednisone should be given as a single morning dose, with a usual maximum of 60 mg daily 1, 2
- The treatment should be administered for 10-14 days at full dose 1, 2
- After full-dose treatment, taper over a similar time period (7-14 days) 1, 2
Alternative Equivalent Dosing
- Methylprednisolone can be used as an alternative at a dose of 48 mg/day, which is 5 times more potent than hydrocortisone 2
- Dexamethasone can be used as an alternative at a dose of 10 mg/day, which is 25 times more potent than hydrocortisone 2
Timing Considerations
- Treatment must begin immediately, ideally within the first 14 days of symptom onset 1, 2
- The greatest spontaneous improvement and treatment benefit occur in the first 2 weeks 1, 2
- Some benefit has been reported up to 6 weeks following onset, but efficacy diminishes significantly after 2 weeks 1, 2
Intratympanic Steroids as Alternative
- For children who cannot tolerate systemic steroids, intratympanic dexamethasone is an alternative, with concentrations of 24 mg/mL, 16 mg/mL, or 10 mg/mL showing better outcomes 1, 3
- Methylprednisolone can also be used intratympanically at concentrations of 40 mg/mL or 30 mg/mL 1
Monitoring and Administration
- Audiograms should be obtained before treatment, at completion, and at delayed intervals 1
- Patients should be monitored for hyperglycemia, especially those at risk 3, 4
- Most serious side effects occur with chronic use, but short 10-14 day courses have acceptable safety profiles 3