I was drawn in by the title of this article, in the expectation that it might be a randomised controlled trial, but it was not. Sudden sensorineural hearing loss is an uncommon condition, which has a potentially disastrous outcome, so any new evidence could be valuable. The paper concludes that “Prescription of a tapering dose of prednisolone is highly recommended as routine management for patients with sudden sensorineural hearing loss. Compared with full-dose treatment, it has equivalent efficacy while reducing the risk of severe side-effects.” The study appears to suggest that there was no significant difference in outcome between the two groups (27 subjects in each) and that one patient in the full dose group developed acute closed-angle glaucoma. This is an interesting observation but it isn’t a sufficiently large or robust study to draw such a confident conclusion. Patients were not randomised to each of the treatment groups, but allocated ‘based on the specialist’s clinical experience’ and this was a retrospective study. There was no control group. The full dose group received seven days of 1mg/kg followed by seven days of a 1/3 dose, whilst the tapered dose group received three days of 1mg/kg, four days of 2/3 dose and seven days of 1/3 dose, so there was not a great deal of difference in dosing regimen between the two treatment groups. It was interesting to note that, in contrast to our practice in the UK, patients presenting to this department with sudden sensorineural hearing loss all underwent both ABR and MRI in order to exclude intracranial pathology, and that they all spent at least seven days as an inpatient. But overall, I don’t think we can learn a great deal about the treatment of sudden sensorineural hearing loss from this article.

The efficacy of varied oral steroid doses on the treatment of sudden sensorineural hearing loss.
Liu CL, Ho KY, Wang LF, et al.
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Emma Stapleton

Manchester Royal Infirmary, UK.

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