Introduction
The reason for a hearing loss is often not known. Many different treatment strategies have been tried in the past decades. So far, no therapy has a scientifically proven advantage over the other therapies.
The assumption that sudden deafness 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 sudden deafness. Here, the glucocorticoids are administered as an infusion or in tablet form.
Indications for a therapy with cortisone for sudden deafness
A sudden hearing loss can occur quite spontaneously. Suddenly the hearing experience is very dull, as if you were under an invisible bell. A noise in the ear or, in extreme cases, severe dizziness can also occur.
Since the sudden hearing loss can be caused by a variety of factors, treatment is difficult. Both disturbances of the blood circulation, bleeding, inflammatory processes or infections are discussed as causes. None of the causes is really proven.
The indication for a cortisone therapy is an inflammatory process in connection with a sudden loss of hearing. Swelling, which can cause sudden deafness, is also reduced with cortisone. However, since a sudden hearing loss disappears by itself in about half of the cases, it is often recommended to wait and see.
In very severe and acute cases of sudden deafness, however, treatment should be given soon. If there is no improvement by waiting, a high-dose cortisone therapy is applied according to the guidelines. If there is no improvement after treatment with cortisone tablets or infusions, cortisone can also be injected directly into the middle ear.
Effect of cortisone in sudden deafness
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 formed in the adrenal cortex and has various effects on the human organism.
It can be regarded as a stress hormone, which acts similarly to the catecholamines adrenaline and noradrenaline. On the one hand, cortisol has effects on the carbohydrate and fat metabolism. Sugar is produced more often and fat tissue is broken down more strongly.
In addition, cortisol has an anti-inflammatory and immunosuppressive effect. This means that the immune system is suppressed and the activity of the white blood cells (leukocytes) is reduced. This reduced immune response can be used to treat inflammations that are not caused by bacteria.
For example, in autoimmune diseases (diseases in which the immune system attacks cells of the own body) the immune system is suppressed to such an extent that the symptoms decrease. The same principle applies to the treatment of acute hearing loss. It is assumed that an inflammation in the ear triggers the acute hearing loss. Glucocorticoids such as prednisolone are administered in an attempt to suppress the inflammation. Once the inflammation has disappeared, the hearing loss should also decrease.
