Steroid Use in Idiopathic Sudden Sensorineural Hearing Loss: What is the Evidence?

Case presentation A 37 year old man was referred to our emergency department by his general practitioner with a three day history of muffled hearing and tinnitus of the right ear. Symptoms were sudden onset, with no associated pain, dizziness or otorrhea and no past history of hearing problems or medical illness. Family history was negative and physical examination was normal. Otologic examination revealed normal tympanic membranes bilaterally, with no evidence of cerumen or middle ear effusion. Tuning fork examination showed positive Rinne test bilaterally but with lateralization of Weber test to the left side, indicating right ear sensorineural hearing loss. Audiometric analysis confirmed sensorineural hearing loss across all frequencies of about 70-db in the right ear. Tympanometric analysis showed normal middle ear pressure and tympanic membrane compliance on both sides with no evidence of middle ear effusion. Ear canal volume was normal indicating intact tympanic membranes bilaterally. Routine lab work including complete blood count, erythrocyte sedimentation rate, random glucose, urea, and electrolytes were all within normal limits. Magnetic resonance imaging of brain and internal auditory canal were also normal.