The reason for a hearing loss is often unknown. Many different treatment strategies have been tried in the past decades. No therapy so far has a scientifically proven advantage over the remaining therapies. The suggestion that an acute hearing loss is triggered by an inflammatory process led to the development of cortisone therapy in the 1970s. Glucocorticoid therapy (cortisone) was introduced in the US at that time and has since become established in the treatment of a hearing loss. Here, the glucocorticoids are administered as an infusion or in tablet form.
A sudden loss of hearing can occur spontaneously. Suddenly, the listening experience is very dull, like being under an invisible bell. Also, a sound in the ear or, in extreme cases, severe dizziness may occur. Since the hearing loss can be caused by a variety of causes, the treatment is difficult. Disorders of blood circulation, bleeding, inflammatory processes or infections are discussed as the cause. None of the reasons is really proven.
The indication for cortisone therapy is an inflammatory process associated with a hearing loss. Even swelling, which can cause the sudden loss of hearing, are reduced by means of cortisone. However, since an acute hearing loss disappears in about half of the cases, it is often advised to wait first.
However, in very severe and acute cases of acute hearing loss, treatment should be given soon. If there is no improvement by waiting, high dose cortisone therapy will be used 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.
The glucocorticoids administered are similar to the human hormone cortisol.
More specifically, cortisone-containing drugs are taken and converted to cortisol in the liver. Cortisol is normally produced in the adrenal cortex and has various effects on the human organism. It can be considered a stress hormone, which acts similarly to the catecholamines adrenaline and norepinephrine. For one, cortisol has effects on carbohydrate and fat metabolism. In this case, sugars are increasingly formed and fat tissue degraded more. In addition, cortisol has anti-inflammatory and immunosuppressive effects. 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 exploited in inflammations that are not bacterial. For example, in autoimmune diseases (diseases in which the immune system attacks cells of the body), the immune system is suppressed so far that the symptoms go down.
The same principle applies to the treatment of the hearing loss. It is believed that inflammation in the ear causes the hearing loss. Now you administer glucocorticoids such as prednisolone and thereby tries to suppress the inflammation. If the inflammation has disappeared, the hearing loss should also go back.
The side effects of glucocorticoids are unfortunately, like the effects, very wide-ranging. Because the glucocorticoids are taken (more frequently) via tablets or infusions, they have a systemic effect. This means that they are absorbed into the bloodstream by the digestive tract mucosa and thus act throughout the body.
With an infusion, the cortisone is directly in the bloodstream. This has the positive effect that the ear is reached and there the inflammation or swelling is combated.
On the other hand, however, this also means that many unwanted side effects can occur throughout the body.
On the one hand, the blood sugar can rise above the sugar reformation. This can be particularly problematic for diabetics. There is also an increase in the level of fat in the blood. In addition, swelling may occur due to accumulation of water in the tissue (so-called edema ). It can come with prolonged intake of cortisone to a so-called "full moon face", which manifests itself in a roundish face shape with bloated cheeks.
In addition to the metabolic processes, the skin and muscles are also affected. The muscles are broken down by the altered protein metabolism and the skin becomes thinner. The circulation and the psyche can also be influenced. Finally, the reduction in immune activity is associated with a higher susceptibility to infection.
The desired effect can also have its downsides. For this reason, it is also recommended to wait for a possible improvement before cortisone therapy and to take glucocorticoids only if there is no improvement. In a cortisone injection, which acts only locally in the middle ear, the systemic side effects are not to be feared.
In addition to the numerous side effects, cortisone therapy also has various interactions. For example, in the treatment of acute viral or bacterial infections should be dispensed with the use of cortisone. In severe diabetes mellitus or high blood pressure, the glucocorticoids should be taken with special care. And also in connection with vaccinations should be taken away from the cortisone therapy.
In any case, current illnesses and the use of other medicines in conjunction with the cortisone therapy should be discussed with the attending physician!