Neurinoma

MEDICAL GOODS

The Efficacy of Corticosteroids in Restoring Hearing Loss in Patients with Acoustic Neuromas

By:Anna Aronzon, MD, Douglas C. Bigelow, MD Michael J. Ruckenstein, MD, MSc, FRCSC

Objective: To evaluate the role of corticosteroids in restoring hearing loss in patients undergoing conservative management of acoustic neuromas.

Study design: Prospective cohort.

Setting: Tertiary referral center.

Patients: Seven patents who presented with acute hearing loss secondary to an acoustic neuroma.

Intervention: Oral Prednisone (1 mg/kg x 1-2 weeks) within a week of onset of hearing loss.

Main outcome measures: Audiometric assessment at the time of presentation and after corticosteroid therapy.

Results: All seven patients had pure tone reception threshold improvements ranging from 10 to 50 dB in at least two frequencies or more. Speech discrimination thresholds improved after therapy in all seven patients with gain of 4 to 38 percentage points.

Conclusions:

1. Patients with acoustic neuromas who are being managed with a "watchful waiting" approach should receive corticosteroid treatment at the first signs of hearing deterioration.

2. A retrocochlear work-up is mandated in patients presenting with sudden hearing loss even if it responds to steroid treatment.

3. Older data documenting the efficacy of corticosteroids in the treatment of sudden hearing loss may need to be re-evaluated, as many of these studies were conducted prior to the advent of MRI scanning.

4. These data are the first to document the efficacy of corticosteroid treatment in reversing acute hearing loss caused by acoustic neuromas.