A 35-year-old woman presents with sudden sensorineural hearing loss in the left ear with tinnitus and vertigo for 3 days. Pure tone audiometry confirms unilateral sensorineural hearing loss. What is the drug of choice for this condition?

Explanation

## Sudden Sensorineural Hearing Loss (SSHL) — Drug of Choice ### Clinical Context Sudden sensorineural hearing loss (SSHL) is defined as ≥30 dB hearing loss over ≤3 consecutive frequencies occurring within 72 hours. The triad of SSHL, tinnitus, and vertigo suggests acute inner ear pathology (viral labyrinthitis, idiopathic SSHL, or vascular compromise). ### Drug of Choice: Systemic Corticosteroids **Key Point:** Systemic corticosteroids (typically prednisolone 1 mg/kg/day, max 80 mg, tapered over 2–4 weeks) are the first-line pharmacological treatment for idiopathic SSHL and viral-induced SSHL. ### Mechanism of Benefit 1. Anti-inflammatory: reduces inner ear inflammation and edema 2. Immunosuppressive: suppresses viral-triggered immune response 3. Improves microcirculation: enhances cochlear blood flow 4. Best outcomes: initiated within 2 weeks of symptom onset (ideally <72 hours) ### Evidence Base - Multiple RCTs and meta-analyses support early corticosteroid use in SSHL - Response rates: 30–60% achieve partial to complete hearing recovery - No clear evidence for antivirals (acyclovir) as monotherapy - Adjunctive agents: vasodilators (pentoxifylline), antioxidants (N-acetylcysteine) may be considered but are not first-line ### Audiological Confirmation - Pure tone audiometry (PTA) shows air-bone gap closure (sensorineural pattern) - Bone conduction thresholds elevated; air-bone gap absent - Distinguishes SSHL from conductive causes (otosclerosis, ossicular discontinuity) **High-Yield:** Early corticosteroid therapy (within 2 weeks, ideally <72 hours) is associated with better hearing recovery outcomes in SSHL. Delay beyond 4 weeks significantly reduces efficacy. **Clinical Pearl:** Idiopathic SSHL has a spontaneous recovery rate of ~30–40%; however, corticosteroids improve this to 50–60%, making them standard of care despite the lack of a proven etiology in most cases. ### Differential: Why Other Drugs Are Not First-Line | Drug | Role | Limitation | |------|------|----------| | **Corticosteroids** | First-line, anti-inflammatory | Must be given early; taper required | | **Antivirals (Acyclovir)** | Adjunct if viral etiology suspected | No proven monotherapy benefit in SSHL | | **Vasodilators** | Adjunct (pentoxifylline, papaverine) | Not superior to steroids alone | | **Antibiotics** | Only if bacterial infection proven | Not indicated in idiopathic SSHL | [cite:Lalwani Textbook of ENT Ch 8]