The efficacy of corticosteroids in restoring hearing in patients undergoing conservative management of acoustic neuromas.'

The efficacy of corticosteroids in restoring hearing in patients undergoing conservative management of acoustic neuromas.'

Department of Otolaryngology and Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.

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

STUDY DESIGN: Prospective cohort.

SETTING:Tertiary referral center.

PATIENTS: Seven patients with acute hearing loss secondary to an acoustic neuroma.

INTERVENTION: Oral prednisone (1 mg/kg for 1 to 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 gains of 4 to 38% points.

CONCLUSIONS: Patients with acoustic neuromas who are being treated with a "watchful waiting" approach should receive corticosteroid treatment at the first signs of hearing deterioration. An evaluation to rule out a retrocochlear lesion is mandated in patients with sudden hearing loss, regardless of whether the hearing loss responds to corticosteroid treatment. Older data documenting the efficacy of corticosteroids in the treatment of sudden hearing loss may need to be reevaluated, given that many of these studies were conducted before MRI was available.