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Corticosteroid Therapy for Inner Ear Disorders - Melbourne ENT Group (MEG). |
Prednisone for ears
Prednisone for ears. Steroid Treatments Equally Effective Against Sudden Deafness
What should I expect? Minor discharge and bleeding from the treated ear may be noticed for short period of time. Any improvement in symptoms is not immediate and may take hours, days or sometimes even weeks to be noticed.
Repeat topical administration Further weekly injections usually two can be arranged with your Specialist Surgeon if ear symptom improvement is noticed confirmed on repeat Audiometry hearing test after 7 days of the first injection.
Discussion of further benefit vs. Concerns or questions? Further information The Department of Health has published a guide on different causes of hearing loss.
Book Appointment Make an appointment with one of our specialists. Make a booking. Have a question? Call Us info melbentgroup. Refer a Patient Refer your patient to see one of our specialists. The tube function to equalize the pressure between the ear and the surrounding environment. Therefore it helps prevent pressure and fluid from building up inside the ears. ETD can be diagnosed through a thorough head and neck examination. The physician will look in the ears to see the eardrum and into the nasal cavity.
On many occasion, a good history can diagnose the condition as well. Steroids are commonly prescribed for sudden hearing loss as well as for autoimmune inner ear disease and vestibular neuritis. The purpose of this page is to outline the usual methodology. We do not discuss their effectiveness or the validity of their indications. There is very little difference with respect to the ultimate results with these drugs and side effects, but they differ in potency and duration of action, and for this reason, the dose must be adjusted.
Oral decadron would seem to us to be a poor choice for a condition in which rapid effects are desirable such as acute hearing loss or vestibular neuritis, as due to it's long half life, it takes 20 days to reach steady state.
Of course, one can adjust one's protocol to give more drug at the beginning, as is the case for the "medrol dose pack". The most common method of administration is by mouth. We will not discuss intravenous administration faster and stronger, sometimes used for situations where symptoms are very severe such as bilateral deafness associated with autoimmune inner ear disease. Administration through the ear-drum is discussed elsewhere.
This method has the advantage of much less side effects, but the disadvantages of higher expense and the need for a subspecialty visit for injection through the ear drum. For the oral method, there are four common protocols that we use in our clinic :.
The easiest, safest, and most convenient method of trying steroids is to use a medrol methylprednisolone dose pack. This is a card that contains 6 days of steroids, with less provided each day.
The gradual decrease in the amount of steroids each day is called a "taper". The reason to do this is to allow the patient's adrenal glands, which are usually suppressed by the steroids, to gradually return to supplying steroids to the patient on their own. Medrol is slightly stronger than prednsone, so to convert this into "prednisone", when using the 4 mg dose-pack, one just has to multiple by 5. In other words, the medrol dose pack is the equivalent of 30 mg of prednisone, tapering down to 0 over a week.
❾-50%}RACGP - Oral corticosteroids for painful acute otitis externa.
The study tested the treatments as they are usually given in the clinic. For oral steroid therapy, patients received 60 milligrams of prednisone for 14 days, followed by a tapering-off period of 5 days. The other group was given 40 milligrams of methylprednisolone injected directly through the eardrum 4 times over the course of 2 weeks.
The study followed the recovery of these patients for 6 months, measuring the success of the treatments based on hearing tests at the first and second weeks, and months 2 and 6. Under both regimens, patients recovered their hearing to about the same extent at 2 and 6 months. The oral steroid patients experienced typical symptoms, such as sleep, mood and appetite changes. Medrol is slightly stronger than prednsone, so to convert this into "prednisone", when using the 4 mg dose-pack, one just has to multiple by 5.
In other words, the medrol dose pack is the equivalent of 30 mg of prednisone, tapering down to 0 over a week. For persons in whom a larger amount of steroids is indicated a longer protocol and more intense protocol is selected.
Longer pulses require longer tapers. Checking the blood pressure to make sure it is not dropping too low and follow up visits during the taper period are often required. Some patients are "steroid dependent". For example, whenever the steroid dose is decreased below a threshold, hearing starts to deteriorate again.
In patients like this, an attempt is made to find a steroid sparing replacement drug such as methotrexate or Enbrel , but in the meantime, the steroids are reduced to as low an amount as is practical. Steroids have many side effects, that are more common with longer administration.
Common ones in the short run i. It can occur during common colds, upper respiratory tract infections, allergies, impeded nasal airflow or chronic drainage of mucus on the tube opening. The Eustachian Tube ET is a small passage way that connects the middle ear to the nasopharynx.
The tube function to equalize the pressure between the ear and the surrounding environment. Your Specialist surgeon will discuss with your further rehabilitation options in case of failure of medical therapy, which may include, hearing rehabilitation options, including conventional hearing amplification ie Hearing aids , Hearing implants and Vestibular physiotherapy. The Department of Health has published a guide on different causes of hearing loss.
Download File. Call Us Corticosteroid Therapy for Inner Ear Disorders. Who is this information for? Corticosteroids are man-made drugs that work like cortisol, a natural steroid hormone in your body. Results One hundred and sixty-four patients were screened for eligibility between 28 October and 19 June Table 1. Table 2. Table 3. Limitations The main limitations of this study were recruitment of participants and loss to follow-up of included participants.
The following potential problems were identified: The researchers noted that the wet seasons in —16 and —17 were unusually dry, resulting in fewer than expected cases of otitis externa. Many GPs in the participating clinics also expressed there were fewer cases than usual.
There is always a time pressure in primary healthcare, and actions linked with financial remuneration are often given some priority. Remuneration for participating practitioners, pharmacists or patients was not available in this study because of the limited funding allocated.
After discussions with colleagues, the researchers first believed recruitment would work well without remuneration. Afterwards, it became evident that this assumption was incorrect, and remuneration to medical practitioners and pharmacists for each included patient, and a small remuneration to patients for returned surveys, may have reduced the recruitment problem and loss to follow-up.
Each can containing study tablets had a unique identifying number, which pharmacists were instructed to note on the survey handed out to patients. Many pharmacists failed to do so, and these returned surveys could therefore not be linked with the correct patient. A checklist was introduced for pharmacists halfway through the study, and this problem was significantly reduced.
Generalisability This study was planned as a randomised controlled trial RCT but, most likely because of insufficient funding, failed to recruit enough patients to be adequately powered to assess the proposed outcomes. Provenance and peer review: Not commissioned, externally peer reviewed.
Funding: Cairns Hospital Foundation, Australia, funded this project. The funder did not take part in planning the project, analysing data or writing the manuscript. Create Quick log. Estimated burden of acute otitis externa — United States, — External otitis among swimmers and nonswimmers. Arch Environ Health ;30 9 — Aust Fam Physician ;38 4 — The relation of patient satisfaction with treatment of otitis externa to clinical outcomes: Development of an instrument.
Clin Ther ;21 6 — Malignant external otitis: Insights into pathogenesis, clinical manifestations, diagnosis, and therapy.
Am J Med ;85 3 — Search PubMed Boustred N. Practical guide to otitis externa. Aust Fam Physician ;28 3 — Search PubMed Murtagh J. Systematic review of topical antimicrobial therapy for acute otitis externa. Adv Ther ;24 3 — External otitis caused by infection with Pseudomonas aeruginosa or Candida albicans cured by use of a topical group III steroid, without any antibiotics.
Acta Otolaryngol ; 4 —
ETD occurs when there is a dysfunction of the Eustachian tube. This condition prevents the release of pressure and fluid from the middle space the space behind the tympanic membrane or ear drum.
It can occur during common colds, upper respiratory tract infections, allergies, impeded nasal airflow or chronic drainage of mucus on the tube opening. The Eustachian Tube ET is a small passage way that connects the middle ear to the nasopharynx.
The tube function to equalize the pressure between the ear and the surrounding environment. Therefore it helps prevent pressure and fluid from building up inside the ears.
ETD can be diagnosed through a thorough head and neck examination. The physician will look in the ears to see the eardrum and into the nasal cavity. On many occasion, a good history can diagnose the condition as well. There are several treatment options for ETD ranging from simple to more invasive.
What is the Eustachian tube? What are the symptoms of ETD? How is it treated? Topical nasal steroids fluticasone, plus many others and oral antihistamines loratadine, plus many others may be used to treat allergies. Ear tubes small tubes that are place into the tympanic membrane directly equalize the pressure and drain the fluid behind the ear drum. This procedure may be performed in the office for adult patients. Balloon dilation of the Eustachian tube is a relatively new treatment for ETD.
The glucocorticoids, prednisolone and dexamethasone, were the most effective in our study in reducing middle ear inflammation in response to bacterial challenge. Prednisone (1 mg / kg / day) or Dexamethasone (10mg / day) should be used for at least days, with a tapering of the dose over a similar time period. Prednisone (1 mg / kg / day) or Dexamethasone (10mg / day) should be used for at least days, with a tapering of the dose over a similar time period. Prednisolone Sodium Phosphate Drops is used to treat inflammation of the eye or ear where there is no infection. 2. What you need to know before you use. Administration through the ear-drum is discussed elsewhere. Medium and stronger pulse -- 21 day prednisone at 1 mg/kg with taper. Oral decadron would seem to us to be a poor choice for a condition in which rapid effects are desirable such as acute hearing loss or vestibular neuritis, as due to it's long half life, it takes 20 days to reach steady state. Problems that can occur after longer administration, besides the ones that may appear above, include. Lost hours as a result of otitis externa were similar in both groups Table 2. Current evidence indicates that a topical steroid is beneficial to patients with otitis externa. Therefore it helps prevent pressure and fluid from building up inside the ears.It is a common problem for which patients present to general practitioners GPs , particularly in coastal temperate and tropical climates. Its monthly incidence in the USA increases during the summer season from 0. However, in tropical parts of Australia the annual incidence is likely to be much higher than 1. The skin in the external ear canal of a healthy ear has a thin protective coating of cerumen, a mixture of secretions from apocrine and sebaceous glands mixed with desquamated epithelial cells.
An infectious organism cannot be found in at least one-third of patients with otitis externa. A secondary infection is likely in severe cases, and common organisms found are Pseudomonas spp. Common consequences for patients with otitis externa are pain, sleep disturbance, temporary loss of hearing, pharmaceutical and consultation expenses, and potentially loss of income. Initial symptoms at presentation to medical practices range from mild irritation with almost no pain to the strongest pain imaginable as measured by a pain scale.
As well as pain, other consequences are costs for healthcare and sometimes also loss of productivity. Most patients fully recover after 5—14 days. Infection may also spread to deeper structures such as the inner ear and the brain, which can be potentially life-threatening. The treatment for otitis externa is usually topical; in selected cases, oral antibiotics are prescribed.
Prednisone or prednisolone is used in doses ranging from 20 to 75 mg daily for 3—5 days. Corticosteroids reduce the immune response. Therefore, corticosteroids given to a patient who has a severe infection could theoretically be detrimental. However, it has previously been shown that corticosteroids can be given safely and with beneficial effect to patients with ongoing infection of low or moderate virulence.
Examples are patients with croup 14 and sore throat. Acute otitis externa is in most cases either an aseptic inflammation that is simultaneously colonised by bacteria, or an infection of low-to-moderate virulence. In these situations, corticosteroids could theoretically be beneficial. Current evidence indicates that a topical steroid is beneficial to patients with otitis externa. We were unable to identify a published clinical trial evaluating the effect of oral corticosteroids in patients with otitis externa.
Giving oral corticosteroids to patients with otitis externa could be beneficial or harmful. It may be that oral corticosteroids in the lower dose range are beneficial while using higher doses could add side effects and risks without benefit.
If a short course of low-dose oral corticosteroids 20 mg prednisone daily is beneficial, then this finding is useful for practitioners currently prescribing a higher dose. If a benefit of oral corticosteroids is not proven, then physicians currently prescribing it need to be advised of this finding. The objective of this study was to assess the efficacy of low-dose oral prednisolone for four days in addition to conventional therapy in the management of painful acute otitis externa.
Primary research questions and subsequent data collection aimed to comply with the only published validated questionnaire for acute otitis externa.
Sixteen primary healthcare centres and 19 adjacent pharmacies in tropical Far North Queensland, Australia, agreed to participate. Consecutive patients attending participating primary healthcare centres for otitis externa were asked by the medical practitioner if they accepted screening in relation to inclusion criteria:. Patients fulfilling all inclusion criteria were referred to one of the participating pharmacies, where further information was given, consent forms were signed and the study medication was dispensed.
A website was created as an ongoing resource for GPs and pharmacists www. Furthermore, GP clinics and pharmacies were visited regularly to ensure they adhered to the agreed study protocol. Age, gender, ethnicity and initial ear pain was noted at baseline. Initial ear pain was measured using a VAS of 10 cm Figure 1. The VAS, subsequent diary and final survey after symptom resolution or up to 10 days after enrolment adhered to the validated VAS, diary and survey published by Shikiar et al in Figure 1.
Visual analogue scale. Randomisation was achieved using random numbers generated by the ResearchRandomizer website www. Medical practitioners, participating pharmacists, patients, staff telephoning patients and the person doing statistical analysis were all unaware of group allocation. The pharmacist checked inclusion criteria for a second time and provided study tablets to patients accepting participation. The intervention was a study capsule taken twice daily for four days in addition to any other treatment prescribed by the medical practitioner.
Capsules with the active ingredient contained 10 mg of prednisone packed in an opaque gelatine capsule. The remaining space was filled with lactose. Capsules with placebo contained lactose packed in a gelatine capsule which was identical in appearance to capsules with the active ingredient. The lactose content was considered insignificant for patients with lactose intolerance.
All patients fulfilling inclusion criteria and with data available were analysed as follows:. The analysis was done as intention to treat. Intention to treat was defined as all patients fulfilling the inclusion criteria with follow-up data available, making analysis possible irrespective of whether they adhered to the allocated treatment arm. Imputation of data for patients lost to follow-up was not made.
Sample size calculations were based on the primary research questions and made two-tailed to avoid the assumption that a difference between groups would always favour the intervention group.
Sample size calculations for survival analysis used the statistical software PASS version We calculated that patients would be sufficient to answer all primary research questions. We expected that some patients would be lost to follow-up so we aimed to include patients. A more detailed description of the sample size calculation is described in the full study protocol.
Patients with any type of side effect mentioned above were instructed in the written information to immediately contact their GP or nearest emergency department if their GP was unavailable. The patient information also outlined that those patients must immediately stop taking the study tablets. Furthermore, they were instructed to notify the steering committee. Patients were also withdrawn from the study if it was their wish.
Detailed rules for discontinuation of the study are presented in the study protocol. The funder, Cairns Hospital Foundation, did not participate in planning, analysing data or writing of the manuscript. One hundred and sixty-four patients were screened for eligibility between 28 October and 19 June Seventy-three patients were randomised and given instructions with surveys to return and a can containing the study tablets.
Forty-three of these patients could not be analysed, while 30 patients submitted identifiable surveys and were included in the final analysis Figure 2. Figure 2. This study did not find evidence that the intervention and control groups differed statistically at baseline Table 1. Two patients in the intervention group stated they took only 3—4 out of eight study tablets.
No reason for this was given. All other patients included in the final analysis stated they took all eight study tablets. It took an average of 5. Lost hours as a result of otitis externa were similar in both groups Table 2.
Side effects during treatment were expected and similar in both groups Table 3. None of these revisits were considered unexpected or serious, and all four patients became completely pain-free in an average of 4. No patient was excluded as a result of worsening of symptoms. The influence of ethnicity was not analysed because most patients were of Caucasian ethnicity Table 1.
Patient satisfaction after treatment was similar in both groups Table 3. It took an average of 3. However, oral corticosteroids did not reduce the time to reporting being completely pain-free complete resolution of pain. The main limitations of this study were recruitment of participants and loss to follow-up of included participants. Recruitment was slower than anticipated, and fewer than half of the patients who were screened were suitable for inclusion. The target was never reached: after 20 months of recruiting, the study was terminated because of slow recruitment of patients.
Fewer than half of the randomised patients returned identifiable surveys. The following potential problems were identified:. A formal process evaluation 24 to see if further lessons could be learnt was not done because of lack of funding. Clinical follow-up by the medical practitioner on days three and six would have added useful information.
However, this would have required substantial funding that was not available. This study was planned as a randomised controlled trial RCT but, most likely because of insufficient funding, failed to recruit enough patients to be adequately powered to assess the proposed outcomes.
However, the study indicates that the measuring tools worked well, the intervention was accepted by patients and the sample size calculation is likely to be adequate. Although we did not plan this to be a pilot study, and it should be classified as an underpowered RCT, our outcomes are useful to inform a larger study in a similar manner to a pilot study.
Therefore, these potentially interesting results should be confirmed in a larger, properly funded clinical trial before applying the results in the routine healthcare setting. Shortening the duration of intense pain by 1. Therefore, pursuing this research with a follow-up study adequately powered to measure complete resolution of pain as an outcome makes sense. However, for a larger study to be feasible, reasonable funding for reimbursement for healthcare providers and participating patients is likely to be required.
A future study with a larger number of patients available for statistical analysis could also investigate the extent to which the effect of oral corticosteroids is influenced by baseline pain, sleep disturbance due to symptoms, occlusion of the ear canal or initial cleaning of the ear canal using suction under microscope. Did you know you can now log your CPD with a click of a button?
Background and objectives Acute otitis externa is often painful. The aim of this study was to evaluate the efficacy of 10 mg oral prednisolone twice daily for four days in addition to conventional therapy. Methods Patients attending general practice clinics in Far North Queensland, Australia, for acute painful otitis externa were given a study capsule with either 10 mg prednisone or placebo. Results Seventy-three patients were randomised. Results from 19 patients in the intervention group and 11 patients in the control group were analysed.
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