Steroids for the Prevention of Sensorineural Hearing Loss Secondary to Acute Otitis Media: A Systematic Review

Introduction Acute otitis media (AOM) is associated with the development of permanent sensorineural hearing loss (SNHL). The potential role of steroids in preventing cochlear damage secondary to AOM has been discussed. Objective To critically analyze the current evidence on the use of steroids to prevent AOM-associated SNHL. Data synthesis A total of 15 studies was categorized into 3 groups: 1) studies on histopathological changes in the inner ear secondary to AOM (n 5); 2) those on the relationship between AOM and hearing outcomes (n ¼ 5); and 3) studies on the (hearing or histological) outcomes of AOM treatment using steroids (n ¼ 5). Experimental studies in animals and human temporal bones revealed that AOM is associated with the upregulation of proinflammatory cytokines in the middle and inner ears, resulting in an inflammatory process. Inflammatory cytokines and bacterial toxins translocate from the middle to the inner ears through the semipermeable round window membrane, causing structural damage to the neuroepithelium, mainly in the cochlear basal turn. In experimental studies, the use of steroids has been shown to reduce the expression of inflammatory cells and cytokines and the structural damage affecting the stria vascularis and hair cells. One study clinically evaluated the effects of steroids on AOM patients with SNHL, and it demonstrated significant improvements in hearing thresholds. Conclusion Experimental data demonstrate that steroids can reduce the expression of inflammatory cytokines and reduce structural damage to the cochlear neurosensory epithelium. However, these findings have yet to be translated to a clinical setting due to the lack of high-level evidence.