The Impact of Perioperative Oral Steroid Use on Low-Frequency Hearing Preservation after Cochlear Implantation

Abstract

Objectives:

(1) Investigate factors that impact low frequency hearing preservation following cochlear implantation. (2) Evaluate the efficacy of a perioperative oral steroid taper in this setting.

Methods:

Retrospective series from a single surgeon at a tertiary academic referral center. Patients were candidates for a hearing preservation protocol based on their preoperative pure tone thresholds. The tympanic space was bathed in steroids prior to opening the round window membrane in all cases, and all patients were implanted using electrodes designed for atraumatic insertion. One group of patients received a 2-week oral prednisone taper beginning 3 days prior to surgery. The primary outcome measure was the preservation of low frequency pure tone hearing on a 1-month postoperative audiogram.

Results:

Twenty-two hearing preservation candidates were implanted during an 18-month period (mean age 50 years; range 3-80) ending in December 2013. Thirteen patients (59.1%, mean age 45.6 years) received the oral prednisone taper while 9 (40.9%, mean age 56.3 years) did not. There was no significant age difference between the groups (P = .18). Within the oral prednisone group, 84.6% of patients had at least a partial hearing preservation (23.1% complete preservation) compared with 33.3% (0% complete preservation) in those not taking prednisone (P < .01).

Conclusions:

Oral steroids may play a role in low-frequency hearing preservation following cochlear implantation. Though the optimal protocol has yet to be identified, a 2-week oral prednisone taper given 3 days before surgery appears to positively impact the rate of and degree of preservation.