Why steroids for a viral inner-ear infection?

February 14, 2007 8:24 PM

My doc thinks I may have a viral inner ear infection. He has prescribed prednisone. How does this help?

I had a cholesteatoma removed in Feb 2006 in a wall-up procedure. Subsequently I underwent surgery in Oct 2006 to take a second look and reconstruct the ossicular chain, with considerable success.

Now suddenly, in the same ear, I am losing hearing that seems to be inner-ear related. No vertigo or anything.

After explaining three or four possibilities, the doc suspects a viral inner ear infection, since I have also had a bad viral upper respiratory infection.

He's prescribed prednisone. What will that be trying to do in these circumstances?

While there are lots of mentions of prednisone in these circumstances, there doesn't seem to be much clarity for the lay-person as to what it's actually doing.

It's not anti-viral (or is it)? If it's suppressing immune response, why do that if I might have a viral infection?

I'm just curious, and will be following up with him in a week, but would love more elucidation.

posted by blue_wardrobe to health & fitness (18 comments total)

I believe prednisone is anti-inflammatory. In this case the logic would be to reduce swelling around your semicircular canals and allow you to keep your sense of balance.
posted by sourwookie at 8:28 PM on February 14, 2007

Yes, these sorts of steroids are significant anti-inflammatory preparations. Often, with serious sinus infections, a doctor will prescribe antibiotics and prednisone (or prednolosone [sp]) to help clear things up and bring down inflammation.
posted by Merdryn at 8:39 PM on February 14, 2007

Thanks for the ideas. So is the anti-inflammatory action what my doc is looking for to limit the inner-ear damage by a viral infection? And does the viral infection then just get fought off by the body's own defenses?

I guess I'm really trying to understand the two, three or four things that go on in these circumstances.

Perhaps I should have asked how the putative viral infection does its damage, and how one limits that damage, and is prednisone one such tool for the latter?
posted by blue_wardrobe at 8:48 PM on February 14, 2007

I think the prednisone is intended to combat your respiratory condition. It must be quite serious, because prednisone about as much subtlety as a nuclear weapon, and about as many side effects.

It's a powerful steroid the is prescribed to people with chronic respiratory diseases like severe asthma.

I suffer from asthma, and, once a year, I get a virus that overwhelms my usual low-key anti-asthma drugs. A year ago, I had problems breathing after contracting a virus, and the emergency doctor prescribed prednisone.

I caught the same cold this year, and had problems breathing (ventilin provided no help). Even so, I did not ask for prednisone.

It will fuck you up. For one thing, it can cause mild psychosis, severe irritability and mood swings. It is hard on your body. So be careful. I nearly lost my job after shouting at my boss while on the drug. It took a couple of days for these strange symptoms to go away.
posted by KokuRyu at 9:02 PM on February 14, 2007

Prednisone has no significant anti-viral action.

In some diseases which cause long term damage, it is a side effect of the immune response, rather than being a direct result of viral activity. Our immune systems are not perfected systems.
posted by Steven C. Den Beste at 9:06 PM on February 14, 2007

Is it possible that your doc couldn't rule out autoimmune inner ear disease and wanted to zap you with prednisone just in case? According to my doctor, it's much easier to prevent hearing loss with prednisone than to do anything about it once it's occurred, so I could see giving it to you as a precautionary measure, even if they're not sure that you have AIED.

I would call your doctor and ask this, though, because prednisone sucks, and it's not a drug that you want to take without good reason. (But do not stop taking it without consulting your doctor. Bad things will happen. You need to taper off of prednisone.)

(I'm not a doctor. Just someone with random autoimmune problems.)
posted by craichead at 9:14 PM on February 14, 2007

2nd KokoRyu. Have somebody you trust there for you to call in case you feel totally nuts. My friend was on prednisone for asthma late last year and basically had to take a leave of absence from school because she just wasn't all there. She kept instant messaging me in the middle of the night with distraught ideas about her brain...it was pretty upsetting.
posted by crinklebat at 9:14 PM on February 14, 2007

Thanks for the advice about the prednisone. I had two courses last year also before the cholesteatoma was finally diagnosed. I understood that time, because the doc was trying to shrink what looked like a polyp.
posted by blue_wardrobe at 9:17 PM on February 14, 2007

Prednisone can be used for immune modulating effects and, yes, anti-inflammation to reduce swelling.

The strange thing is here that he told you it was FOR the infection from the virus. Its an immune suppressant, and you need your immune system to fight the virus, so it's not working in that regard exactly. It's more like your immune system in fighting the virus got out of whack and caused swelling -- so the prednisone modulates the response so its not so crazy. Remember, all your immune cells care about is get rid of invader, collateral damage be dammed!

Antibtics are going to be usd for BACTERIAL infections. You use anti-virus drugs for virus infections (like HIV).

I hope you get better soon. Is you prednisone a tapered dosage? That is, by the fifth day or so you take a lot fewer pills?
posted by skepticallypleased at 9:20 PM on February 14, 2007

SCDB: good point. I assume therefore that in inner ear viral diseases, the immune response is sometime what does the damage.

craichead: AIED wasn't mentioned. Does AIED tend to affect both ears at once, or can it occur one sidedly?
posted by blue_wardrobe at 9:23 PM on February 14, 2007

skepticallypleased:
The doc didn't say it was FOR the infection from the virus. He didn't really explain, but was explaining all the other possibilities also, and may have been heading off something else. Hence my question, and I will indeed ask him when I see him again.

This time (unlike my two previous times) it's not a taper pack. I asked him why, and he said he wanted not to use a taper pack, and again didn't get an explanation so much as reassurance.

I kind of like explanations better, but am highly confident in this particular doc, and don't always manage to get every question answered every time. Mostly my own omission.
posted by blue_wardrobe at 9:27 PM on February 14, 2007

The most extreme example of negative side effects from immune overreaction I know of is anaphylactic shock, which can kill you stone dead within ten minutes of onset through respiratory failure. (The treatment is an immediate injection of epinephrine.)

River Blindness is a weird case. It's common in certain parts of Africa and it's caused by a parasite. Only it isn't the parasite that makes you blind. Sometimes they collect in the cornea, and if that happens repeatedly the immune response there to kill them also will cause fogging of the cornea. Too much of that and the cornea becomes permanently opaque.

Fever as a disease symptom isn't actually caused by the disease. Certain white blood cells release a hormone when they detect disease pathogens. That hormone is detected by the hypothalamus which responds by turning up the thermostat. The purpose of a fever is to increase the rate of chemical reactions in the body so that the process of dealing with the disease takes place more rapidly. However, in some extreme cases there can be too much hormone released, leading to an extremely high fever that can cause brain damage.

Serious local inflammation can also result in long term damage, and I find it completely plausible that it could lead to partial deafness in the case of an inner ear infection, either by neural damage or by damage to the physical mechanisms. (For instance, really serious inflammation could interfere with local blood flow and lead to localized cell death, especially among nerves.)
posted by Steven C. Den Beste at 11:27 PM on February 14, 2007

The side-effects of prednisone can be pretty strong, but it really depends on the dosage you're taking and how long for.

My dad has been on high-doses of prednisone for several years (to treat myasthenia gravis, an auto-immune disorder), and he displays the predicted bloating, hypertension, mood swings, insomnia, etc.

Some time back, I took a mild dose for a few months to treat a flare-up of my asthma. I didn't experience any side effects whatsoever.

I imagine that your experience will be closer to mine.
posted by randomstriker at 12:16 AM on February 15, 2007

The diagnosis in question here is "sudden sensorineural hearing loss" which has a lot in common with Bell palsy.

Basically the 8th cranial nerve travels out through the skull in a pretty tight canal. There's not a lot of space in there. When the nerve gets infected with a virus we hypothesize that it swells up in this confined space and this is not good for it, causing the nerve to die.

What we know about SSNHL and Bell palsy from clinical trials is that if given early enough (first 48 hours), steroids can reduce or eliminate the amount of long term damage to the nerve.

One of the problems with this is that no one dies of SSNHL or Bell palsy so we don't get a corpse to dissect to confirm our ideas about exactly what's happening in there.
posted by ikkyu2 at 4:55 AM on February 15, 2007 [1 favorite has favorites]

The side-effects of prednisone can be pretty strong, but it really depends on the dosage you're taking and how long for.
Seconded.
My son is away at school and developed a nasty bronchial infection. In addition to antibiotics, the local doc put him on a course of prednisone. Emotionally, he headed straight downhill after that. He became extremely moody, agitated and depressed. It scared the bejeesus out of him, as well as us. Once he got off the prednisone, he came back up for air.
Pretty scary stuff.
posted by Thorzdad at 7:02 AM on February 15, 2007

Iikyu2: Thanks for the info. Now his actions seem to make sense. Hearing seems to be recovered a little. Still got to take the rest of the course and get another hearing test on Wednesday.
posted by blue_wardrobe at 2:41 PM on February 16, 2007

I was took Prednisone a lot as a child for Asthma. Now that I'm an adult and see how those side-effects changed my life, I'm wishing something else had been prescribed.
posted by IndigoSkye at 7:49 AM on February 18, 2007

So, had the hearing test today. No notable improvement, so it's on to the next working hypothesis of Meniere's.

Diuretics + low sodium diet. On top of low carb, low calorie diet for Type II diabetes.

Oh, what joy!
posted by blue_wardrobe at 6:23 PM on February 20, 2007