Alternative treatment for hearing loss
Currently there is intriguing data that aldosterone supplementation may improve hearing. For those with hearing loss and balance disorders, this advancement could significantly improve quality of life. Aldosterone does not have the side effects of the current treatment with steroids (prednisone/prednisolone/dexamethasone) and may better address the underlying cause of hearing and vestibular disease.
Due to their anti-inflammatory and immune suppressive functions, glucocorticoids (steroids) have traditionally been used for suspected cases of inner ear inflammation – called immune mediated inner ear disease. Glucocorticoid treatment affects many areas of the body, and alters the feedback loop that naturally regulates the levels of glucocorticoids that result in homeostasis. For example, glucocorticoid ear drops greatly decrease natural levels of cortisol and in some people it may take a year for normal levels to return.
The status quo has been shaken in recent years due mainly to the work of two researchers in the U.S.: Dennis Trune of the Oregon Health & Science University and Robert Frisina of the University of South Florida. In a 2012 review of corticosteroid treatment for hearing loss and balance disorders, Trune & Canlon indicate that there are a number of misconceptions regarding the use of steroids. Efficacy of steroid use is equivocal, due to the complicated nature of hearing problems, small sample sizes, spontaneous recovery and little information about the underlying cause of the hearing and vestibular problem. Other studies have questioned the anti-inflammatory and immune suppression role of steroids to treat hearing and balance problems, and indicate that the mechanism of action may actually be sodium ion transport (Trune et al., 2000).
Aldosterone and hearing
This is where aldosterone comes in. Aldosterone is a naturally-occurring hormone called a mineralocorticoid – a type of steroid – which is produced in the adrenal glands. It influences sodium and potassium transport, which are important for hearing. As we age, aldosterone levels usually decrease. Some people also have low aldosterone levels due to other problems.
Frisina and colleagues reported in 2005 that aldosterone levels were significantly different in people with normal hearing and those with age-related hearing loss, called presbycusis. The authors concluded that aldosterone may have a protective effect on hearing. Aldosterone has been shown to be effective against Meniere’s disease which produces excess fluid in the inner ear (Pappas & Banyas, 1991). Synthetic aldosterone (fludrocortisone) plus low-dose prednisolone was effective at treating hearing loss in mice (Trune & Kempton, 2010). Thus, aldosterone may be a useful treatment for both immune-mediated and age-related hearing loss.
Aldosterone is not approved to treat hearing loss yet, but evidence is building. A clinical trial using fludrocortisone for sudden hearing loss is being conducted by the Oregon Health and Sciences University. A clinical study by Campos-Banales and colleagues comparing glucocorticoids, mineralcorticoids (fludrocortisone) and vasodilators for the treatment of a specific type of hearing loss (sensorineural hypoacusis) found that hearing gain was most significant with fludrocortisone. In addition, a physician in Washington, Dr. Jonathan Wright, has prescribed aldosterone to patients with low aldosterone levels, but he has not published his findings. More information on Dr. Wright’s work can be found in his article “Don’t go deaf, blind or lose your mind!”
Robert Frisina’s group has also recently applied for a patent to treat hearing loss using aldosterone, and is working with a pharmaceutical company to license the concept and bring this treatment to market.
Before you start treatment with aldosterone, keep in mind that its function is on sodium and calcium transport, and so aldosterone may affect blood pressure and too much increases the risk of stroke. Keeping aldosterone levels within the normal range is thus important and requires monitoring by a physician.
The Parsemus Foundation urges continued evaluation of aldosterone treatment for hearing and balance disorders. If the effect is confirmed, this simple treatment can begin helping the millions of people with hearing loss.
Campos-Banales EM, et al. (2015). A comparative study on efficacy of glucocorticoids, mineralocorticoids and vasoactive drugs on reversing hearing loss in patients suffering idiopathic sensorineural cochlear hypoacusis. A preliminary clinical trial. Acta Otorrinolaringol Esp. 2015;66:65–73. Free full text in English and Spanish.
Frisina RD. (2009) Age-related hearing loss: Ear and brain mechanisms. International Symposium on Olfaction and Taste: Ann. N.Y. Acad. Sci. 1170: 708–717.
Frisina RD. (2012). Hormones and hearing: Too much or too little of a good thing can be ototoxic. Seminars in Hearing 33:231-241. Free full text.
Frisina RD, Frisina DR.(2013). Physiological and neurobiological bases of age-related hearing loss: biotherapeutic implications.Am J Audiol. 22(2):299-302.
Frisina RD et al., (2016). Age-related hearing loss: prevention of threshold declines, cell loss and apoptosis in spiral ganglion neurons. Aging (Albany NY). 8(9):2081-2099. Free full text.
Halonen J et al., (2016). Long-term treatment with aldosterone slows the progression of age-related hearing loss. Hear Res. 336:63-71.
Pappas DG, Banyas JB. (1991) A newly recognized etiology of Meniere’s syndrome. A preliminary report. Acta OtolaryngolSuppl 485:104–107.
Trune DR, Canlon B. (2012) Corticosteroid therapy for hearing and balance disorders. Anatomical Rec. 295:1928-1943. Free full text.
Trune DR, Kempton JB. (2010). Low dose combination steroids control autoimmune mouse hearing loss. J. Neuroimmunol 229(1-2):140-145. Free full text.
Trune DR, Kempton JB, Kessi M. (2000) Aldosterone (mineralocorticoid) equivalent to prednisolone (glucocorticoid) in reversing hearing loss in MRL/MpJ-FASlpr autoimmune mice. Laryngoscope 110:1902-1906.