INI-CET EXAM -2026
Medical & Surgical Nursing
Easy
A patient develops acute-onset severe unilateral hearing loss with no identifiable cause. Audiometry confirms sensorineural hearing loss. Which of the following pharmacological regimens is considered the first-line treatment for this condition?
Appeared in: INI-CET EXAM -2026
Explanation
- The clinical presentation describes Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL), which is considered an otologic emergency.
- Oral systemic corticosteroids, like prednisolone, are the established first-line therapy for ISSNHL.
- The primary mechanism of action is reducing inflammation and edema within the cochlea and auditory nerve, which is the presumed cause in many idiopathic cases.
- Early initiation of steroid therapy is critical and is associated with a higher likelihood of partial or complete hearing recovery.
Why Other Options Were Wrong
- Option A: Intratympanic steroid injections are not the first-line treatment for most patients.
- Option B: Topical steroid ear drops cannot penetrate the tympanic membrane to reach the inner ear, where the sensorineural hearing loss originates.
- Option C: Gentamicin is an ototoxic antibiotic that can cause or worsen sensorineural hearing loss. Its use is contraindicated for treating this condition.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to First-line pharmacological treatment for Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL) to guide bedside assessment, documentation, and the next nursing action.
- Nurses must recognize sudden hearing loss as a medical emergency requiring prompt referral to an otolaryngologist for diagnosis and initiation of time-sensitive treatment.
- Patient education is a key nursing role, focusing on the importance of adherence to the steroid tapering schedule and monitoring for potential side effects like hyperglycemia, hypertension, mood changes, and insomnia.
- What if? If the patient had a history of poorly controlled diabetes or a peptic ulcer? In this case, systemic steroids would be relatively contraindicated, and the physician might choose intratympanic steroid injections as the first-line therapy to minimize systemic risks.
How to Approach the Question
- First, analyze the patient's symptoms: acute onset, unilateral, severe hearing loss confirmed as sensorineural, and idiopathic (no identifiable cause).
- Recognize this specific constellation of symptoms as the definition of Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL).
- Recall that ISSNHL is treated as an otologic emergency, and the goal is to reduce inflammation in the inner ear.
- Evaluate the treatment options based on their ability to deliver an anti-inflammatory agent to the cochlea and auditory nerve.
- Eliminate options that are ineffective (topical drops) or harmful (ototoxic antibiotics).
- Differentiate between first-line (systemic steroids) and second-line (intratympanic steroids) therapies to select the correct answer.
Concept Tested & Keywords
- Concept Tested: First-line pharmacological treatment for Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL).
- Stem keywords: acute-onset, severe unilateral hearing loss, no identifiable cause, audiometry, sensorineural hearing loss
- Lead-in keywords: first-line treatment
- Negative lead-in flag: false
Question ID
Q2vi4n7UPpZkRBEmKjsHSA
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1802-1804
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