Ophth-Otologic
3 cases on corticosteroid decisions in neuro-ophthalmologic and otologic disease — optic neuritis, idiopathic intracranial hypertension, and sudden sensorineural hearing loss — choose a case below to open its full multi-voice debate.
A single patient with acute optic neuritis and a clean brain MRI. High-dose IV corticosteroids won’t change her eventual vision — ONTT already established that — but they will get her back to functioning faster. The debate is whether that speed is worth a real glycemic cost for a guardian who can’t afford to be sidelined.
A single patient with idiopathic intracranial hypertension and real, if mild, visual field loss. Acetazolamide is the only drug shown to help patients at her exact severity, and an eight-year-old sulfa reaction may not be the reason to avoid it that it looks like.
A single patient with sudden sensorineural hearing loss and poorly controlled diabetes. Oral and intratympanic steroids work about the same — the real question is which route she can actually start today, and what the other one would cost her.