According to the National Institute on Deafness and Other Communication Disorders (The National Institute of Health), sudden hearing loss occurs at the rate of approximately 4,000 new cases each year. If you, or someone you know has a sudden hearing loss (SHL), do not hesitate to see an Ear, Nose, and Throat Physician and don’t wait for your HMO to approve it! There are important reasons why this is crucial and why the ENT physician is the specialist to see. The most compelling reason is the fact that some diseases continue to cause hearing damage after the initial insult and most respond better to treatment earlier in the process. Based on the best possible outcome, the initial treatment should be within the first or second day of onset. The ENT physician is the specialist of choice, because he or she is trained to diagnose the condition and provide the best medical treatment to aid in hearing recovery. An Audiologist is frequently consulted to perform diagnostic testing, confirm the origin of the hearing loss, and provide rehabilitation. Allow me to review some of the problems associated with sudden hearing loss and you will understand why this is the best recommendation you can get.
The issue is whether the hearing loss is due to ear wax, an ear infection, or a cold or is it because there is significant nerve damage in the inner ear. In rare and more extreme cases, the brain. In the typical case of SHL, there is frequently no pain or outward signs even though there can be serious consequences. The causes of SHL are many. Well-known culprits of SHL are viruses and vascular diseases, but there are others. We should also be reminded that senior patients with low immune systems are more susceptible to infection (influenza,pneumonia, and others) and consequently at a greater risk for SHL.
SHL is typically described as any loss of hearing that occurs in less than 3 day’s time. Some cases of sudden hearing loss progress over a short period of time and others more immediately. There are cases of hearing loss occurring within minutes; however, for the most part patients report that they noticed the loss in one ear upon awakening in the morning. Sudden hearing loss in both ears is extremely rare and requires immediate treatment and a trip to the emergency room. In addition to the loss of hearing, approximately 90% of the patients report tinnitus or ringing the ears, 40% reported dizziness, and 40% reported fullness in one or both ears.
In a recent study of 837 patients with sudden hearing loss (B Fetterman, J Sanders, &W Luxford, (1996), The American Journal of Otology, pp.529), 17% had an associated virus, 17% had hypertension, 13% had small blood vessel disease (high cholesterol noted), and 9% had trauma, which ranged from sneezing to head injury. In the same study, thirty-two patients reported that the SHL occurred during airplane travel. Other secondary conditions included 3% with autoimmune deficiencies and even 1% was associated with pregnancy. The results of this and other similar studies points out the fact that there are a variety of conditions that produce SHL. The ENT physician will determine the best treatment based on individual history,physical examination, medical considerations, contraindications, and the diagnosis.
The gamble is whether the hearing will recover back to normal, partially, or not at all. According to articles by physicians from the House Ear Institute and USC, approximately 35 to 50% of patients recover without any treatment. The remaining patients have various degrees of hearing loss. In some cases, even amplification may not be sufficient to make the ear usable. In many cases that receive the best possible treatment, partial or total hearing loss can remain. In these cases, properly fitted and adjusted hearing aid should be obtained as recommended by your Audiologist. Improvement with amplification can be substantial if the damaged ear can tolerate the needed loudness, and sound is not vibrating or severely distorted as to cause irritation or discomfort.
In any event and for all patients with SHL, the best opportunity for treatment is within the first 24 to 48 hours after the initial change in hearing. The hearing loss, in most cases, will be accompanied by ringing in an ear and to a lesser degree ear fullness or dizziness may also occur. Seeing an ENT physician to diagnose the condition and provide appropriate treatment can be highly beneficial. Consulting an Audiologist for diagnostic testing upon the onset of the loss and thereafter for hearing rehabilitation is always indicated.