As an Orange County hearing geek and Doctor of Audiology, I see multiple cases of sudden hearing loss every year and find that treatment options are not very well known by the public. This knowledge can save your hearing. So, let me give it a try and see if you understand this problem and know what to do should it happen to you or someone you know.
According to the National Institute on Deafness and Other Communication Disorders (NIDCD), sudden hearing loss (SHL) occurs at the rate of approximately 4,000 new cases each year. Sudden hearing loss is described as a loss of hearing that occurs in 3 days time. With the exception of the obvious ear wax in the canal or an ear infection, SHL is primarily an ear problem that is affecting the nerve and should not be discounted. There are a number of problems that may occur and the first symptom is hearing loss in one or both ears. In fact, there are more than 100 causes of SHL.
Sudden hearing loss is typically found only in one ear, but may occur in both. A sudden change in both ears is extremely rare and represents a serious health issue. Although hearing changes vary, many patients report that they noticed a loss in one ear upon awakening in the morning. Some identify the loss by listening to the telephone between ears or listening to television while plugging one ear at a time. Yet others discover the loss when lying down in bed on their pillow and switching sides. In addition to the loss of hearing, some patients also report ringing in the affected ear, dizziness, and fullness or pressure of the ear. The causes may vary considerable from one patient to another and so can the reported symptoms.
In a number of recent studies, patients with sudden hearing loss were evaluated for the cause. The results identified cases that were associated with viruses, high blood pressure, high cholesterol, autoimmune problems, stroke, tumors, and ear trauma, which ranged from sneezing to a cracked skull. Remarkably, a small percentage was associated with pregnancy and other obscure conditions. However, even with the best diagnostic capabilities many of the cases remain of unknown origin.
A moderate number of patients recover to some degree without treatment. However, current wisdom would suggest that SHL be treated at the onset with the correct medications as the rates of recovery are remarkably better than no treatment at all. The approach to treatment covers multiple problems because there are so many possibilities and there is literally no time to test for them all. Unless treatment is started within the first 24 to 48 hours, in most cases, there will be more permanent damage to the ear than necessary.
The treatment can be a single medication or combinations designed to reduce inflammation, treat a possible virus, and increase blood circulation into the inner ear. In cases of bacterial infection, antibiotics may also be prescribed and for Meniere’s disease a diuretic, viral medication and low salt diet may be part of regime, amongst others. Some researchers have reported that hyperbaric oxygen treatments or vitamins C and E show some promise. However, in most cases, steroid treatment is almost always
prescribed as part of the regime if not contraindicated, such as in cases of diabetes and other diseases that react negatively to prednisone for example.
The key to maximizing the treatment of SHL is preliminary hearing testing to demonstrating if the loss is from a middle ear infection or hearing
nerve damage. I frequently see patients in the office that had a SHL, only to find that the first treatment was antibiotics for a suspected middle ear infection and nerve damage was never addressed. By the time they are seen for testing, the opportunity to reverse and maximize recovery is lost.
The real gamble is whether the hearing will recover back to normal, partially, or not at all. Some patients will not completely recover and will benefit from properly fitted and adjusted hearing aids and other devices. I find that improvement with amplification can be substantial if the damaged ear can tolerate sound loudness and not vibrate or be severely distorted. However, in cases where standard amplification does not work, a bone anchored hearing aid (BAHA, cochlearamericas.com), TransEar wearable bone stimulator (transear.com), CROS and BICROS hearing aids, or a cochlear implant (cochlearamericas.com) can be very effective.
Regardless of the causation of SHL, the best opportunity for treatment is within the first 24 to 48 hours. Testing should be conducted on an emergency basis to identify the type of hearing loss and ensure proper treatment. This must be followed by a consultation with an ENT physician who is the best trained to maximize treatment and the recovery. Should residual hearing loss or dizziness occur, further diagnostic hearing and balance evaluations should be conducted to identify the extent of the disorder and provide best in class care, instrumentation, and services.
PHYSICIANS: Catch my feature article in the September 2008 issue of M.D. News on “Ideopathic Sudden Sensorineural Hearing Loss” for more technical information.