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Sudden Hearing Loss

By Adrian Roberts, M.D.

Sudden hearing loss is a frightening symptom and typically results in a physician visit or a trip to the emergency room. It is more common than you might think and occurs at a rate of 5-20 cases for every 100,000 population, or about 4000 cases a year in the United States. The cause for the hearing loss can be variable with virus infection, blood flow compromise, autoimmune disorders, and medication side effects as some of the possibilities.

The typical presentation is a sudden drop in hearing in one or both ears over a <72 hour period. Patients frequently also complain of ringing in the affected ear(s) or tinnitus and can also get a fullness in the ear like it feels stuffed up. Sometimes this can lead to a delay in seeking medical help as people assume they just have fluid in the ear or wax. It is important, however, that patients are referred to an audiologist for hearing testing if the cause for the loss is unclear so that an accurate cause for the decrease in hearing can be found. When the loss is from fluid or wax it is called a conductive hearing loss, whereas when it is from damage to the inner ear or hearing nerve it is called a sensorineural loss. The sensorineural loss can be permanent and may not be correctable even with hearing aids, so it is important to identify that it is the cause of any sudden hearing deficit.

The natural course of sudden hearing loss can vary on several factors including the patient’s age, presence of vertigo at onset, degree of hearing loss, audiometric configuration and time between onset of the hearing loss and treatment. The only one of these variables we can change is the time between the loss and treatment, again emphasizing the importance of early diagnosis. The generally accepted first treatment for sudden hearing loss is to give high dose steroids my mouth. The typical spontaneous recovery ranges from one third to two thirds of patients so any improvement in those odds  makes a substantial difference. When the steroids are given more than 2 weeks after the onset of the hearing loss, however, they do not help with hearing recovery. When the oral steroids fail to improve the hearing another option is to deliver the steroid by injecting it directly through the eardrum into the middle ear. Generally studies have shown an overall benefit in recovery of patients who are salvaged in this manner, though the results have been somewhat variable. Another option might be the use of hyperbaric oxygen, though it is very expensive and for every 5 people who are treated only one person will improve and only by 25%. It should be given within 3 months of the hearing loss to offer any chance of improvement in outcome.

In conclusion, taking care of your general health with regular exercise and a healthy diet will also keep your ear and hearing healthy as well. Should you ever suffer from a sudden change in hearing, however, it is critical that you seek help quickly so that an appropriate diagnosis and effective treatment can be made.

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