# 330 Sudden Sensorineural Hearing Loss
You feel that you, and the patient before you, are fortunate because, working nearby, he presented about half an hour following the sudden onset of unilateral tinnitus, fullness, and marked loss of hearing. You explain this to him and say that it favors possible improvement or recovery of hearing if he takes a course of steroids and follow up with an Otologist. Prompt presentation is not as common as it should be. That it is an emergency needing prompt treatment is not always realized by patients.
90% of cases are idiopathic. "Sudden sensorineural hearing loss affects 5 to 27 per 100,000 people annually, with about 66,000 new cases per year in the United States." [Executive Summary] Tinnitus, which can be loud, diminished hearing, loss of aural directionality, vertigo and dizziness, can be stressful and discouraging to patients, possibly even impairing their livelihood.
Contact your consultant, be guided in management, and refer for follow up. Some patients may recover spontaneously, but it is considered best practice to initiate steroids promptly.
- Changes to the key action statements (KASs) from the original guideline:
- KAS 1: When a patient first presents with sudden hearing loss, conductive hearing loss should be distinguished from sensorineural.
- KAS 2: The utility of history and physical examination when assessing for modifying factors is emphasized.
- KAS 3: The word routine is added to clarify that this statement addresses a nontargeted head computed tomography scan that is often ordered in the emergency room setting for patients presenting with sudden hearing loss. It does not refer to targeted scans such as a temporal bone computed tomography scan to assess for temporal bone pathology.
- KAS 4: The importance of audiometric confirmation of hearing status as soon as possible and within 14 days of symptom onset is emphasized.
- KAS 5: New studies were added to confirm the lack of benefit of nontargeted laboratory testing in sudden sensorineural hearing loss.
- KAS 6: Audiometric follow-up is excluded as a reasonable workup for retrocochlear pathology. Magnetic resonance imaging, computed tomography scan if magnetic resonance imaging cannot be done, or, secondarily, auditory brainstem response evaluation are the modalities recommended. A time frame for such testing is not specified, nor is it specified which clinician should be ordering this workup; however, it is implied that it would be the general or subspecialty otolaryngologist.
- KAS 7: The importance of shared decision making is highlighted, and salient points are emphasized.
- KAS 8: The option for corticosteroid intervention within 2 weeks of symptom onset is emphasized.
- KAS 9: Changed to KAS 9a and 9b; hyperbaric oxygen therapy remains an option but only when combined with steroid therapy for either initial treatment (9a) or for salvage therapy (9b). The timing is within 2 weeks of onset for initial therapy and within 1 month of onset of sudden sensorineural hearing loss for salvage therapy.
- KAS 10: Intratympanic steroid therapy for salvage is recommended within 2 to 6 weeks following onset of sudden sensorineural hearing loss. The time to treatment is defined and emphasized.
- KAS 11: Antioxidants were removed from the list of interventions that the clinical practice guideline recommends against using.
- KAS 12: Follow-up audiometry at conclusion of treatment and also within 6 months posttreatment is added.
- KAS 13: This statement on audiologic rehabilitation includes patients who have residual hearing loss and/or tinnitus who may benefit from treatment. [Executive Summary]
Tara Haelle. New Guideline Issued for Sudden Hearing Loss. Medscape.com. Aust 7th, 2019.
Sujana S. Chandrasekhar, MD, et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngology–Head and Neck Surgery. First Published August 1, 2019. [PDF] https://doi.org/10.1177/0194599819859885
Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary [PDF]
Plain Language Summary: Sudden Hearing Loss. [PDF]
Julia Belluz. Sudden hearing loss is a health emergency — but few people know it exists. VoxMedia.com September 27th, 2018.
Rachel Ely, DO, MHA, NRP. ED Management of Acute Hearing Loss: Pearls and Pitfalls. emDocs.net. September 10th, 2019.
Vijayendra, H., Buggaveeti, G., Parikh, B., & Sangitha, R. (2012). Sudden sensorineural hearing loss: an otologic emergency. Indian Journal of Otolaryngology and Head & Neck Surgery, 64(1), 1-4. (Free Access] PMID: 23448732 PMCID: PMC3244585 [PDF]
DOI: 10.1007/s12070-010-0049-x
Sommer, L, Ivankovic, M, Helman, A. Episode 38: ENT Emergencies Pearls, Pitfalls, Tips and Tricks. EmergencyMedicineCases.com. November 2013. [Webpage & Podcast] https://emergencymedicinecases.com/ent-emergencies/.
Olex-Zarychta, D. (2017). Successful treatment of sudden sensorineural hearing loss by means of pharmacotherapy combined with early hyperbaric oxygen therapy: Case report. Medicine, 96(51). Published online 2017 Dec 22. PMID: 29390550 PMCID: PMC5758252 [Free Access] [PDF] DOI: 10.1097/MD.0000000000009397
Donna Rohwer. Sudden Hearing Loss Is a Medical Emergency. Hearing Health Foundation. November 1st, 2018.
