Sudden Sensorineural Hearing Loss

Red flags

  • Make sure that you are dealing with a sudden sensorineural hearing loss (SSNHL). There must be no history of head trauma, recent ear surgery or any signs of systemic illness eg meningitis. These symptoms would point you to another diagnosis such as temporal bone fracture or post-operative vestibulocochlear failure.

 

Why is this important? 

Hearing loss can be debilitating and may affect patients with pre-existing chronic hearing loss. 

     

    When to involve the ENT registrar

    During working hours if you need a specialist opinion.

     

    Who to admit

    Most UK ENT departments would not admit patients with SSNHL. 

     

    Assessment and Recognition

    The aetiology of SSNHL is not clear; it is also known as idiopathic sensorineural hearing loss. Prevalent hypotheses include i) atheromatous blockage of the vestibulocochlear blood supply and ii) viral neuronitis. A small minority of patients will have a vestibular schwannoma (acoustic neuroma). 

    Patients will present with a history of sudden hearing loss. It is almost always unilateral. Many seem to go to bed fine and wake up with deafness. There may be associated tinnitus or vertigo but there should be no significant otalgia, or any discharge or focal neurology. 

    This usually prompts them to seek medical help urgently. Occasionally, patients with pre-existing hearing loss may not notice until a family member notices worsening deafness or that the television volume is turned further up.  

    • Take a full history and perform a full examination of the ears, including otoscopy, facial nerve examination and balance tests; it is prudent to document general neurological findings ie GCS, mobility etc.
    • If you are seeing the patient during working hours and have access to Audiology support, ask whether they can perform an urgent audiogram for SSNHL
    • If not, perform bedside hearing tests and document the results clearly; make arrangements for the patient to re-attend for an urgent audiogram during the next working day

     

    Immediate and overnight management

    Higher-quality evidence for the treatment of SSNHL is contradictory in many cases. The following is based on Cochrane Reviews and trials:

    • There is no good evidence for benefit, but many units have a policy of prescribing oral steroid eg 60mg prednisolone reducing over ten days; if you prescribe steroid, you should consider gastric protection 
    • There is no good evidence for benefit, but many units have a policy of prescribing anti-virals eg aciclovir for five days
    • There is some evidence for the benefit of using hyperbaric oxygen therapy but this may not be available to every unit; you can check with the ENT team during working hours
    • There is no good evidence for the use of vasodilators like carbogen 
    • Request an MRI IAMs (internal auditory meatus) as an outpatient
    • The patient should be followed-up in a clinic that has Audiology support - please note that many emergency clinics will not have access to Audiology so please liaise with the ENT team

     

    Further management 

    For many patients, hearing will recover spontaneously: studies suggest that around two-thirds will recover. The presence of vertigo may be a poor prognostic sign. 

    For those with persistent hearing loss, hearing aids may be an option if the loss is not profound. Hearing therapy (available through many Audiology departments) can also help people to deal with hearing loss and tinnitus. 

     

    References

    Wei BPC, Stathopoulos D, O'Leary S (2013). Steroids for idiopathic sudden sensorineural hearing loss (Cochrane Review).

     

     

     

    Page last reviewed: 23 September 2016