From the Guidelines
Acute hearing loss requires prompt medical attention, and the diagnostic process should begin with a detailed medical history and physical examination, focusing on the ear canal and tympanic membrane, as recommended by the 2019 clinical practice guideline update 1. The diagnostic steps for acute hearing loss include:
- Audiometric testing to determine the type and severity of hearing loss
- Tympanometry to assess middle ear function
- Acoustic reflex testing
- Otoacoustic emissions
- Blood tests to identify underlying conditions like infections or autoimmune disorders
- Imaging studies such as MRI or CT scans to rule out structural abnormalities or tumors
For sudden sensorineural hearing loss (SSHL), oral corticosteroids, typically prednisone at 1 mg/kg/day (maximum 60 mg daily) for 10-14 days with a gradual taper, are the primary treatment, as suggested by the 2019 guideline update 1. Intratympanic steroid injections, usually dexamethasone 10-24 mg/mL, may be used as primary therapy or as salvage treatment when oral steroids fail. For conductive hearing loss, treatment addresses the underlying cause, such as:
- Antibiotics for infections (amoxicillin 500 mg three times daily for 7-10 days for acute otitis media)
- Removal of impacted cerumen Hyperbaric oxygen therapy may be considered as an adjunctive treatment within 2-4 weeks of onset. Patients should avoid loud noises during recovery and follow up within 1-2 weeks to monitor progress. Early intervention within the first 1-2 weeks of symptom onset significantly improves the chances of hearing recovery, as delayed treatment may result in permanent hearing loss, as emphasized by the 2019 guideline update 1.
The importance of shared decision making and patient education is highlighted in the 2019 guideline update 1, and follow-up audiometry at conclusion of treatment and also within 6 months post-treatment is recommended 1. Audiologic rehabilitation, including patients who have residual hearing loss and/or tinnitus, may benefit from treatment, as stated in the 2019 guideline update 1.
In terms of specific treatment options, the 2019 guideline update recommends corticosteroid intervention within 2 weeks of symptom onset, and hyperbaric oxygen therapy remains an option but only when combined with steroid therapy for either initial treatment or salvage therapy 1. Intratympanic steroid therapy for salvage is recommended within 2 to 6 weeks following onset of sudden sensorineural hearing loss, as suggested by the 2019 guideline update 1.
Overall, the diagnostic and treatment approach for acute hearing loss should prioritize prompt medical attention, accurate diagnosis, and evidence-based treatment, with a focus on improving hearing recovery and patient quality of life, as recommended by the 2019 clinical practice guideline update 1.
From the Research
Diagnostic Steps for Acute Hearing Loss
- A thorough history and examination should be conducted, including a pure tone audiogram (PTA) where possible 2
- Baseline and targeted laboratory tests should be carried out to diagnose specific conditions 2
- Imaging studies, such as MRI, should be performed in all cases of idiopathic sudden sensorineural hearing loss (ISSNHL) 2, 3
- If MRI imaging is contraindicated, either CT or auditory brainstem response (ABR) testing should be performed 2
Treatment Options for Acute Hearing Loss
- If a specific cause for sudden sensorineural hearing loss (SSNHL) is found, the patient should be managed accordingly 2
- If idiopathic in nature, patients may be offered a course of oral steroid 2
- Intratympanic steroids, such as dexamethasone, may be considered as primary or salvage therapy, especially for patients who cannot tolerate systemic steroids 4, 5
- There is no evidence to support the routine use of antiviral therapy, hyperbaric oxygen therapy, or vasodilator and vasoactive agents 2
Follow-up and Rehabilitation
- Follow-up should be done at regular intervals, including tonal and speech audiometries, to assess treatment outcomes 3
- Consideration should be given to both temporary and permanent hearing amplification when required 2
- Patients should be counseled on the importance of protecting their hearing and the potential benefits of hearing aids or other rehabilitation options 6