How is sensorineural hearing loss managed?

Management of Sensorineural Hearing Loss

The management of sensorineural hearing loss should include prompt diagnosis, appropriate medical intervention for potentially reversible causes, and rehabilitation strategies for those with permanent hearing loss, with corticosteroids being the primary medical treatment for idiopathic sudden sensorineural hearing loss. 1, 2

Diagnosis and Initial Assessment

• Distinguish sensorineural hearing loss (SNHL) from conductive hearing loss using tuning fork tests:

  • Weber test: Sound lateralizes to the affected ear in conductive loss and away from the affected ear in SNHL
  • Rinne test: Air conduction should be better than bone conduction; if bone conduction is better, conductive hearing loss is present 1, 2

• For sudden SNHL (SSNHL), defined as ≥30 dB hearing loss over at least 3 consecutive frequencies occurring within 72 hours:

  • Consider this a medical emergency requiring prompt evaluation
  • Diagnose idiopathic SSNHL (ISSNHL) if audiometry confirms criteria and no underlying cause is identified 1

• Assess for concerning features that may indicate specific underlying disorders:

  • Bilateral sudden hearing loss
  • Fluctuating hearing loss
  • Concurrent severe vestibular symptoms
  • Focal neurological findings
  • Recent head trauma 1

Evaluation for Underlying Causes

• Obtain MRI to evaluate for retrocochlear pathology (e.g., vestibular schwannoma)

  • If MRI is contraindicated, consider auditory brainstem response testing or audiometric follow-up 1, 3

• Do not routinely order:

  • CT of the head/brain for initial evaluation
  • Routine laboratory tests unless clinically indicated 1

Medical Management for Idiopathic SSNHL

• First-line treatment: Oral corticosteroids

  • May be offered as initial therapy for ISSNHL
  • Should be started promptly, ideally within the first 2 weeks 1, 4

• For patients with incomplete recovery or contraindications to systemic steroids:

  • Intratympanic steroid perfusion as either primary or salvage therapy 1, 5

• Not recommended for routine use:

  • Antiviral medications
  • Thrombolytics
  • Vasodilators or vasoactive substances
  • Antioxidants 1, 3

• Optional therapy:

  • Hyperbaric oxygen therapy may be considered within 3 months of diagnosis
  • Limited availability and cost may make this impractical 1, 3, 5

Rehabilitation for Permanent SNHL

• For patients with incomplete hearing recovery:

  • Counsel about the benefits of amplification and hearing-assistive technology
  • Discuss impact on communication, safety concerns, and quality of life 1, 2

• Amplification options:

  • Hearing aids for mild to severe hearing loss
  • Contralateral routing of signal (CROS) or bilateral CROS (BiCROS) systems for unilateral loss
  • Bone conduction devices
  • Cochlear implants for severe to profound hearing loss 2

Follow-up Care

• Obtain follow-up audiometric evaluation within 6 months of diagnosis
• Long-term follow-up is recommended as some patients may have underlying causes identified later
• Address psychological aspects, as incomplete recovery can lead to social isolation, anxiety, and depression 1, 6

Prognosis

• Approximately 32-65% of ISSNHL cases recover spontaneously, usually within about 2 weeks
• Factors affecting prognosis include:
  • Patient age
  • Presence of vertigo at onset
  • Degree of hearing loss
  • Audiometric configuration
  • Time between onset and treatment 1, 4, 7

Important Considerations

• Delayed diagnosis can lead to missed treatment opportunities
• Misdiagnosis can result in inappropriate treatment
• Incomplete evaluation may miss retrocochlear pathology
• The impact of unilateral hearing loss on quality of life is often underestimated 1, 2