What is the treatment for sudden sensory hearing loss?

Treatment for Sudden Sensorineural Hearing Loss

Oral corticosteroids are the first-line treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) and should be started promptly, ideally within the first 2 weeks of symptom onset. 1

Definition and Epidemiology

• Sudden sensorineural hearing loss (SSNHL) is defined as a rapid onset hearing loss occurring over a 72-hour period with ≥30 dB hearing loss over at least 3 consecutive frequencies 2, 1
• Affects 5-27 per 100,000 people annually, with approximately 66,000 new cases per year in the US 2, 1
• Considered a medical emergency requiring prompt evaluation and treatment 1

Diagnostic Approach

1. Distinguish SNHL from conductive hearing loss

   • Use tuning fork tests (Weber and Rinne) at initial presentation 2, 1
   • Obtain audiometry as soon as possible, within 14 days of symptom onset 2

2. Assess for concerning features

   • Bilateral sudden hearing loss
   • Recurrent episodes of sudden hearing loss
   • Focal neurologic findings
   • Severe vestibular symptoms 2, 1

3. Imaging and testing

   • MRI is recommended to evaluate for retrocochlear pathology (e.g., vestibular schwannoma) 2, 1
   • If MRI is contraindicated, consider auditory brainstem response testing 2, 1
   • Do not order routine head CT in initial evaluation 2
   • Do not obtain routine laboratory tests 2

Treatment Algorithm

First-Line Treatment

• Oral corticosteroids (e.g., prednisone) started promptly, ideally within first 2 weeks 2, 1, 3
• High-dose regimen recommended, though optimal dosing is not definitively established 4, 3

For Incomplete Recovery or Contraindications to Systemic Steroids

• Intratympanic steroid perfusion as either primary or salvage therapy, typically offered 2-6 weeks after symptom onset if incomplete recovery 2, 1

Not Recommended (Strong Evidence Against)

• Antivirals
• Thrombolytics
• Vasodilators or vasoactive substances 2, 1

Optional Therapy

• Hyperbaric oxygen therapy may be considered within 3 months of diagnosis, but availability and cost may be limiting factors 2, 1

Follow-Up and Rehabilitation

1. Audiometric evaluation

   • At conclusion of treatment
   • Within 6 months of completing treatment 2

2. For patients with residual hearing loss and/or tinnitus

   • Counsel about benefits of audiologic rehabilitation 2
   • Consider hearing amplification options:
     • Hearing aids
     • Contralateral routing of signal (CROS) systems
     • Bone conduction devices
     • For severe to profound loss: cochlear implants 2, 1

Prognosis

• Approximately 32-65% of cases recover spontaneously, usually within about 2 weeks 2, 1
• Factors affecting prognosis:
  • Patient age
  • Presence of vertigo at onset (worse prognosis)
  • Degree of hearing loss (severity significantly influences outcome) 1, 5
  • Audiometric configuration
  • Time between onset and treatment 2, 1

Common Patient Concerns to Address

• Risk of losing hearing in the other ear (very low)
• Treatment options and their risks/benefits
• Management strategies for unilateral hearing
• Amplification options if hearing does not fully recover 2

Caution

In divers or fliers with sudden SNHL, consider the possibility of perilymph fistula which may require surgical exploration rather than medical management 6.