What is the treatment for Sudden Sensorineural Hearing Loss (SSNHL)?

Treatment for Sudden Sensorineural Hearing Loss (SSNHL)

Corticosteroids are the primary treatment for sudden sensorineural hearing loss, with oral steroids recommended as initial therapy within the first 14 days of symptom onset, followed by intratympanic steroid injections as salvage therapy if initial treatment fails.

Diagnosis and Initial Evaluation

• Distinguish sensorineural from conductive hearing loss through physical examination
• Confirm SSNHL with audiometry within 14 days of symptom onset (≥30 dB loss at 3 consecutive frequencies)
• Evaluate for retrocochlear pathology with MRI or auditory brainstem response (ABR) testing 1
• Assess for bilateral hearing loss, recurrent episodes, or focal neurologic findings that may indicate specific underlying causes 2

Initial Treatment Options

Oral Corticosteroids (First-Line)

• Recommended regimen: Prednisone 1 mg/kg/day (maximum 60 mg daily) as a single dose for 10-14 days, followed by a taper over a similar period 1, 2
• Equivalent alternatives: Methylprednisolone 48 mg/day or Dexamethasone 10 mg/day 1
• Begin treatment as soon as possible, ideally within first 14 days of symptom onset 1, 2

Intratympanic Steroids

• Can be used as initial therapy, particularly in patients with contraindications to systemic steroids 2
• Recommended agents: Dexamethasone 24 mg/mL (compounded) or 10 mg/mL (stock) 1
• Administration: Anterosuperior myringotomy after topical anesthetic, with multiple injections over 2 weeks 1

Hyperbaric Oxygen Therapy (HBOT)

• May be offered in combination with steroid therapy within 2 weeks of symptom onset 1
• Can also be used as salvage therapy within 1 month of symptom onset 1

Salvage Therapy (for Incomplete Recovery)

• Intratympanic steroid therapy should be offered when patients have incomplete recovery 2-6 weeks after symptom onset 1
• Combined intratympanic and systemic steroid therapy has shown better outcomes than systemic steroids alone in patients with poor prognostic factors 3

Treatments to Avoid

• Do not routinely prescribe antivirals, thrombolytics, vasodilators, or vasoactive substances 1
• Avoid routine CT of the head or laboratory tests in initial evaluation 1

Prognostic Factors

• Better outcomes associated with:
  • Earlier treatment initiation (within 14 days) 2, 4
  • Milder initial hearing loss 4
  • Absence of vertigo 5
• Approximately one-third to two-thirds of patients recover some hearing within 2 weeks 1, 2

Follow-up and Rehabilitation

• Obtain audiometric evaluation at the conclusion of treatment and within 6 months 1
• Counsel patients with residual hearing loss about audiologic rehabilitation options, including amplification and hearing-assistive technology 1, 2
• Consider psychological support for patients experiencing anxiety, depression, or social isolation due to hearing loss 1

Special Considerations

• Patients with contraindications to systemic steroids (insulin-dependent diabetes, labile hypertension, glaucoma, tuberculosis, peptic ulcer disease, prior psychiatric reactions) may benefit from intratympanic steroid injections instead 2
• High-dose steroid regimens may provide greater hearing recovery in some patients, though evidence is mixed 6