Management Options for Sensorineural Hearing Loss
For patients with sensorineural hearing loss (SNHL), amplification through hearing aids and assistive listening devices should be the primary management approach, with surgical options like cochlear implants reserved for severe to profound cases that don't respond to conventional amplification. 1
Initial Management and Counseling
Immediate Counseling
- Begin counseling immediately after diagnosis rather than waiting to see if hearing recovers 2
- Address common patient concerns including:
- Potential for hearing recovery
- Risk of hearing loss in the unaffected ear
- Available treatment options and their risks/benefits
- Management strategies for unilateral hearing loss 2
Assessment Tools
- Use standardized tools to measure impact on quality of life:
- Hearing Handicap Inventory for Adults (HHIA)
- Hearing Handicap Inventory for the Elderly (HHIE)
- Tinnitus Handicap Inventory for associated tinnitus 2
Amplification Options
Conventional Hearing Aids
- Monaural hearing aids for patients who can benefit from amplification in the affected ear
- Significantly improves quality of life by reducing psychosocial and emotional manifestations 2
CROS/BiCROS Systems
- Contralateral Routing of Signal (CROS) hearing aids for unilateral hearing loss
- Microphone on impaired ear transmits sound to the better ear
- Modern digital versions are smaller and more cosmetically acceptable
- Bilateral Contralateral Routing of Signals (BiCROS) for patients with pre-existing hearing loss in the better ear 2
Hearing Assistive Technology Systems (HATS)
- Useful during initial treatment stages and for specific listening environments
- Include headphones with handheld/lapel-worn microphones
- Sound transmitted via hardwire, infrared, or FM technology
- Consider auditory, visual, and tactile alerting systems for safety 2
Surgical Options
Bone Conduction Devices
- Osseointegrated bone conductive implants transfer sound from affected side to better-hearing cochlea
- Non-surgical headband options available for non-surgical candidates
- Deep intracanal devices provide non-surgical bone conduction sound transmission 2
Cochlear Implantation
- Option for unrecovered severe to profound SNHL
- Particularly beneficial for patients with associated tinnitus (96% report improvement)
- Improves sound localization and speech discrimination
- Evidence supports use in asymmetric hearing loss when the poorer ear meets implant criteria 2, 3
- Patients with postlingual onset of severe hearing loss show greater benefit than those with pre/perilingual onset 3
Follow-up and Rehabilitation
Audiometric Monitoring
- Obtain follow-up audiometric evaluation within 6 months of diagnosis
- Continue long-term follow-up to identify any underlying causes that may emerge later 1
Rehabilitation Support
- Consider internet-delivered rehabilitation interventions
- Refer to consumer-based organizations like Hearing Loss Association of America for support and information 2
Prognosis Factors
- Recovery rates vary (32-65% recover spontaneously, usually within 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
Common Pitfalls to Avoid
- Delayed intervention: Don't wait to address hearing rehabilitation needs; begin counseling and discussing options immediately after diagnosis 2
- Overlooking psychosocial impact: Even unilateral hearing loss significantly impacts quality of life and safety (sound localization difficulties) 2
- Limiting options to conventional hearing aids: Consider the full range of technologies including CROS/BiCROS systems, bone conduction devices, and cochlear implants 2
- Neglecting associated symptoms: Address tinnitus and balance issues which often accompany SNHL 2
- Underestimating rehabilitation needs: SNHL patients often require extensive multidisciplinary rehabilitation 2
Special Considerations for Sudden SNHL
- For sudden SNHL specifically, oral corticosteroids are first-line treatment, ideally started within 2 weeks
- Intratympanic steroid perfusion may be considered as primary or salvage therapy (2-6 weeks after onset)
- Hyperbaric oxygen therapy is an optional therapy within 3 months of diagnosis
- Avoid routine use of antivirals, thrombolytics, vasodilators, and antioxidants 1