Can stress cause or contribute to sudden sensorineural hearing loss (SSNHL)?

The Relationship Between Stress and Sudden Sensorineural Hearing Loss

While stress is not definitively established as a direct cause of sudden sensorineural hearing loss (SSNHL), there is evidence suggesting stress may influence both the development and recovery from SSNHL through various physiological mechanisms.

Understanding SSNHL and Its Relationship with Stress

Sudden sensorineural hearing loss (SSNHL) is defined as a rapid-onset hearing loss of at least 30 dB over at least three contiguous frequencies occurring within 72 hours or less 1. In 85-90% of cases, despite thorough evaluation, the underlying cause remains unknown or uncertain at the time of presentation, classifying these as idiopathic SSNHL (ISSNHL) 1.

Several potential mechanisms may link stress to SSNHL:

1. Stress hormone effects: Research suggests that stress-related hormones may play a role in the pathogenesis of SSNHL. A 2021 study found that serum DHEAS levels correlated with hearing thresholds at diagnosis, and patients with elevated ACTH levels showed poorer hearing outcomes 2.

2. Treatment response influence: Patients with moderate stress levels showed significantly better results after steroid treatment for SSNHL compared to those with low or high stress levels, suggesting stress may affect treatment efficacy 3.

3. Psychological impact: SSNHL can cause significant psychological distress, with patients being 2.17 times more at risk for developing depressive disorders compared to those without SSNHL, particularly in younger patients (<60 years) 4.

Clinical Implications and Management

Assessment Considerations

When evaluating a patient with SSNHL:

• Look for clinical features that may suggest specific underlying causes rather than idiopathic SSNHL:

  • Prior episodes of fluctuating hearing loss
  • Bilateral sudden hearing loss (rare in ISSNHL)
  • Focal neurological findings
  • Vertigo or dizziness (present in 30-60% of cases and often associated with poorer prognosis) 1

• Do not routinely order laboratory tests or CT scans in patients with presumptive ISSNHL, as these do not improve management and have potential harms related to false results 1.

Treatment Approach

• Initiate systemic corticosteroids within 14 days of symptom onset for optimal outcomes 5.

• Monitor stress levels during treatment, as they may influence recovery:

  • Patients with moderate stress levels may respond better to steroid treatment than those with very low or very high stress levels 3.
  • Consider assessing depression using validated tools like the Beck Depression Inventory, as higher depression scores have been correlated with poorer hearing outcomes 2.

• Be aware that the psychological impact of SSNHL can be significant:

  • Nearly universal accompanying tinnitus can contribute intensely to anxiety and depression 1.
  • The sudden loss of hearing can cause fear, frustration, and psychological distress.

Long-term Management

• Follow-up is essential as some patients will have an underlying cause identified that may not be evident at initial presentation 1.

• For patients with partial or no hearing recovery:

  • Consider hearing aids or other assistive devices
  • Address persistent tinnitus with appropriate management strategies
  • Monitor for and address psychological impacts, particularly depression 4

• Implement effective communication strategies:

  • Face the person directly
  • Speak clearly
  • Minimize background noise
  • Use visual aids to supplement verbal communication 5

Important Considerations

• Quality of life impact: SSNHL, particularly when accompanied by tinnitus and dizziness, can result in significant decrements in quality of life 1.

• Psychological burden: The psychological response to sudden loss of a primary sense can be profound and requires attention from the healthcare team 1.

• Team approach: A multidisciplinary approach involving otolaryngology, audiology, and psychological support is encouraged for comprehensive management 1.

• Prognosis factors: Recovery prognosis depends on multiple factors including patient age, presence of vertigo at onset, degree of hearing loss, audiometric configuration, and time between onset and treatment 1.

While stress may not be definitively established as a direct cause of SSNHL, addressing stress levels and psychological impacts appears important for optimal management and recovery outcomes in patients with this condition.