Treatment Options for Hearing Loss
The most effective treatment for hearing loss depends on the type, severity, and cause of the hearing impairment, with options ranging from hearing aids for mild to severe sensorineural hearing loss to cochlear implants for profound hearing loss that doesn't respond to conventional amplification. 1
Diagnostic Assessment
- Distinguish between conductive and sensorineural hearing loss through comprehensive audiometric evaluation including air and bone conduction threshold measures, speech audiometry, and otoacoustic emission testing 1
- Evaluate for sudden sensorineural hearing loss (SSNHL), defined as rapid onset hearing impairment occurring over a 72-hour period, which requires urgent intervention 2
- Perform physical examination to identify potential causes such as cerumen impaction, tympanic membrane abnormalities, or middle ear pathology 3
Treatment Options by Type of Hearing Loss
Conductive Hearing Loss
- Remove cerumen impaction through irrigation or curettage, which can be potentially curative 3
- Consider surgical intervention for malformations of the outer and middle ears, including bone-anchored hearing aids when appropriate 2
- Treat persistent otitis media with effusion (OME) promptly, especially in patients with underlying sensorineural hearing loss 2
Sensorineural Hearing Loss (SNHL)
Sudden SNHL (SSNHL)
- Offer corticosteroid therapy within 2 weeks of symptom onset as initial treatment 2, 1
- Consider intratympanic steroid therapy for salvage treatment within 2-6 weeks following onset if initial treatment fails 2
- Hyperbaric oxygen therapy may be an option when combined with steroid therapy, either as initial treatment (within 2 weeks) or salvage therapy (within 1 month) 2
Age-Related or Other Chronic SNHL
- Recommend hearing aids as first-line management for residual hearing 1
- Consider cochlear implantation for severe to profound bilateral hearing loss when hearing aids provide insufficient benefit 1
- Implement audiologic rehabilitation addressing communication strategies, assistive listening devices, and counseling 1
Follow-Up Care
- Obtain audiometric evaluation at the conclusion of treatment and within 6 months of completion 2, 1
- Monitor hearing status regularly to assess for changes and adjust management accordingly 1
- Address psychological impacts of hearing loss, particularly tinnitus which frequently accompanies SSNHL and can contribute to anxiety and depression 2
Special Considerations
- For asymmetric or sudden sensorineural hearing loss, obtain MRI of the brain and internal auditory canals to rule out retrocochlear pathology such as vestibular schwannoma 1
- Auditory brainstem response testing may be considered as an alternative screening tool when MRI cannot be performed 1
- Avoid delay in audiologic rehabilitation as it can lead to auditory deprivation and poorer outcomes 1
- For children with unilateral hearing loss, assess for appropriateness of hearing aid fitting based on degree of residual hearing 2
Common Pitfalls to Avoid
- Delaying treatment for sudden sensorineural hearing loss—prompt intervention within 14 days of symptom onset is critical 2
- Failing to distinguish between conductive and sensorineural hearing loss, which require different treatment approaches 2
- Overlooking the need for imaging in cases of asymmetric hearing loss or sudden SNHL 1
- Neglecting audiologic rehabilitation, which should be addressed as soon as hearing loss is identified 1