From the Guidelines
Sudden severe stress can contribute to the development of sensorineural hearing loss, particularly idiopathic sudden sensorineural hearing loss (ISSHL), as it may trigger or exacerbate underlying conditions that lead to this condition. According to the clinical practice guideline update on sudden hearing loss from 2019 1, ISSHL affects 5 to 27 per 100,000 people annually, with about 66,000 new cases per year in the United States. The exact mechanisms by which stress contributes to ISSHL are not fully understood but may involve the effects of stress hormones like cortisol on blood flow to the inner ear, immune system compromise leading to inflammation, or direct damage to the delicate hair cells in the cochlea.
Key points to consider in the management of sudden sensorineural hearing loss include:
- Prompt recognition and management may improve hearing recovery and patient quality of life 1.
- Distinguishing sensorineural hearing loss from conductive hearing loss at the time of presentation is crucial for appropriate management.
- Identifying rare, nonidiopathic causes of sudden sensorineural hearing loss is important to separate these patients from those with idiopathic sudden sensorineural hearing loss, who are the target population for therapeutic interventions.
Given the potential for stress to contribute to the development of ISSHL, managing stress and avoiding additional stressors is advisable for individuals experiencing sudden hearing loss. However, the primary approach to managing ISSHL involves medical interventions such as oral corticosteroids or intratympanic steroid injections, which should be initiated as soon as possible after the onset of symptoms, preferably within 2-4 weeks, to maximize the chances of recovery 1.
From the Research
Sudden Severe Stress and Sensorineural Hearing Loss
- Sudden sensorineural hearing loss (SSNHL) is a condition where there is a sudden loss of hearing, often due to inflammation of the cochlea 2.
- The exact cause of SSNHL is often unknown, but stress is commonly considered a potential cause 3.
- Research has shown that stress-related hormones, such as cortisol and ACTH, may be elevated in patients with SSNHL, and that these hormones may play a role in the pathogenesis of the condition 3.
- A study found that patients with moderate stress levels showed significantly better results after steroid treatment for SSNHL than patients with low or high stress levels 4.
- Another study suggested that depressive stress response can be a strong predictor of treatment response in patients with SSNHL, but the impact of response to stress on the inner ear and endolymph homeostasis remains unknown 3.
Mechanism of Stress-Induced Hearing Loss
- The exact mechanism by which stress causes SSNHL is not fully understood, but it is thought to involve the release of stress-related hormones, which can cause inflammation and damage to the cochlea 3.
- Oxidative stress has also been proposed as a potential mechanism, with reactive oxygen species (ROS) contributing to the pathogenesis of SSNHL 5.
- However, a study found no significant correlation between the concentration of oxidative stress markers in peripheral blood and the severity of initial hearing loss or prognosis of hearing recovery in patients with SSNHL 5.
Treatment and Management
- Steroid treatment is a common approach for managing SSNHL, and has been shown to be effective in some cases 2, 4.
- The effectiveness of steroid treatment may be influenced by the level of stress, with patients with moderate stress levels showing better results than those with low or high stress levels 4.
- Other treatments, such as vasodilator therapy, rheological agents, and antioxidants, may also be used, but the evidence for their effectiveness is limited and conflicting 6.