Treatment Options for Hearing Deficit Following Electroconvulsive Therapy (ECT)
For patients experiencing hearing deficit after ECT, audiological evaluation should be conducted promptly, followed by appropriate rehabilitation measures including hearing aids or other hearing-assistive technology if the deficit persists.
Initial Assessment
- Patients with suspected hearing loss following ECT should undergo comprehensive audiological evaluation, including pure-tone audiometry, to determine the type and severity of hearing loss 1
- The evaluation should establish whether the hearing loss is sensorineural, conductive, or mixed in nature, which will guide treatment approaches 1, 2
- Audiological assessment should include speech-reception thresholds and word-recognition testing to fully characterize the deficit 3
- Asymmetrical hearing loss warrants additional evaluation with imaging studies to rule out retrocochlear pathology 3, 2
Treatment Approach
Immediate Management
- For sudden hearing loss (defined as loss of 30 dB or more within 72 hours), prompt referral to an otolaryngologist is required as this represents a potential medical emergency 1, 2
- Corticosteroids may be offered as initial therapy for sudden sensorineural hearing loss, either in oral form or as intratympanic injections for patients with contraindications to oral steroids 1
- Hyperbaric oxygen therapy may be considered within 2 weeks of initial diagnosis of sudden sensorineural hearing loss or up to 1 month in conjunction with steroids 1
Rehabilitation Options
- For persistent hearing deficits, audiologic rehabilitation should be initiated as soon as the hearing loss is identified 1
- Hearing aids should be considered for patients with sensorineural hearing loss that persists after initial treatment 1, 2
- Over-the-counter hearing aids may be appropriate for mild to moderate hearing loss 3
- Hearing-assistive technology (HAT) beyond traditional amplification should be considered for patients with incomplete recovery 1
- Counseling about communication strategies should be provided to both patients and their families 1, 4
Monitoring and Follow-up
- Follow-up audiometry should be performed within 6 months of the initial diagnosis of hearing loss 1
- Recovery should be measured against the unaffected ear (unless pre-existing asymmetry was known) 1
- Complete recovery requires return to within 10 dB of the unaffected ear and recovery of word recognition scores to within 5-10% of the unaffected ear 1
- Partial recovery can be defined as an improvement of at least 10 dB in pure-tone thresholds or an improvement of ≥10% in word recognition scores 1
Preventing Hearing Deficits During Future ECT
- If additional ECT sessions are required, consider modifying the ECT technique to reduce risk of further hearing deficits 5
- Use the lowest effective electrical dose that is moderately above seizure threshold 5
- Consider spacing treatments to reduce side effects if significant issues occur 5
- Ensure proper electrode placement and stimulation parameters are used 5
Addressing Psychological Impact
- Hearing loss following medical procedures can cause embarrassment, frustration, anxiety, insecurity, and social isolation 1, 4
- Individual or group counseling may be beneficial for supporting patients with sudden hearing loss 1
- For children and adolescents with hearing issues following ECT, a multidisciplinary approach including mental health professionals may be particularly important 6
When to Refer
- Refer to an audiologist for comprehensive hearing assessment and consideration of hearing aids 7, 2
- Refer to an otolaryngologist for conductive hearing loss, sudden sensorineural hearing loss, or sensorineural loss that does not improve with hearing aids 1, 2
- Consider referral for cochlear implants in cases of severe or refractory hearing loss 2