What are the treatment options for sensorineural hearing loss?

Treatment Options for Sensorineural Hearing Loss

For sensorineural hearing loss, treatment depends critically on whether the hearing loss is sudden (within 72 hours) or chronic/progressive, with corticosteroids being the primary medical therapy for sudden cases when initiated within 2 weeks of onset, while chronic cases require audiologic rehabilitation with hearing aids or cochlear implantation. 1, 2

Initial Diagnostic Confirmation

• Distinguish sensorineural from conductive hearing loss immediately using tuning fork tests (Weber and Rinne) or audiometry at first presentation 1
• Obtain formal audiometry within 14 days of symptom onset to confirm diagnosis, documenting at least 30 dB hearing loss at 3 consecutive frequencies for sudden sensorineural hearing loss 1
• Complete audiometric assessment should include air/bone conduction thresholds, speech audiometry, and otoacoustic emissions 2

Critical History and Physical Examination

• Assess specifically for bilateral hearing loss, recurrent episodes, or focal neurologic findings (stroke, tumor) that require urgent intervention 1
• Evaluate for vertigo at onset, which affects prognosis and treatment decisions 1, 3
• Do NOT order routine CT head, routine laboratory tests, or routine blood work as these have no proven benefit 1

Treatment for Sudden Sensorineural Hearing Loss

Primary Medical Therapy

• Offer systemic corticosteroids within 2 weeks of symptom onset as the mainstay of treatment for idiopathic sudden sensorineural hearing loss 1, 2, 3
• Typical regimen: methylprednisolone or prednisone with tapering schedule 3

Salvage Therapy

• Offer intratympanic steroid perfusion for incomplete recovery 2 to 6 weeks after onset when initial systemic therapy fails 1
• Hyperbaric oxygen therapy may be considered only when combined with steroid therapy, not as monotherapy 1

Medications to AVOID

• Do NOT routinely prescribe antivirals, thrombolytics, vasodilators, or vasoactive substances as these lack evidence of benefit 1

Treatment for Chronic/Progressive Sensorineural Hearing Loss

Audiologic Rehabilitation

• Hearing aids are first-line management for residual hearing loss and should be offered immediately upon diagnosis 2
• Address audiologic rehabilitation as soon as hearing loss is identified to prevent auditory deprivation and cognitive decline 2
• Counsel patients that delay in amplification leads to poorer outcomes 2

Cochlear Implantation

• Consider cochlear implantation for severe to profound bilateral hearing loss when hearing aids provide insufficient benefit 2
• This represents the definitive treatment for severe sensorineural hearing loss unresponsive to conventional amplification 2

Over-the-Counter Options

• Less expensive over-the-counter hearing aids may help mild to moderate hearing loss 4

Mandatory Workup for Retrocochlear Pathology

• Obtain MRI of brain and internal auditory canals to rule out vestibular schwannoma (acoustic neuroma), stroke, or malignancy 1, 2
• MRI with dedicated internal auditory canal protocol using thin sections is the imaging modality of choice 1
• If MRI cannot be performed, auditory brainstem response testing is an acceptable alternative 1, 2
• This workup is particularly critical for unilateral or asymmetric sensorineural hearing loss 2, 4

Patient Education and Counseling (Mandatory)

• Educate patients about natural history: 32-65% may recover spontaneously, but this likely overestimates actual recovery rates 1, 3
• Discuss benefits and risks of medical interventions and limitations of existing evidence 1
• Counsel all patients with residual hearing loss and/or tinnitus about audiologic rehabilitation benefits including impact on communication, safety, cognition, and quality of life 1, 2
• Address psychological response to sudden loss of hearing, as anxiety and depression are nearly universal with accompanying tinnitus 1

Follow-Up Requirements

• Obtain audiometric evaluation at conclusion of treatment and within 6 months of completion 1, 2
• Long-term follow-up is essential as underlying causes may not be evident at initial presentation and are identified in only 10-15% of cases initially 1
• Regular monitoring allows adjustment of management and detection of progressive changes 2

Common Pitfalls to Avoid

• Do not delay evaluation: New onset ear blockage or fullness warrants prompt assessment, as both patients and physicians often underestimate this symptom 1
• Do not order routine CT head in emergency settings for sudden hearing loss evaluation 1
• Do not prescribe antiviral medications routinely despite their historical use 1
• Do not delay audiologic rehabilitation once diagnosis is confirmed, as auditory deprivation worsens outcomes 2