Hearing Aid Candidacy After Sudden Hearing Loss
The patient needs to recover to "serviceable hearing" levels for traditional hearing aids to work effectively—specifically, achieving a pure tone average (PTA) ≤50 dB and word recognition score (WRS) ≥50%. 1
Understanding Serviceable vs. Non-Serviceable Hearing
The American Academy of Otolaryngology-Head and Neck Surgery defines serviceable hearing as the threshold where traditional amplification becomes beneficial: 1
- Class B (Usable hearing): PTA 31-50 dB with discrimination 50-69% 2
- Class C (Usable hearing): PTA >50 dB with discrimination 50-69% 2
Recovery to serviceable levels typically indicates the ear would be a candidate for traditional hearing amplification, while recovery to less-than-serviceable levels indicates an ear that would, in most circumstances, not benefit from traditional amplification. 1
What Constitutes Meaningful Recovery at 1 Week
Since you report "mild improvement" at 1 week, here's what matters clinically: 1
- Meaningful partial recovery requires ≥10 dB improvement in pure tone thresholds (anything less is classified as "no recovery") 1
- Complete recovery requires return to within 10 dB of the unaffected ear and WRS within 5-10% of the unaffected ear 1
- The majority of recovery (77% of cases) occurs by 2 months post-treatment and stabilizes by 6 months 1
Frequency-Specific Recovery Patterns
Regarding your concern about lower frequency recovery: 3
- Lower frequencies show significantly greater improvement after steroid treatment for sudden sensorineural hearing loss compared to higher frequencies 3
- This general pattern of greater low-frequency recovery is stable and occurs with both oral and intratympanic steroid treatments 3
- Mid-frequency (flat-type) hearing loss patterns show the highest rates of slight recovery (10-30 dB improvement) 4
Timeline for Hearing Aid Consideration
You should counsel the patient about amplification options now, even while recovery is ongoing, rather than waiting to see if lower frequencies recover. 1
The American Academy of Otolaryngology-Head and Neck Surgery strongly recommends counseling patients with residual hearing loss about audiologic rehabilitation and hearing aids as soon as incomplete recovery becomes evident. 1 This is because:
- 86% of adults with unilateral sudden hearing loss report hearing handicap even with one normal ear 1
- Hearing aids may serve as a bridge during the treatment period or as a permanent solution if recovery plateaus 1
- Final evaluation should occur at 6 months, with rare spontaneous recovery beyond this timeframe 5
Specific Amplification Thresholds
If the patient's hearing remains in the non-serviceable range (PTA >50 dB with WRS <50%), traditional hearing aids will provide minimal benefit. 1 In this scenario, alternative options include:
- CROS or BiCROS hearing aids to route sound from the affected ear to the better-hearing ear 5
- Cochlear implantation for severe-to-profound bilateral loss when hearing aids provide insufficient benefit 5
- Hearing-assistive technology beyond traditional amplification 6
Common Pitfall to Avoid
Do not delay audiologic rehabilitation counseling while waiting to see if lower frequencies recover. 1 The guideline emphasizes that continuous dialogue about amplification options assists the patient's adjustment to changes that may be permanent, and early counseling does not preclude continued medical treatment or spontaneous recovery. 1