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What Causes Sudden Sensorineural Hearing Loss

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Unilateral Sudden Hearing Loss

Dr. Ted Talks – Sudden Sensorineural Hearing Loss

Both sudden and single-sided hearing loss can occur simultaneously in the form of hearing loss known as acute unilateral hearing loss. This form of hearing loss is not particularly common. Yet, it is critical to be aware of it and seek care if you experience a sudden loss of hearing in one ear.

Read on for a closer look at this unique form of hearing loss and the things that can cause it.

Is There Additional Testing Needed With Ssnhl

Once in a while SSNHL is due to a benign tumor on the nerve that connects the ear to the brain. These tumors are called vestibular schwannomas. Your healthcare provider may order a magnetic resonance imaging scan to look for this tumor if an MRI is safe for you. Another option is a type of hearing test called Auditory Brainstem Response . However, if the ABR is abnormal, your healthcare provider should recommend an MRI.

What To Look Out For

Patients often notice the hearing loss first thing in the morning, and can report a sudden pop in the ear before the loss occurs. In addition, patients will often experience a ringing or buzzing in the affected ear and patients can also report a sensation of the world spinning or loss of balance .

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How Sshl Is Diagnosed

When you visit Lakeshore Ear, Nose & Throat Center with symptoms of SSHL, well check your hearing with a test that uses decibels and frequencies to determine the extent of your hearing loss.

A decibel measures the loudness of sound. For example, a whisper is about 30 decibels, and regular conversational speech is around 60 decibels.

Frequency measures sound waves in a unit called a hertz . The range of frequencies that humans can hear is generally accepted to be 20-20,000 Hz.

If the results of your hearing test show that youve lost at least 30 decibels in three connected frequencies, youll probably be diagnosed with SSHL.

Diagnosis Of Sudden Sensorineural Hearing Loss

Indications for Hyperbaric Oxygen Therapy

There are various ways to diagnose SSHL which include:

1. Otoscopy

In otoscopy, the external canal of the ear canal is examined. The instrument which is used in otoscopy is otoscope.

This device helps doctors to see directly into the ear canal. It uses the light to see clearly into the ear. It examines the external ear, middle ear, and eardrum.

2. Tympanometry

Tympanometry is a process of examining the condition of the middle ear and movement of the eardrum. It also checks the variations of air pressure in the external canal.

The test helps in recognizing the conductive hearing loss. The result of the tympanometer is called a tympanogram.

3. Audiometry

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How Is Sudden Hearing Loss Treated

There are many treatments for SSNHL. Watchful waiting may be recommended. This is because half of patients may get back hearing on their ownthese are usually patients with mild to moderate degrees of hearing loss, but healthcare providers do not currently have a way to predict who will get better without treatment. Initial treatment should be given within two weeks and can include steroids in pill form or injected into the ear directly , or hyperbaric oxygen therapy given with steroids. If the first treatments do not work, your otolaryngologist should discuss salvage therapy. You may be offered HBOT with steroids, but your healthcare provider should recommend intratympanic steroid injections through the eardrum. The benefits of therapy may include more quick and complete recovery of hearing, but there are also side effects that must be considered when choosing from the available options.

Why Does It Happen

There are over a hundred possible reasons why SSNHL occurs and is dependent on a number of factors that are specific to each patient. The majority of patients with SSNHL have no identifiable cause for hearing loss. Most fall into one of several broad categories including infectious, autoimmune, traumatic, vascular, neoplastic, metabolic, and neurologic. However, in most cases the true reason is unknown.

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Are There Warning Signs For Sshl

SSHL doesnt always show up in the same way. Some people assume they are suffering from allergies, earwax blockage, or sinus infection. Some describe noticing hearing loss instantaneously in the morning while others report that it rapidly developed over a period of hours or days. In either case, they notice that their hearing is different. Others dont notice a difference until they hold the phone up to that particular ear or try to listen to headphones. In some cases, SSHL is preceded by a very noticeable and alarming pop. After an occurrence, some report a feeling of fullness in the affected ear or a strange feeling on that side of the head, accompanied by tinnitus and dizziness. The severity of the hearing loss varies from one person to another.

Theories Of The Etiology Of Idiopathic Ssnhl

Sudden Sensorineural Hearing Loss (SSHL) — Dr. Aftab H. Patni

The etiology remains unknown in the majority of patients who present with SSNHL and therefore their hearing loss is classified as idiopathic . Numerous hypotheses of the pathophysiology of idiopathic SSNHL have been proposed. The most widely accepted theories are vascular compromise , cochlear membrane rupture , and viral infection .

However, the clinical course and radiographic findings characteristic of most cases of idiopathic SSNHL are not consistent with a vascular etiology. In cases of sensorineural hearing loss resulting from a known intravascular insult, the loss is permanent, whereas, hearing loss in the majority of cases of idiopathic SSNHL is reversible . Potentially as a reflection of the amount of damage and permanence of the hearing loss following occlusion of the cochlear vasculature, cochlear fibrosis occurs over the subsequent weeks , and this fibrosis can be seen in radiologic studies of patients with hearing loss following known vascular occlusion . In idiopathic SSNHL, cochlear fibrosis is not typically observed . Thus, though a vascular etiology may explain a few cases of idiopathic SSNHL, it is not the cause of most cases of this disorder.

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What Are The Causes Of Sudden Hearing Loss

Different kind of disorders affecting the ear can lead to Sudden Sensorineural Hearing Loss or SSHL. Only in 10% of the cases, a clear identifiable cause is diagnosed. SSHL is known as Idiopathic Hearing loss or hearing loss due to unrecognized causes. The factors which could lead to Sudden deafness are:

  • A tumour on the auditory nerve
  • Untreated chronic middle ear infection
  • Neurological problems like Multiple Sclerosis and inner ear disorders like Menieres Disease.

Sudden Sensorineural Hearing Loss

  • For correspondence:

A 36-year-old woman presents to the clinic and reports left-sided hearing loss. She first noticed it five days prior when she could not use the telephone on her left side. She notes a buzzing sound and plugged left ear. She says she does not have vertigo or neurologic symptoms. Examination by otoscopy is normal. There is lateralization to the right for the Weber test, and air conduction using a tuning fork is greater than bone conduction bilaterally.

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How Is Sudden Deafness Treated

The most common treatment for sudden deafness, especially when the cause is unknown, is corticosteroids. Steroids can treat many disorders and usually work by reducing inflammation, decreasing swelling, and helping the body fight illness. Previously, steroids were given in pill form. In 2011, a clinical trial supported by the NIDCD showed that intratympanic injection of steroids was as effective as oral steroids. After this study, doctors started prescribing direct intratympanic injection of steroids into the middle ear the medication then flows into the inner ear. The injections can be performed in the offices of many otolaryngologists, and are a good option for people who cannot take oral steroids or want to avoid their side effects.

Steroids should be used as soon as possible for the best effect and may even be recommended before all test results come back. Treatment that is delayed for more than two to four weeks is less likely to reverse or reduce permanent hearing loss.

Additional treatments may be needed if your doctor discovers an underlying cause of your SSHL. For example, if SSHL is caused by an infection, the doctor may prescribe antibiotics. If you took drugs that were toxic to the ear, you may be advised to switch to another drug. If an autoimmune condition caused your immune system to attack the inner ear, the doctor may prescribe drugs that suppress the immune system.

You Have A Brief Window To Seek Treatment

What is Sudden Sensorineural Hearing Loss/Sudden Deafness ...

Everyone’s hearing naturally declines with age, and people often have one ear that hears better than the other. But if hearing loss appears suddenly in one ear for no apparent reason, you may have experienced sudden sensorineural hearing loss, or SHL, a kind of nerve deafness.

There are about 66,000 new cases of SHL per year in the United States, according to research in the August 2019 issue of Otolaryngology Head and Neck Surgery. But these numbers are hard to come by, since the condition may be underdiagnosed.

“The main reason is that people don’t view it as a serious problem and don’t get the medical care they need. This delay increases the risk of permanent hearing loss,” says Dr. Steven Rauch, an Ear, Nose and Throat specialist with Harvard-affiliated Massachusetts Eye and Ear.

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How Is Sshl Treated

Early treatment may increase your chances for a full recovery. But, your doctor will try to find the cause of your hearing loss before starting treatment.

Steroids are the most common treatment. They can reduce inflammation and swelling. This is especially helpful in people who have diseases of the immune system, such as Cogan syndrome. Your doctor may also prescribe antibiotics if an infection is the cause of your SSHL.

In some cases, a doctor can surgically insert a cochlear implant into your ear. The implant doesnt completely restore hearing, but it can amplify sounds to a more normal level.

Can Sensorineural Hearing Loss Get Worse

Yes, a sensorineural hearing loss can get worse. Some types of sensorineural hearing loss develop over time such as an age-related hearing loss, where people typically lose more and more of their hearing ability over time. Other types of sensorineural hearing loss are more stable. It always depends on the cause of the hearing loss. If you experience your hearing loss getting worse, it is important to get your hearing tested and get your hearing aids adjusted to the actual hearing level.

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Why Has Sudden Sensorineural Hearing Loss Not Been Addressed Sooner

Most of us have become educated about the warning signs of stroke, heart attack, and other illnesses. And in order to hold off or treat those conditions, weve been advised to watch our diet, exercise more, control our cholesterol and blood pressure, perhaps take baby aspirin, or other medications. But what about SSHL? Are there warning signs? Which protocols should you follow if you should experience SSHL? What are the treatments to resolve SSHL? And is there agreement about these questions in the medical community?

Every year, about 8,000 people in the US experience sudden onset hearing loss, according to Healthy Hearing and the American Hearing Research Foundation. That number, of course, does not include those cases that go unreported and undiagnosed. Nine out of 10 occurrences of SSHL is in one ear only, but sudden bilateral hearing loss also happens. Men and women are affected equally. The average age of first occurrence is mid-40s to mid-50s, with an increasing incidence with age. Tinnitus is reported in roughly 40% of cases. SSHL accounts for 1% of all sensorineural hearing loss cases.

What Are The Side Effects Of Each Treatment

Sudden Sensorineural Hearing Loss

Side effects are different with each type of treatment but may include anxiety, pain, dizziness, high blood sugar, high blood pressure, depression, or sleep problems. In head-to-head comparisons, intratympanic injection of steroids causes much fewer side effects than oral steroids. You should talk to your healthcare provider about side effects from any treatment that you are considering.

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Sudden Sensorineural Hearing Loss Treatment

The recommended treatment for SSHL is a course of high dose steroids . Access to treatment very quickly after the onset of SSHL is crucial to improving the chances of restoring your hearing, ideally within 48 hours or less. You should at this point be referred to the care of an ENT specialist.

Once on steroid medication, recovery can take a few weeks or longer and may require a repeat course of steroids. Seek advice from ENT for all options available to you.

Causes Of Sudden Hearing Loss

What causes sudden hearing loss? Among the many possible sudden hearing loss causes are:

  • Earwax in the ear canals
  • Viral infections. Some patients with SSHL report suffering from an upper respiratory infection within a month before the hearing loss. What virus causes sudden hearing loss? Viruses associated with sudden hearing loss include mumps, measles, rubella, as well as meningitis, syphilis and AIDS, among many others.
  • Tumours. A variety of tumours in the ear, benign as well as malignant, may cause SSHL.
  • Head trauma affecting hair cells in the ear, eardrum or bones. Regaining hearing after a hearing loss that has been caused by a head injury can be expected partially or even totally.
  • Drugs and insecticides. A long list of prescription drugs and chronic abuse of painkillers may cause sudden hearing loss. Insecticides such as malathion and methoxychlor have been associated with sudden hearing loss in both ears .Immunological disorders.
  • Idiopathic disorders, such as multiple sclerosis, Meniere’s disease and others.

If you think that you might have a sudden Hearing Loss, we recommend that you get your hearing checked by a hearing professional.

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How Long Does It Take To Recover From Sudden Hearing Loss

There is a healthy recovery in 32-79% of the cases if the treatment starts within the first two weeks. The chances of complete hearing recovery are less for patients if the sudden Sensorineural hearing loss is accompanied by vertigo, tinnitus or is severe to profound. Lower the age, better are the chances of a complete recovery.

Since the cases of sudden deafness are very low, it is natural that people are not very well informed compared to other types of hearing loss.

We answer some of the FAQs for the benefit of our readers.

  • Is Sudden Hearing Loss A Sign Of A Stroke?

People who experience Sudden Sensorineural Hearing Loss are vulnerable to a stroke. Any symptoms of sudden deafness is a warning, a complete health check is a must to avoid an actual stroke which might take place in the near future.

  • What Causes Sudden Hearing Loss in the Elderly?

The chances of getting SSHL is higher in the age group of 50 to 60 years, the problem could be hereditary or occur because of the changes in the inner ear and the auditory nerve. Scientists feel that the changes could be due to exposure to noise throughout life and other damaging factors which slowly wear down the ears delicate machinery. Diseases like Diabetes, Hypertension, Cardiac problems increase the chances of SSHL among the elderly.

  • Can Neurological Problems Cause Hearing Loss?

  • Which Illnesses Causes Sudden Hearing Loss?

  • Can Stress Cause Sudden Hearing Loss?

  • Can Earwax Cause Sudden Hearing Loss?

References

What Does Sudden Deafness Feel Like

Sudden Sensorineural Hearing Loss: Causes, Symptoms, and ...

People who experience sudden deafness in one ear experience a variety of symptoms which may vary from person to person. Some experience a sudden muffled hearing in one ear they experience difficulty in following conversations and are unable to hear if the background noise is high. Some suffer from high frequency hearing loss and find it difficult to hear high-pitched sounds. People also suffer from dizziness, balance issues or vertigo and tinnitus

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Testing For Sudden Hearing Loss

If you suspect you might have SSNHL, the first step is to make an appointment with a hearing healthcare professional. She may conduct a hearing test called pure tone audiometry to measure the hearing loss.

The test can also determine the range of hearing loss in decibels. SSNHL will be diagnosed in the case of a hearing loss of at least 30 decibels in at least three connected frequencies. After diagnosis, she may order further tests in an attempt to determine an underlying cause. Blood tests, MRIs and balance tests are just a few examples that might help get to the bottom of your hearing loss.

If any of your healthcare providers are unwilling to thoroughly investigate your sudden hearing loss, seek a second opinion. As audiologist Dennis Colucci stated, healthcare providers must “understand that sudden hearing loss is a medical emergency. Without immediate action, there is likely to be less benefit and more burden to patients, their families, and the healthcare system.”

What Are The Treatments For Sudden Hearing Loss

The recommended treatment for Sudden Sensorineural Hearing Loss is the immediate use of corticosteroids over a period of 2 to 3 weeks.

Antibiotics are also prescribed if the cause is infection. People should be particular about their diet and medicines if they are suffering from diabetes, cardiac problems and hypertension, keeping these diseases in control can also help in early recovery.

In case, the person is under treatment for another ailment and the medicines are the cause of ototoxicity, the doctor will change the medicines to reduce ototoxicity.

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What Treatments Exist For A Sudden Sensorineural Hearing Loss

Just as the precise source of your sudden hearing loss may be hard to pinpoint, the treatment of sudden hearing loss may be difficult. It is strongly advised to see your doctor for a sudden hearing loss treatment on an emergency basis as soon as possible after the occurrence of SSHL in order to determine or eliminate causes demanding immediate attention.

However, the usefulness of medical sudden hearing loss treatment of itself is debatable. People who experience a sudden sensorineural hearing loss may be treated with steroids.

Whereas some specialists favour aggressive treatment of underlying causes in the hope of reversing or curing many cases of sudden hearing loss, others conclude based on earlier studies that their patients are equally likely to regain their suddenly lost hearing fully or partially whether they receive treatment or not.

However, some recent studies indicate improved results in patients receiving some forms of steroid therapy when this sudden hearing loss treatment is deemed appropriate.

For some patients, a sudden sensorineural hearing loss becomes permanent. The treatment options for sudden hearing loss for these patients vary from hearing aids to hearing implants such as cochlear implants.

The vast majority of cases are those with sudden hearing loss in one ear. Unilateral hearing loss particularly affects communication in situations with background noise.

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