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Sudden Sensorineural Hearing Loss (SSNHL) is a medical emergency defined as an individual experiencing at least 30 dB (decibels) of sensorineural hearing loss occurring over a time period of three days or less.
Sudden sensorineural hearing losses are most commonly associated with head trauma (such as a car accident), acoustic trauma (such as being too close to a gun or firecrackers when they explode), viral infections, tumors, decreased circulation to the inner ear, membrane breaks, medication for erectile dysfunction or ototoxic drug exposure. Sudden sensorineural hearing loss affects approximately 5-20 people per 100,000 population per year. Sudden sensorineural hearing loss is a complicated condition which must be fully evaluated by an otolaryngologist before a treatment plan can be established. Sudden sensorineural hearing losses requires immediate comprehensive medical examination and specialty care from an Otologist, who is an otolaryngologist (ENT) who has undergone two additional years of training and specializes in issues related hearing only. Click here to make an appointment with the California Ear Institute to consult with one of our board certified Otologists regarding your condition. Medical Website Design - Websites for Doctors of Otology, Audiology, Ears & Hearing by Vital Element, Inc.
If you do have sudden sensorineural hearing loss, treatment with steroids within the first 2 weeks of the symptoms provides the best chance that some of the hearing may return. The gold standard treatment for sudden deafness, if caught within two weeks of the onset of the symptoms, is high-dose steroids, taken by mouth.
Evidence now suggests that injection of medication into the middle ear, using a relatively painless and quick procedure in the clinic, is also effective in treating sudden sensorineural hearing loss without the side effects that can be seen when taking high-dose steroids by mouth. This study will compare high dose oral steroids with intratympanic, or middle-ear injections of a special formulation of steroid medication for the treatment of sudden sensorineural hearing loss. This Sudden Sensorineural Hearing Loss Multicenter Treatment Trial is the first prospective, randomized clinical trial to compare these two different treatment options. If you have any questions about Sudden Sensorineural Hearing Loss and treatment, please feel free to call Dr. Hearing Views discusses important issues that impact both audiology professionals and the people with hearing loss that they serve. Patients that experience SSNHL are often very alarmed by the sudden onset of their symptoms, particularly with the prospect that their hearing loss could become permanent. Some cases of sudden hearing loss are quickly and effectively reversible (such as complete wax occlusion for example).
First and perhaps my most significant challenge, is to see an otologist as soon as possible after the onset of symptoms. The evaluation should be a typical comprehensive hearing evaluation (pure tones, speech testing), as well as impedance measurements, acoustic reflexes and decay, Otoacoustic emissions (OAEs) and auditory brainstem response (ABR) to determine if lesion is of cochlear, VIIIth nerve origin, or both. If tumor has been ruled out, the lesion may be of viral or vascular origins and the patient has many options. Despite whether the hearing has recovered, serial audiometry, including speech testing, need to be performed on a regular basis. Idiopathic sudden sensorineural hearing loss is a medical emergency that requires urgent diagnosis and treatment, and the adaptation of a proper protocol for management is a priority. Idiopathic sudden sensorineural hearing loss (ISSNHL) [1] is a well-known clinical condition characterized by a sudden occurrence in one or both ears of sensorineural hearing loss of more than 30 dB in at least three contiguous audiometric frequencies over a time course of no more than 72 hours. Hearing impairment is a common problem worldwide and even more problematic in developing countries. Sensorineural hearing loss [4-9] (or nerve-related deafness) involves damage to the ear caused by aging, prenatal and birth-related problems, viral and bacterial infections, heredity, trauma, exposure to loud noise, fluid backup, or tumor in the inner ear. This retrospective study was conducted from January 2002 to December 2003 to identify patients with ISSNHL. We found no age relation or significant side predilection, and the duration of improvement was variable, extending from less than 1 week to up to 6 weeks. The prognosis of tinnitus involved full recovery in all but one of the grade 4 patients; the unrecovered patient had at 8 kHz a dip that did not improve. All but three patients who developed dizziness (those with very severe hearing loss) had fully recovered in a few days; the unrecovered group had dizzy spells that lasted more than a few days. ISSNHL is a symptom of cochlear injury and is characterized by sudden onset; within a few hours, it reaches its maximum peak.
Although called sudden, hearing loss seems unlikely to be abrupt but rather probably evolves over a few hours [6].
Research conducted by the Institute of Audiology in Turin documented that 5,925 cases were diagnosed over a 5-year period (1990-1995) [7]. Many causes can trigger sudden hearing loss [6-10] but, despite extensive evaluation, the majority of cases elude definitive diagnosis and, therefore, remain idiopathic. Our study revealed that the treatment protocol involving steroid therapy in Qatar resulted in hearing improvement in 57.4% of patients with ISSNHL. Hearing loss caused by an ear infection, sinus infection, or wax build up is conductive in nature and is generally temporary.

With appropriate medical treatment and therapy, individuals with SSHL can make a partial or even full recovery.
A typical patient loses his or her hearing in one ear over a period of one to several days, associated with a feeling of fullness in the ear, and often tinnitus, or ringing of the involved ear.
Occasionally, the patient may report an upper respiratory infection (cold symptoms) prior to the onset of the hearing loss. The symptoms of decreased hearing and fullness of the ear are often diagnosed as a middle ear infection (otitis media) and so the referral to an audiologist or otolaryngologist (ENT specialist) is made too late. The diagnosis can only be made by specialized hearing testing in a sound-proof chamber by an audiologist. Topics range from education and advocacy to industry, technology and the client-professional relationship, and more. Causes could range from viral infection, autoimmune disorder, perilymph fistula, among others. However, for the overwhelming proportion of persons with SSNHL, the challenge is considerable. Not by an otologist primarily concerned with middle ear surgery, but one whose interests and experience include evaluation and treatment of SSNHL. The initial patient contact should last at least a full hour, as all possible etiologies and factors need to be considered. Miller, PhD, is Professor Emeritus of Audiology, New York University Steinhardt School of Culture, Education and Human Development. Management of Idiopathic Sudden Sensorineural Hearing Loss: Experience in Newly Developing Qatar. A report prepared by the Department of Otolaryngology [3] at University of Texas Medical Branch documented approximately 15,000 reported cases of ISSNHL per year worldwide, with 4,000 of those cases occurring in the United States. Therefore, we have a pressing need to study the causes of ISSNHL and suggest a treatment protocol for ISSNHL. Of the studied subjects, 81% were male and 19% were female (median age, 43 years; range, 24-67 years).
Of the seven patients (33.3%) who showed no improvement in their hearing both audiologically and clinically (grade 1), six patients had dizzy spells when first seen, four had audiometric HTLs of 65 dB or no response at 8 kHz, five had high-frequency sloping audiometric curves, and all showed no improvement at 6 weeks' duration.
Incidentally that patient developed recurrence of hearing loss 12 week later but in the opposite ear, which was also treated with steroid therapy and showed remarkable improvement. ISSNHL is the most intractable of hearing loss types, because its fundamental cause is hair cell death. The researchers concluded that sudden idiopathic hearing loss, often attributed to general vascular causes, was one of the most frequent reasons for monolateral hearing loss. Furthermore, we concluded that results can be improved if the disorder is diagnosed early in patients using proper protocols and if early treatment is undertaken. Department of Medical Statistics and Epidemiology, Hamad General Hospital and Hamad Medical Corporation, Doha, Qatar. The numbers below represent the softest intensity that sound delivered in decibels is perceived by an individual tested with pure tone air conduction testing. Pure-tone thresholds, speech discrimination scores, acoustic reflex testing, and distortion product otoacoustic emission testing, the parts of a complete audiometric evaluation, are performed to confirm the diagnosis of a sudden sensorineural hearing loss. Unfortunately, there are still a few otologists around who do not believe in treating SSNHL.
Throughout his career, he has directed programs in Communication Disorders at some of the nation’s leading medical and academic institutions. The aim of this study was to determine and identify as early as possible those factors that play the important role in the prognosis of the condition, to describe the experience, and to suggest a treatment protocol that can be adopted in a tertiary hospital, such as Hamad General Hospital. Because of its various etiological possibilities and its prognostic characteristics, urgent attention and treatment are required, and the condition may be considered as an emergency. One in every 10,000- 15,000 people experience this condition, with the highest incidence occurring between 50 and 60 years of age. The prevalence of hearing loss increases with age; most hearing losses develop over a period of 25-30 years. The aim of this study was to identify patients with ISSNHL as early as possible, to describe their experience, and to suggest a treatment protocol that can be adopted in a tertiary hospital, such as Hamad General Hospital. Tympanometry showed a type-A curve in all patients, and acoustic reflex results were negative in the affected ear in 13 patients.
Spectacular advances have recently been made in our understanding of hair cell physiology and molecular biology, offering new hope of alleviating ISSNHL [10]. Also, we observed in our study that most patients who had ISSNHL ranged in age from 40 to 60 years, although the highest rate was found among men.
Monolateral sensorineural hearing loss, which is not seriously disabling, represents a handicap from the social point of view.

The degree of hearing loss may vary from mild to severe and may involve different parts of the hearing frequency range. Suggested causes of ISSNHL include viral infections, immunologic vascular compromise, and intracochlear membrane breaks. Samson, Department of Epidemiology and Medical Statistics, Hamad Medical Cor poration, for her kind help in preparing and typing the manuscript. Sudden hearing loss due to large vestibular aqueduct syndrome in a child: Should exploratory tympanotomy be performed? This comprehensive testing by an audiologist will ensure that the loss is nerve-related, and not due to fluid, infection, or a perforation, or hole in the ear drum.
They believe that the results of intervention aren’t any better than spontaneous recovery. Of course, patients should be careful to avoid exposure to excessive noise levels in and out of the workplace. However, because of controversies regarding etiology and the need for urgent treatment, various diagnosis and treatment protocols were advocated by different centers. Many hypotheses have been advanced to explain its etiology: viral inflammation, vascular diseases, allergic reaction, rupture of intralabyrinthine membranes, and autoimmune diseases.
Audiological evaluation, including pure-tone audiometry, tympanometry, speech audiometry, and auditory brainstem-evoked response testing results were included. All patients except one had unilateral ear involvement and revealed almost equal frequency of involvement for both left and right ears. Only three patients had speech audiometry and, for auditory brainstem response, results in nine patients were normal except for decreased HTL. Six patients of the grade 4 group had flat, basin-shaped or up-turning audiometric curves (Fig. We observed in our study that some of the causes of sudden or fluctuating sensorineural hearing loss were meningitis, multiple sclerosis, or Friedreich's ataxia.
MRI scan of the brain, with gadolinium contrast, is also performed to exclude the presence of a cerebellopontine angle tumor, such as a vestibular schwannoma (acoustic neuroma).
Many practitioners (and I agree with them) prefer steroids, either systemic or by local injection into the tympanic membranes for absorption by the round window membrane. Miller has authored five books, over 120 articles in peer-reviewed journals, and numerous monographs and chapters in widely used audiology textbooks. It was conducted in the ear, nose, and throat outpatient clinics at Hamad General Hospital and the ear, nose, and throat wards at Rumailah Hospital.
Recently, increasing interest is centered on the means of diagnosis and treatment, leading to the emergence of quite a variety of protocols adopted by different treatment centers. With respect to laboratory investigations, results of complete blood cell count, erythrocyte sedimentation rate, blood film for abnormal cells, and coagulation screening were normal in all patients. Many studies have been carried out to assess the histopathology of the labyrinth in cases of ISSNHL and to provide a better understanding of the etiopathogenesis [10]. In ten of the twelve patients who showed improvement, the duration of onset was less than 14 days and was less than 7 days in six of eight patients in grade 4. The incidence of tinnitus compares well with that in the literature [11,12]; however, tinnitus did not assist well in determining which patients would suffer hearing loss. In all the studied cases, patients had an intact tympanic membrane and revealed no other ear, nose, and throat abnormality.
The treatment protocol that was adopted-consisting of high-dose steroid therapy, full-dose antiviral drug (acyclovir), and a histamine analog, betahistine-resulted in hearing improvement in 57.4% of cases.
Finally, most causes of ISSNHL remain unknown; thus the term idiopathic is applied to these cases.
In respect to the duration of illness, 33.3% of the studied patients had the complaint for 2 weeks, and 19% had it for more than 4 weeks.
However, a high incidence of associated dizziness may be responsible for poor recovery incidence in our series, so it can be considered to indicate a poor prognosis [13-15]. The results of our study revealed that the steroid therapy protocol practiced in Qatar resulted in hearing improvement in patients with idiopathic sudden sensorineural hearing loss. Good prognostic factors include early diagnosis, marked reduction of symptoms, and improved shape of the audiometric curve.

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Comments to «What is sudden sensorineural hearing loss»

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  2. Naile writes:
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  3. Fire_Man writes:
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