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Stay up to date with the latest news on treatments for sudden hearing loss and tinnitus by visiting frequently. Having my story out there will hopefully help others fight the battle against sudden hearing loss, or at least help them learn to cope. Losing your hearing is very common in people these days, so I think it`s important to have information like this one!
Sudden hearing loss, also known as sudden sensorineural hearing loss, is a medical emergency that is extremely frightening for the person experiencing it. There have been ongoing debates as to whether Intra-Tympanic Steroid Injections would be the most effective medical intervention in treating Sudden Hearing Loss or if the widely practiced evidence-based medical management of oral steroids would be a safer choice. When seeking the different options for tinnitus treatment, there are a couple of options that one can consider.
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INTRODUCTION: Sudden deafness is characterized by an abrupt onset, often idiopathic and tinnitus is present, and becomes the main complaint in up to 80% of patients.
OBJECTIVE: To review carefully all studies of the past 10 years on sudden deafness and tinnitus and analyze the effectiveness of oral and intratympanic steroids for tinnitus control in eight patients with sudden deafness and severe disabling tinnitus.
METHOD: An analytical prospective in which 64 patients after sudden deafness with tinnitus were monitored and 08 of these suffering with severe disabling tinnitus underwent hearing evaluation and application of the Tinnitus Handicap Inventory and Visual Analogue Scale before, during and after sudden deafness treated with oral and intratympanic steroids. Sudden sensorineural hearing loss (SSHL) was first described by De Kleyn in 1944 and defined as a hearing loss of at least 30 dB in three sequential frequencies in the standard pure-tone audiogram over 3 days or less1.
Population studies of SSHL show a wide distribution, ranging from 5 to 30 cases per 100.000 per year, with an average of 50-60 years and no sex preference.
Hypotheses are proposed to explain the pathogenesis of sudden hearing loss as the vascular, the viral, the autoimmune and the rupture of membranes one. Patients with tinnitus and SSHL are very frustrated by residual tinnitus even after accomplishment of the treatment for SSHNL. All patients received information about the risks and expectations of therapy and signed a free informed consent form. Next, salvage therapy with intratympanic methyl-prednisolone was offered to XX patients with a diagnosis of SHL, after systemic therapy failed and no improvements were demonstrated audiometrically. All patients underwent tonal and vocal audiometry and speech recognition rate analysis done by audiologists before and after treatment. Prior to any procedure, patients were oriented as to the risks and expectations about the procedure and signed a free informed consent form.
After intratympanic application of the steroid, the patient remained in the supine position and cervical rotation at 45? for 30 minutes to maximize exposure of the round window membrane to the solution.
The criteria for defining successful recovery after therapy vary in the literature on intratympanic therapy.
All patients underwent Questionnaire Tinnitus Handicap Inventory (THI)5 and the Visual Analogue Scale (VAS) to assess quantitatively and qualitatively the therapeutic response in relation to tinnitus. The search strategy employed in the literature review was guided by the combination of two descriptors indexed in MeSH (Medical Subject Headings): sudden deafness and tinnitus. Most of the patients had vertigo associated with sudden deafness, being classified as mild in 75% of cases and severe in 12.5%.
We performed a literature search with the following aliases: sudden hearing loss and tinnitus.
Their ages ranged from 26-73 years with a mean of 39,5 years and the ear most affected was the left ear (n = 5). In this study, we chose to intratympanic corticosteroid associated with oral corticosteroids and showed that this association was particularly effective in relation to tinnitus, from the eight cases analyzed, seven of these showed a significant improvement verified by THI and EVA. Several factors may affect the prognosis of the PANSS (eg, hearing loss severity, symptoms duration before treatment, vertigo, type of audiogram, and the patients ages). Regarding hearing improvement, only two patients had good responses to therapeutic intervention.
Given the results, we note that in addition to the proposed intervention, especially those cases where there were no improvement or even where there were worsening of symptoms over time, there are other recommended therapies such as cognitive-behavioral and Tinnitus Retraining Therapy.
Some therapies for tinnitus tend to focus on the impact of noise on the quality of life and humor, and include antidepressants, anticonvulsants and benzodiazepines, or attempt to mask their own noise with white noise generators.
In 2005, a review of published randomized clinical trials addressing the correlation between sudden sensorineural hearing loss and tinnitus and treatment by hyperbaric oxygen therapy (HBOT). The sudden sensorineural hearing loss (SSHL) is a considerable diagnostic challenge because it can be caused by many different diseases and there is still no definitive treatment for PANSS universally accepted. In search of a therapeutic approach, the efficacy of enoxaparin sodium associated with venous hemofiltration was studied. In 2008, Ishida et al.15 investigated how the symptoms of ear fullness, tinnitus and otoacoustic emissions (OAE) varied over the course of recovery thresholds in pure tone audiometry in SSHL.
Kleinjung et al.16, in 2009, described the case of a man of 55 years who suffered from tinnitus in the right ear as a result of a SSHL. Hikita-Watanabe et al.17, in 2010, in an article entitled "Tinnitus as a prognostic factor of sudden deafness", rebound that in the group "buzzing rare" there was a worst prognosis to hear than in the group "buzz often".
In 2012, Fioretti et al.18 described the case of a 67 years-old women with severe and disabling tinnitus in the right ear, hyperacusis and mild headache. In 2012, a research was also conducted by Ramos et al.10, in which the authors assessed the effectiveness of cochlear implants in patients with SSHL and disabling tinnitus. The tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI) and the Visual Analogue Scale (VAS) before and after deployment. Given the results, it can be concluded that the reduction of tinnitus after cochlear implantation may be due to several mechanisms such as habituation, acoustic masking, direct stimulation of the cochlear nerve and reorganization of cortical areas. Michiba et al.19, in 2013, highlighted the fact that many patients are frustrated with the SSHL residual buzz, even after complete SSHL treatment. The hearing improvement rate was determined by comparing the thresholds before and 6 months after initiation of treatment. The improvement of hearing thresholds were significantly correlated with improvement in the score of tinnitus 6 months after initiation of treatment compared with before treatment. Generally, subjective feelings for the ringing residual 6 months after initiation of SSHL treatment are almost the same as 24 months after treatment. Patients that carriers sudden deafness and severe disabling tinnitus, and underwent intratympanic and oral corticosteroids showed, in this study, significant reduction or remission of tinnitus.


Paper submitted to the ITJ-SGP (Publishing Management System) on September 4, 2013; and accepted on October 4, 2013. It is ideal for people who need a device that is not visible and one that can facilitate their hearing. Hearing loss can be classified as sudden only if it occurs within 72 hours or less (usually over few hours) and in case hearing reduction is greater than 30 dB over at least 3 contiguous frequencies. Eight patients treated with intratympanic and oral corticosteroids were selected, just two patients showed improvement over the hearing but seven of them showed big improvement in their tinnitus, which was demonstrated by an improvement in the values of the degrees of severity of tinnitus.
In most cases, there is a unilateral hearing loss, with bilateral involvement reported en less than 5%1. However, the current trend is to consider the sudden deafness as a disease of multifactorial etiology2.
In idiopathic cases, the oral corticosteroids are widely used, although the supporting evidence is weak.
However, there are few theories trying to explain its mechanism, one of than associates this symptom with a maladaptive attempts of a cortical reorganization process due to peripheral deafferentation4. The majority ask doctors about the prognosis of residual tinnitus at the final day of medical treatment for SSNHL. From June 2011 to July 2013, 64 patients with a diagnosis of sudden sensorineural hearing loss were seen at the otorhinolaryngology outpatient and emergency unit of our Center, Eight was suffering from severe disabling tinnitus. A detailed clinical history was taken, followed by an otoneurological examination, and an initial audiological assessment by tonal and vocal audiometry, impedance testing, speech recognition rate (SRR), laboratory tests, and an image exam (magnetic resonance imaging with contrast of the inner auditory canal). Eight patients suffering from severe disabling tinnitus agreed to undergo rescue therapy and signed the free informed consent form to be included in this study. All patients with fluctuating hearing loss or suspected Meniere's disease were also excluded from this study.
A second injection was done if there was any possibility that the first injection was not adequate. A 20 dB improvement at 0.5, 1 and 2KHz, or a 20% improvement in discrimination was enough to consider the intervention as successful.
In the Visual Analogue Scale (VAS) score ranges from 1 to 10, where 10 represents the highest degree of tinnitus severity. However, corticosteroids seem to have universal acceptance and are the ones with proven effectiveness. Such treatments aim to improve inner ear oxygenation and include vasodilators, plasma expanders, steroids and anticoagulants11. In the EVA, it is observed that 100% of patients had a score greater than or equal to 7 and a significant reduction in scores of patients 1, 2, 3, 4, 7 and 8, in order to reduce at least two points on score and the same was observed in the degree of severity in THI (Table 1). Patient 2, despite their age, presents a clinical STD (sexually transmitted disease) that could prevent or reduce the effectiveness of the proposed treatment. The administration of hyperbaric oxygen is based on the argument that both the hearing loss and the tinnitus may result from a hypoxic event in the cochlea, and that hyperbaric oxygen therapy may be able to reverse the oxygen deficit.
Eight patients were followed with improvement in SSHL auditory thresholds (Group A) and eight patients with poor hearing improvement (Group B), to elucidate the behavior of these symptoms in your ongoing recovery.
Several therapeutic efforts including intravenous steroids and graft in the round window showed no positive responses. All subjects had SSHL, although the group "short" had a better prognosis than the group "longer duration" when restricted to SSHL accompanied by tinnitus.
Ten patients with sudden hearing loss and severe-profound unilateral tinnitus associates were implanted with a mean age of 42.7 years deployment. It was conducted a prospective study that analyzed gender, laterality and age of patients, along with changes in the level of hearing and tinnitus, after scoring early SSHL to determine the prognostic factors of residual tinnitus after the last day of treatment for SSHL. The tinnitus was assessed subjectively by a questionnaire before, 6 and 24 months after initiation of treatment. The scores of tinnitus in all three items were significantly better 6 months after initiation of treatment comparing with the last treatment.
Especially younger patients with hearing improvement achieve an improvement of tinnitus in the period between 6 and 24 months after initiation of treatment. Specialist in Otology and Neurotology by Harvard Medical School, Boston, MA, USA, PhD in Medical Sciences from the University of Brasilia, Professor at Health Sciences School - University of Brasilia - Brasilia - DF - Brazil.
The condition generally affects people between 30 and 60 years of age and is equally present in both genders.In majority of cases sudden hearing loss affects only one ear but it may be possible that a person develops bilateral sudden hearing loss. In many cases, the etiology remains unknown and constitutes a major challenge, even after complete otologic evaluation, and these cases are classified as idiopathic sudden deafness3. Intratympanic dexamethasone has been trialled in patients with sudden sensorineural hearing loss, because it provides a high concentration of steroids in the labyrinth in animal models1, although its evidence are conflicting.
This study was approved by the institutional review board of the Medical School and the University Hospital in which it was carried out. Below are the details of inclusion criteria, the audiometric assessment, application technique, analysis of The Tinnitus Handicap Inventory and Analogue Visual Scale for Tinnitus and outcome of recovery of Hearing Loss and Tinnitus.
The speech recognition rate (SRR) was based on the percentage of correct answers for monosyllables. EMLA cream was placed in the outer ear canal and the tympanic membrane and left for 30 to 45 minutes, after which it was removed. Failure of oral prednisolone therapy was absence of improvement, as just described, after 14 days of treatment. In relation to the mean-tone, obtained as a result of the following classifications: mild (25%), moderate (25%), severe (25%) and deep (25%). Sudden hearing loss can occur mainly in the age group 43-53 years7, with equal gender distribution. Already Patient 4 also showed no change in auditory thresholds, showed a significant change in their tinnitus. Significant increase of 25% was found in the hearing threshold of patients undergoing this type of therapy, but in relation to tinnitus, the study was not conclusive13.
Seven patients (70%) treated with enoxaparin sodium and venous hemofiltration (group A) had reduced subjective tinnitus and four patients (40%) showed a complete hearing recovery after the first procedure.
Given the failure of the rapies performed, it was suggested the cochlear implant that, according to the authors, is a routine procedure for patients with profound bilateral sensorineural hearing loss, and succeeded, some reports showed a suppression of tinnitus as a side effect after implantation. This indicates that the tinnitus by itself cannot be a problem sign in the prognosis of hearing, but may be an essential sound for the early recovery of the damaged auditory system.
Shortly after the standard fitting procedure, the patient reported a reduction of tinnitus, hyperacusis, and the headache disappeared completely in the follow-up of 3, 6 and 12 months.


Seven patients experienced an improvement inTHI in different degrees and in only one patient there was no change.
44 patients with SSHL were followed, all treated with systemic steroids administration for 2 weeks and oral ingestion of vasoactive drugs and B12 vitamin for 6 months. Among the comparison between 6 and 24 months after initiation of treatment, there was no significant change.
Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial. Intratympanic dexamethasone injections as a treatment for severe, disabling tinnitus: does it work? Cochlear implant in patients with sudden unilateral sensorineural hearing loss and associated tinnitus. Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss and tinnitus: a systematic review of randomized controlled trials. Sodium enoxaparin and venovenous hemofiltration in treating sudden sensorineural hearing loss and tinnitus. Otoacoustic emissions, ear fullness and tinnitus in the recovery course of sudden deafness. Curing tinnitus with a Cochlear Implant in a patient with unilateral sudden deafness: a case report.
Apart from hearing problems there may be additional symptoms such as vertigo, tinnitus etc. Only 2 patients had improvement of hearing (from severe to normal, mild to normal), keeping unchanged all other results and no worsening (Table 2 and Figure 2). Patient 8, 73 years, has hypertension and diabetes, as well as probable hearing loss due to presbycusis before the episode of sudden deafness.
In group B, eight patients (80%) treated with conventional therapy showed a reduction of subjective tinnitus and hearing score also improved in eight patients (80%) - the hearing remained unchanged in two patients (20%).
All patients in both groups had ear fullness and tinnitus in association with the onset of the SSHL.
One year after the onset of symptoms on the right side, the cochlear implant was performed, and resulted in a complete suppression of tinnitus after activating the implant. It was concluded that, according to the survey of tinnitus, the time factor is the most reliable item for subjective tinnitus. The condition is either short-lived or in severe cases the person develops permanent hearing loss.Sudden Hearing Loss - CausesMany experts are simply unable to identify the underlying cause of sudden hearing loss, hence the condition is most commonly classified as idiopathic.
The procedure is well tolerated and relatively easy to perform as outpatient procedure performed under local anesthesia (topical), general anesthesia can be avoided, most patients understand the concept of intratympanic therapy and easily accepts the proposed therapy. Regarding the THI scores, it ranged from 58 to 96, prior to initiation of therapy, 8-82 and 30 days after. Such comorbidities could not justify the improvement in hearing thresholds after the proposed therapy.
None of the patients experienced side effects from this treatment, and the authors concluded that this option can be beneficial as adjuvant therapy for hearing improvement in patients with PANSS, but cost factors are the main obstacles to the use of this therapy14.
However, these symptoms improved only in Group A, showing a significant relationship between recovery of hearing thresholds and improvement of aural fullness. Clinical improvement was also reflected by a decrease in the scores of questionnaires THI and VAS. The hearing recovery was determined by comparing the hearing levels before and after treatment and tinnitus was subjectively evaluated by using a questionnaire.
However, it seems that viruses represent the cause of sudden hearing loss in approximately 60% of all cases. However, it should be emphasized again that in relation to complaints of tinnitus, it has undergone a significant change, in which catastrophic change of the degree to mild (Table 1). Given this, the authors suggested the use of cochlear implants as a possible therapy for tinnitus persisted after sudden deafness. Many viruses can be blamed for this condition and influenza type B, mumps, rubeola, varicella-zoster, measles and infectious mononucleosis are only some of them.Diagnosing Sudden Hearing LossPatients notice they have hearing problems and they turn to their doctors. We obtained an average difference of 38.6 points among patients who reported an improvement in tinnitus before and after the course of oral steroids and intratympanic. In group A, the OAE responses appeared simultaneously with the improvement in hearing levels in five patients (63%). Referring to EVA, there was a change from 7 to 10 points before therapy and from 1 to 8 points after it, in relation to intensity.
It was concluded that patients with hearing improvement PANSS (Group A) tend to have OAE responses and sensations of fullness in the ear and tinnitus improved almost simultaneously with the hearing improvement. In relation to the nuisance, there was a change from 7 to 10 points before and 0-08 points after therapy. The authors concluded that patients with poor hearing improvement tend to have absent OAE and ear fullness and tinnitus persisted.
This is a testing for hearing ability able to determine a subject's hearing levels and can effectively record hearing loss.Differential diagnosis includes several more illnesses such as viral disease, Lyme disease, vascular disease, autoimmune phenomena, parilymph fistulae, acoustic neuroma and Meniere's disease. It is essential to exclude all other conditions prior to setting a definitive diagnosis of sudden hearing loss.
Sudden Hearing Loss - TreatmentTreatment for sudden hearing loss usually includes administration of steroids (most commonly prednisone).
There have been many studies regarding treatment of hearing loss and treatment success data vary a lot. For example, some patients have responded well when they were administered transtympanic steroids since they have been unable to tolerate oral form of the medication.Another treatment option is hyperbaric oxygen therapy. This particular treatment includes 90-minute sessions of breathing pure oxygen at 2.2 atmospheric pressure in a multiperson chamber. There is not much evidence regarding treatment with carbogen and MgSO4 but these treatments may be adopted in the near future. And finally, since the condition may be caused by viral infection it is logical for doctors to opt for available antiviral drugs.



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