II. Definitions

  1. Sensorineural Hearing Loss
    1. Disorder of converting mechanical sounds to neuroelectric sound in the inner ear or auditory nerve

III. Epidemiology

  1. Age of onset over 40 years old

IV. Causes

  1. See Sudden Sensorineural Hearing Loss
  2. Presbycusis related to aging (often bilateral)
    1. Most common cause of Sensorineural Hearing Loss
  3. Noise Induced Hearing Loss (bilateral)
    1. Acute exposure to sudden loud noise >130 dB noise
    2. Chronic exposures to loud noise >85 dB
  4. Cranial Nerve 8 disease
    1. Meniere's Disease (associated with Tinnitus and Vertigo)
    2. Acoustic Neuroma (unilateral)
  5. Hematologic from vascular sludging and Hypoxia
    1. Polycythemia Vera
    2. Sickle Cell Anemia
    3. Leukemia
    4. Hypercoagulable states
  6. Microvascular disease
    1. Diabetes Mellitus
    2. Hyperlipidemia
  7. Ototoxic Medications (bilateral)
    1. See Ototoxic Hearing Loss
  8. Infectious Causes
    1. Tertiary Syphilis
    2. Lyme Disease
    3. Acute Labyrinthitis (Viral Labyrinthitis)
      1. Mumps is most common cause
    4. Meningitis
    5. Otitis Media complication
  9. Endocrine Disease
    1. Hypothyroidism
  10. Autoimmune Hearing Loss
  11. Congenital Deafness
  12. Trauma
    1. Temporal Bone Fracture involving Cochlea or vestibule
    2. Perilymph fistula
      1. Round window or oval window rupture with leak
      2. Caused by Trauma, lifting, straining, coughing

V. Symptoms

  1. Tinnitus
    1. Ringing, buzzing, humming, hissing, "crickets in ears"
    2. Occurs early in Hearing Loss course
  2. Pain with loud noise exposure
  3. Hearing Loss
    1. See Hearing Impairment Severity Scale
    2. Frequently ask others to repeat what they have said
    3. Impaired word understanding often present
    4. Loud patient's voice
    5. Hearing difficult in noisy environments

VI. Signs

  1. Otoscopy
    1. Ear Canal and TM are normal
  2. Weber Test (Tuning Fork at Midline) Abnormal
    1. Sound radiates to ear with less sensorineural loss
  3. Rinne Test (Tuning Fork on Mastoid) Abnormal
    1. Both air conduction and bone conduction reduced

VIII. Imaging

  1. MRI Head at Internal Auditory Canal (IAC)
    1. Gold standard to evaluate for Acoustic Neuroma
    2. Evaluates for inflammation such as due to Herpes Zoster Oticus
    3. Vascular lesions may be evident
  2. MRA head
    1. Indicated if vascular lesion is suspected
  3. CT Temporal Bone
    1. Evaluates infectious causes (e.g. Mastoiditis, Cholesteatoma)
    2. Evaluates bone anatomy (Ossicles and Cochlea, vestibular aqueduct swelling, Fractures)
    3. Can also identify Acoustic Neuroma and vascular lesions but MRI is preferred

IX. Management

  1. Formal audiology testing
  2. Acute Hearing Loss (within 3 days)
    1. Urgent evaluation needed for 30 db loss
    2. High dose Steroids (1 mg/kg/d) (uncertain efficacy)
    3. Carbogen Inhalation (5% CO2 and 95% Oxygen)
      1. May increase Cochlear Blood Flow by vasodilation
      2. Duration determined by serial Audiograms
    4. Otolaryngology evaluation
  3. Chronic
    1. See Hearing Aid

X. Course

  1. Often no etiology identified
  2. May resolve spontaneously

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Related Studies

Ontology: Sensorineural Hearing Loss (disorder) (C0018784)

Definition (NCI) Hearing loss caused by a problem in the inner ear or auditory nerve. A sensorineural loss often affects a person's ability to hear some frequencies more than others. This means that sounds may be appear distorted, even with the use of a hearing aid. Sensorineural losses can range from mild to profound.
Definition (MSH) Hearing loss resulting from damage to the COCHLEA and the sensorineural elements which lie internally beyond the oval and round windows. These elements include the AUDITORY NERVE and its connections in the BRAINSTEM.
Definition (CSP) due to lesions of the cochlea and the auditory division of the eighth cranial nerve; problem of cellular dysfunction rather than airborne conduction.
Concepts Disease or Syndrome (T047)
MSH D006319
ICD9 389.10, 389.1
ICD10 H90.5
SnomedCT 194427003, 155256000, 194421002, 267770004, 60700002
English Hearing Loss, Sensorineural, SNHL-Sensorinl hear los, Sensorineural hearing loss, unspecified, Deafness Sensorineural, Hearing loss, sensorineural, Deafness, sensorineural, Deafness, neurosensory, sensorineural hearing loss, sensorineural hearing loss (diagnosis), Neuro sensory deafness, Deafness neurosensory, Sensorineural Hearing Loss (disorder), Sensorneur hear loss NOS, Hearing loss, perceptive, Perceptive hearing loss NOS, Unspecified sensorineural hearing loss, Sensorineural deafness NOS, Hearing Loss, Sensorineural [Disease/Finding], sensory hearing loss, Deafness;sensoneural, hearing loss sensorineural, perceptive deafness, hearing loss sensori neural, neurosensory deafness, sensorineural hearing losses, sensorineural deafness, sensory neuro deafness, inner ear hearing loss, Perceptive hearing loss NOS (disorder), Perceptive deafness [diagnos], Sensorineural Deafness, Sensorineural hearing loss, PD - Perceptive deafness, Perceptive hearing loss, SNHL - Sensorineural hearing loss, Sensorineural deafness, Neurosensory deafness, Perceptive deafness, SND - Sensorineural deafness, Sensory-neural deafness, Sensory-neural hearing loss, deafness; perception, hearing; loss, sensorineural disorder, loss; hearing, sensorineural disorder, perception; deafness, Perceptive deafness, NOS, Perceptive hearing loss, NOS, Sensorineural hearing loss, NOS, Sensorineural Hearing Loss, Perceptive hearing loss or deafness, sensori-neural deafness, Perceptive hearing loss NOS (finding), Sensorineural hearing loss (finding), Sensorineural hearing loss (disorder)
Italian Sordità neurosensoriale, Sordità percettiva, Sordità neurosensoriale, non specificata, Ipoacusia neurosensoriale
Dutch sensineuraal gehoorverlies, niet-gespecificeerd, sensineurale doofheid, sensineuraal gehoorverlies, perceptiedoofheid, doofheid; perceptie, gehoor; verlies, door perceptiestoornis, perceptie; doofheid, verlies; gehoor, door perceptiestoornis, Gehoorverlies door perceptiestoornis, niet gespecificeerd, doofheid neurosensorisch, Sensorineurale slechthorendheid, Slechthorendheid, sensorineurale, Doofheid, sensoneurinale, Sensorineurale doofheid
German perzeptive Taubheit, sensorineurale Taubheit, neurosensorische Taubheit, sensorineuraler Gehoerverlust, unspezifisch, sensorineuraler Hoerverlust, Hoerverlust durch Schallempfindungsstoerung, nicht naeher bezeichnet, Schallempfindungsschwerhoerigkeit, Schwerhörigkeit, Schallempfindungs-
Portuguese Surdez de percepção, Défice auditivo neurossensorial NE, Défice auditivo neurossensorial, Hipoacusia Neurossensorial, Perda Auditiva Sensoneural, Perda de Audição Neurossensorial, Perda Auditiva Sensitivoneural, Surdez neurossensorial, Perda Auditiva Neurossensorial, Perda Auditiva Sensorineural
Spanish Sordera de percepción, Sordera sensorineural, Pérdida de audición neurosensorial no especificada, Pérdida de audición neurosensorial, pérdida auditiva sensitivoneural (hallazgo), hipoacusia de percepción, SAI (hallazgo), pérdida de la audición sensorioneural, sordera perceptiva, pérdida auditiva sensitivoneural, pérdida auditiva sensitivoneural (trastorno), pérdida de la audición neurosensorial (trastorno), sordera neurosensitiva, hipoacusia sensorioneural, pérdida de la audición neurosensorial, hipoacusia de percepción, SAI, hipoacusia de percepción, SAI (trastorno), Hipoacusia Neurosensorial, pérdida auditiva perceptiva, Sordera neurosensorial, Pérdida Auditiva Sensorineural
Japanese 詳細不明の感音性難聴, カンオンセイナンチョウ, カンオンナンチョウ, ショウサイフメイノカンオンセイナンチョウ, 感音性聴力損失, 感覚神経性聴力損失, 聴力損失-感音性, 感音性難聴, 感音難聴, 難聴-感音性
Swedish Hörselnedsättning, sensorisk
French Perte d'audition sensorineurale, Perte d'audition sensorineurale, non précisée, Surdité de perception, Surdité neurosensorielle, Perte d'audition de perception, Déficience auditive neurosensorielle
Czech nedoslýchavost senzorineurální, nedoslýchavost percepční, Percepční hluchota, Senzorineurální ztráta sluchu, blíže neurčená, Senzorineurální hluchota, Senzorineurální ztráta sluchu
Finnish Sensorineuraalinen kuulovika
Korean 상세불명의 감각신경성 난청
Polish Utrata słuchu typu odbiorczego, Głuchota odbiorcza, Niesłyszenie czuciowo-nerwowe, Głuchota czuciowo-nerwowa, Uszkodzenie słuchu zmysłowo-nerwowe, Niedosłuch odbiorczy, Utrata słuchu czuciowo-nerwowa
Hungarian Perceptiós süketség, Nem meghatározott sensoro-neuralis hallásvesztés, Sensoro-neuralis hallásvesztés, neurosensoros süketség, Neurosensoros süketség, Sensoro-neuralis süketség
Norwegian Hørselstap, sensorinevralt, Sensorisk hørselstap, Hørselstap, sensorisk, Sensorinevralt hørselstap