//fpnotebook.com/
Sudden Sensorineural Hearing Loss
Aka: Sudden Sensorineural Hearing Loss, Idiopathic Sudden Sensorineural Hearing Loss, SSHNL, Sudden Hearing Loss
- See Also
- Sensorineural Hearing Loss
- Hearing Loss
- Conductive Hearing Loss
- Hearing Impairment Severity Scale
- Epidemiology
- Incidence: 5-20 per 100,000 people annually aged 40-60 years old
- Causes
- See Sensorineural Hearing Loss
- Background
- Idiopathic in 80-90% of cases
- Significant underlying pathology identified in 16% of cases
- Most common causes
- Autoimmune inner ear process
- Viral infection
- Herpes Zoster Oticus (Ramsay Hunt Syndrome)
- Presents with severe Otalgia, ear vessicles, Bell's Palsy
- HIV Otitis
- Presents with Mastoiditis and other Cranial Nerve neuropathies
- Vascular event
- Vertebrobasilar Vascular Disease
- Presents with bilateral internal auditory artery Occlusion
- Brainstem infarct could also cause acute Hearing Loss
- Hyperviscosity Syndrome
- Presents with Retinopathy, mucous membrane bleeding, neurologic signs, pulmonary signs
- Other causes
- Neoplasms
- Neurofibromatosis II
- Bilateral Vestibular Schwannomas
- Intravascular Lymphomatosis
- Meningioma
- Hyperviscosity Syndrome
- Toxins
- Lead Poisoning
- Ototoxic Medications
- Infections
- Mononucleosis (Epstein-Barr Virus)
- Group A Streptococcus
- Herpes Simple Virus
- Herpes ZosterVirus
- HIV Infection
- Lyme Disease
- Meningitis
- Syphilis
- Trauma
- Head Injury
- Barotrauma
- Temporal BoneFracture
- Acute exposure to sudden loud noise >130 dB noise
- Miscellaneous
- See Ototoxic Medications
- Genetic disorders
- Sarcoidosis
- Meniere Disease
- Pregnancy
- Cerebrovascular Accident
- Cogan Syndrome
- Presents with interstitial Keratitis, Hearing Loss and Vertigo
- Mitochondrial disorders (MELAS)
- Presents with Mitochondrial Encephalopathy, Lactic Acidosis, Stroke-Like episodes
- Symptoms
- Sudden onset Hearing Loss
- Typically unilateral (bilateral is rare)
- Sounds are harsh and distorted
- Associated with aural fullness
- Vertigo and Ataxia may be present
- Exam
- See Hearing Loss
- See Hearing Impairment Severity Scale
- Differential Diagnosis
- Conductive Hearing Loss
- Evaluation
- Labs
- Not indicated unless dictated by history (e.g. Lyme Titer)
- Urgent Audiogram
- Perform same day of presentation
- Confirms Sensorineural Hearing Loss
- Repeat at 6 months from initial Audiogram
- Diagnosis: Audiogram
- Rapid loss of hearing within a 72 hour period
- Hearing Loss of 30 DB in at least 3 connected frequencies
- Imaging
- Indicated if SSHNL confirmed by Audiogram
- MRI with gadolinium
- Evaluates retrocochlear lesion (e.g. Schwannoma)
- CT Head is not recommended as alternative
- Management
- Sudden Sensorineural Hearing Loss requires immediate evaluation
- Otolaryngology evaluation is recommended within 24 hours
- Consider antiviral medications
- Corticosteroids
- Targets inflammatory cell death cascade in Sudden SNHL
- Standard of care treatment, but does not appear to significantly improve outcomes
- Labus (2010) Laryngoscope 120(9): 1863-71 [PubMed]
- Systemic Corticosteroids orally
- Typical adult dose: 60 mg for 5 days and then taper off over next 5 days
- Intratympanic Corticosteroids by Otolaryngology
- Indicated for patients not recovering spotaneously or after initial treatment
- Hyperbaric oxygen
- May be beneficial in first 3 months
- Other measures used
- Diuretics
- Plasma expanders
- Immunosuppressants (in addition to Corticosteroids as above)
- Measures without evidence of benefit
- Antiviral agents
- Consider only if suspected underlying viral etiology (e.g. HSV, VZV)
- Previously 10 days of Valacyclovir, Famciclovir, or Acyclovir was considered
- Thrombolytics
- Vasodilators
- Vasoactive substances
- Antioxidants
- Prognosis
- Spontaneous recovery in up to 70% of idiopathic cases
- References
- Browning (2008) Park Nicollet Primary Care Update, Lecture, St. Louis Park, MN
- Orman and Finley (2018) EM:Rap 18(2): 15-6
- Michels (2019) Am Fam Physician 100(2): 98-108 [PubMed]
- Rauch (2008) N Engl J Med 359(8): 833-40 [PubMed]
- Stachler (2012) Otolaryngol Head Neck Surg 146(3 Suppl): S1-35 [PubMed]