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Sudden Sensorineural Hearing Loss
Sudden Sensorineural Hearing loss
Sudden hearing loss (SHL) is defined as greater than 30 dB hearing reduction, over at least three contiguous frequencies, occuring over 72 hours or less. It occurs most frequently in the 30 to 60 year age group and affects males and females equally.
SHL is usually unilateral (that is, it affects only one ear); and is often accompanied by tinnitis. vertigo, or both. The amount of hearing loss may vary from mild to severe, and may involve different parts of the hearing frequency range. SHL may be temporary or permanent. About one third of people with SHL awaken in the morning with a hearing loss.
Causes :
Many theories have been put forward but there is no conclusive evidence available proving a particular cause for this condition.
Although some hold that this disease is generally idiopathic (of unknown cause), viral disease appears to be the basis for about 60% of all cases of SHL.
The vascular theory holds that partial or complete blockage of the blood circulation of the inner ear may cause idiopathic sudden SNHL.
Vascular spasm has also been implicated as a factor in sudden hearing loss, due to a reported association between migraine headaches and a temporary, reversible hearing loss.
The third theory is based on the rupture of the delicate inner ear membrane and fistulae of the round and/or oval window. Round and oval window ruptures are reported to occur when pressures from within (cerebrospinal pressure) or without (middle ear pressure) suddenly increase causing breaks in the cochlear membrane, resulting in sudden hearing loss. Often, there is a history of strenuous physical activity or straining, or sudden changes in barometric pressure, such as in flying or scuba diving.
Treatment :
Most authorities noted that while numerous treatments have been studied aiming to improve blood flow, such as carbogen inhalation or stellate ganglion block, all remain controversial or simply lack convincing evidence of efficacy. there is presently a limited ability to determine what is the optimal treatment of SHL.However, most studies suggest a better hearing prognosis for treated vs. untreated patients .
Keeping all these factors in mind a very effective therapeutic protocol has been devised at the Clinic that allows us to give an improvement in over 80% of cases of sensorineural hearing loss presenting within 72 hours of onset of symptoms.
No guarantees can be given regarding the success of this therapeutic regimen due to the fact that there is no conclusive evidence regarding its etiology.
However 2 things are conclusively proved :
- It is essential to provide early intervention.
- Treated patients have a better prognosis than untreated patients. Antivirals seem reasonable, given the frequency that herpes family viruses have been associated with SHL.
Steroids : Studies have shown a 78% response to steroids and a 38% response to placebo in a double blind study. They found that the steroids had the greatest benefit in patients with moderate, unilateral sudden hearing loss less than 40 years of age.
The use of Vasodilators is based on the premise that it promotes blood flow and eliminates vasospasm (i.e., the cause is vascular).
Immunosuppressants in sudden fluctuant SNHL: Wang et al recently reported that etanercept given acutely in experimental labyrinthitis resulted in much better hearing results. While this animal study may not apply to humans, it suggests that acute treatment with etanercept or a related anti-TNF drug (Remicade, Humira), may improve hearing results for sterile inflammation.