Sudden sensorineural hearing loss: Difference between revisions
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*Complete [[neurologic exam]] to rule out [[stroke]] | *Complete [[neurologic exam]] to rule out [[stroke]] | ||
*Audiometric evaluation (typically as outpatient) | *Audiometric evaluation (typically as outpatient) | ||
*Consider [[brain MRI|MRI]] to rule out acoustic neuroma, perilymphatic fistula, [[ | *Consider [[brain MRI|MRI]] to rule out [[acoustic neuroma]], perilymphatic fistula, [[Meniere's disease]], vascular insufficiency, [[MS]] | ||
==Management== | ==Management== | ||
Revision as of 15:30, 26 October 2019
Background
Epidemiology
- Mostly idiopathic
- Prognosis depends on severity of hearing loss
- Incidence estimates range from 2-20 per 100,000 people per year
- Most commonly 43-53 years of age
- Men and women affected equally
Clinical Features
- Immediate/rapid hearing loss or hearing loss upon awakening
- Mostly unilateral hearing loss
- Sensation of blocked or full ear, patient doesn’t recognize hearing is gone
- Difficulty in localizing sound
- Tinnitus is common
- Some patients report vertigo
- Occasionally ear pain is present
- No sign of obstruction or otitis media on physical exam
Differential Diagnoses
- Acute stroke, usually AICA occlusion
- Multiple Sclerosis
- Meningitis
- Vestibular schwannomas
- Migrainous infarction
- Acute otitis media
- Traumatic TM rupture
Ear Diagnoses
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Evaluation
- Weber test and Rinne test
- Otoscopic exam to rule out OM, OE, foreign bodies, perforated TM or cholesteatoma
- Remove impacted cerumen and re-examine
- Complete neurologic exam to rule out stroke
- Audiometric evaluation (typically as outpatient)
- Consider MRI to rule out acoustic neuroma, perilymphatic fistula, Meniere's disease, vascular insufficiency, MS
Management
- Glucocorticoids orally (prednisone 1mg/kg/day up to 60mg maximum for 10-14 days or dexamethasone 300mg daily for 3 days)
- Glucocorticoids locally (intratympanic instillation, dexamethasone 10 to 24mg/mL or methylprednisolone 30 to 40mg/mL) if refractory to oral GCs
- Antivirals for possible HSV-1 infection (valacyclovir 1g TID or famciclovir 500mg TID)
Disposition
Outpatient follow-up with:
- Audiogram in six months after initial diagnosis
- Possible auditory rehabilitation for patients with permanent hearing loss
- Consider assistive hearing devices
Prognosis
- Spontaneous improvement is common
- Better prognosis if high- or low-frequency hearing loss pattern rather than flat across all frequencies
- Around 2/3 of patients will regain hearing in the affected ear
- Worse prognosis in older patients
- Worse in patients with vertigo
See Also
References
- Weber PC. Sudden sensorineural hearing loss. In: UpToDate. Accessed Sept 22 2014.
- Weber PC. Etiology of hearing loss in adults. In: UpToDate. Accessed Sept 22 2014.
- Molina, FJ. Hearing Loss, Chapter 18. Tintinalli’s Emergency Medicine.