Sudden sensorineural hearing loss: Difference between revisions
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===Diagnosis=== | ===Diagnosis=== | ||
*[[Weber test]] and [[Rinne test]] | *[[Eponyms_(T-Z)#Weber_test|Weber test]] and [[Eponyms_(Q-S)#Rinne_test|Rinne test]] | ||
*Otoscopic exam to r/o OM, OE, foreign bodies, perforated TM or cholesteatoma | *Otoscopic exam to r/o OM, OE, foreign bodies, perforated TM or cholesteatoma | ||
*Remove impacted cerumen and re-examine | *Remove impacted cerumen and re-examine | ||
Revision as of 23:55, 30 September 2014
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 Manifestations
- 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 OM on physical exam
Diagnosis
- Weber test and Rinne test
- Otoscopic exam to r/o OM, OE, foreign bodies, perforated TM or cholesteatoma
- Remove impacted cerumen and re-examine
- Complete Neurologic Exam to r/o stroke
- Audiometric evaluation
- MRI to r/o acoustic neuroma, perilymphatic fistula, Ménière’s disease, vascular insufficiency, MS
Differential Diagnoses
- Acute stroke, usually AICA occlusion
- Multiple sclerosis
- Meningitis
- Vestibular schwannomas
- Migrainous infarction
- Acute otitis media
- Traumatic TM rupture
Treatment
- Glucocorticoids orally (prednisone 1 mg/kg/day up to 60 mg maximum for 10-14 days or dexamethasone 300 mg daily for 3 days)
- Glucocorticoids locally (intratympanic instillation, dexamethasone 10 to 24 mg/mL or methylprednisolone 30 to 40 mg/mL) if refractory to oral GCs
- Antivirals for possible HSV-1 infection (valacyclovir 1g TID or famciclovir 500mg TID)
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 with SSHL will regain hearing in the affected ear
- Worse prognosis in older patients
- Worse in patients with vertigo
Follow-Up
- Audiogram in six months after initial diagnosis
- Possible auditory rehabilitation for patients with permanent hearing loss
- Consider assistive hearing devices
Sources
- 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.