Sudden sensorineural hearing loss

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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 OM on physical exam

Differential Diagnoses

Ear Diagnoses

External

Internal

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
  • MRI to rule out acoustic neuroma, perilymphatic fistula, Ménière’s disease, vascular insufficiency, MS

Management

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

  1. Weber PC. Sudden sensorineural hearing loss. In: UpToDate. Accessed Sept 22 2014.
  2. Weber PC. Etiology of hearing loss in adults. In: UpToDate. Accessed Sept 22 2014.
  3. Molina, FJ. Hearing Loss, Chapter 18. Tintinalli’s Emergency Medicine.