Sudden Sensorineural Hearing Loss, You Should Treat it as a Medical Emergency
Sudden Loss of Hearing, What You Need to Know
Sudden Sensorineural Hearing Loss (SSHL), What You Need To Know
Not all sudden hearing losses are necessarily a really bad sign, the problem is that it could be, so therefore you should treat it as such. Cases of Sudden Sensorineural Hearing Loss (SSHL), sometimes just called sudden deafness appear to be on the rise. SSHL is, and should be treated as a medical emergency when it occurs. When any sudden onset hearing loss occurs, the faster you get it checked, the better the outcome may be for your hearing. If it is SSHL, the faster you get treatment, the better it will be for your long term ability to hear. Sudden deafness could be just a temporary conductive problem, that's a problem with your middle ear or ear canal, not a problem with your cochlea (inner ear). But how will you know? Is there a difference? The answers are, you may not be able to tell and while there are some differences in symptoms, they can be very subtle. Let's talk about sudden hearing loss.
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The Two types of Sudden Deafness, What are They?
A sudden hearing loss tends to be just that, very little warning, just a sudden event. However, not all sudden deafness is sensorineural (inner ear related). There are two types of sudden hearing loss that may happen, they are:
- Sudden Conductive Hearing Loss
- Sudden Sensorineaural Hearing Loss
Sudden Conductive Hearing Loss
A conductive hearing loss is a hearing loss that is caused by a problem in either the middle ear or the outer ear. Sometimes a temporary sudden conductive hearing loss may occur caused by wax or middle ear infection. Both can generally be diagnosed and treated easily.
A clear indication that it may be wax is if the hearing loss occurs after a swim. a bath or a shower. Wax is like a sponge, it will soak up water very quickly, as it does it expands. If there is enough wax in the ear canal, it will expand enough to block the ear canal and cause issues with your hearing. Even if you think the cause of your sudden deafness is wax, get it checked quickly, do not put it off.
A clear indication of a mid ear infection being a cause of hearing loss is pain in the ear affected. Normally in a sudden sensorineural hearing loss, there is no pain. Again, even if you think it may be an infection, go and get attention. In fact, a mid-ear infection can cause real complications for hearing. The quicker it is treated, the better the outcome. You may have ringing in your ears (tinnitus) with a sudden conductive hearing loss.
Recovery From Sudden Conductive Deafness
Depending on what caused the conductive hearing loss, there may be spontaneous recovery within a week or two. If the problem is earwax, it probably won't resolve itself without some sort of treatment to remove the wax blockage. If the problem is in the mid ear and caused by some sort of eustachian tube problem, it may clear itself when the eustachian tube opens. If the problem is a viral infection of the mid ear cavity, it will sort itself out after a week or two. However if the infection becomes acute, you will need some sort of medical treatment.
Causes of Sudden Conductive Deafness
The possible causes of sudden conductive deafness include:
- Outer ear infection (Otitis Externa)
- Earwax blockage
- Middle ear infection (Otitis Media)
- Head injury causing ossicular chain damage (damage to the small bones in the middle ear cavity)
Sudden Sensorineural Hearing Loss (SSHL)
Sensorineural hearing loss refers to an inner ear (cochlea) hearing loss, which is commonly known as nerve deafness. Sudden sensorineural hearing loss (SSHL) may be caused by a viral infection or some sort of cardiovascular event where the blood supply to the cochlea is reduced or temporarily cut off. The causes can be unclear, however, it needs to be diagnosed and treated quickly.
SSHL is defined as a greater than 30 dB hearing reduction, over at least three contiguous frequencies, occurring over a period of 72 hours or less. Some people report that their hearing loss was noticed immediately often in the morning. However, some report that their hearing loss developed over a period of hours or days.
Sudden Hearing Loss Needs To Be Treated As A Medical Emergency, Early Treatment (48 Hours) Gives Best Chance of Recovery In Cases of SSHL
Recovery From SSHL
The severity of this type of hearing loss often varies from one person to another, oddly enough, usually only one ear is affected at the beginning. However, it may spread to the second ear over time and research makes it clear that it often involves both ears. The issue really is that the symptoms of both types of loss can be very similar, this is why rapid investigation is needed. Rapid treatment for SSHL can mean almost total recovery, some people who develop SSHL may, in fact, recover totally without treatment, but many don't, so why take the risk? As you will see further down the page, your level of fitness may also have a bearing on recovery even with treatment.
Causes of SSHL
There are varying thoughts about the underlying causes of Sudden Sensorineural Hearing Loss. It can be some sort of a cardiovascular event which impairs blood supply to the cochlea. However, there are many theoretical causes for sudden hearing loss which include infectious, circulatory, inner ear problems like Meniere's disease, neoplastic, traumatic, metabolic, neurologic, immunologic and toxicity. Even after a thorough search for a possible cause, the cause of sudden hearing loss nearly always remains idiopathic (fancy term for we don't have a clue) in most people. The possible causes are:
- Infectious diseases
- Trauma, such as a head injury
- Autoimmune diseases
- Ototoxic drugs (drugs that damage the inner ear)
- Blood circulation problems
- A tumour (auditory neuroma) on the nerve that connects the ear to the brain
- Neurologic diseases and disorders
- Disorders of the inner ear, such as Ménière’s disease
SSHL and Metabolic Syndrome
It appears that people with Metabolic Syndrome may have a worse recovery rate from a sudden sensorineural hearing loss than people without it. According to guidelines used by the medical profession, metabolic syndrome is present if an individual has three or more of the following traits or is taking medication to control them:
- Large waist circumference — a waistline that measures at least 35 inches (89 centimetres) for women and 40 inches (102 centimetres) for men
- High triglyceride level — 150 milligrams per deciliter (mg/dL), or 1.7 millimoles per litre (mmol/L), or higher of this type of fat found in blood
- Reduced high-density lipoprotein (HDL) cholesterol — less than 40 mg/dL (1.04 mmol/L) in men or less than 50 mg/dL (1.3 mmol/L) in women of this “good” cholesterol
- Increased blood pressure — 130/85 millimetres of mercury (mm Hg) or higher
- Elevated fasting blood sugar — 100 mg/dL (5.6 mmol/L) or higher
A recent study published in JAMA indicates that adults diagnosed with metabolic syndrome have a poorer recovery rate from episodes of sudden sensorineural hearing loss. The study, which was undertaken in Korea retrospectively studied 124 adults, diagnosed with a sudden sensorineural hearing loss (SSNHL). The researchers evaluated the demographic and clinical characteristics as well as several audiological variables of each patient diagnosed with SSNHL.
Of the 124 patients (52 men and 72 women with a mean age of 56 years), 70 had metabolic syndrome and 54 did not. Rates of type II diabetes, hypertension, obesity and mean concentrations of triglycerides were significantly higher, while mean concentrations of high-density lipoprotein, so-called “good” cholesterol was significantly lower in the group with metabolic syndrome than in the group without metabolic syndrome.
The researchers concluded that the rate of recovery from SSNHL was lower among patients with metabolic syndrome than among those without metabolic syndrome. Prognosis for recovery was poorer in patients with four or more diagnostic factors of the metabolic syndrome.
SSHL in Children
It appears that younger children may have a poorer prognosis for recovery from SSHL in comparison to adolescents and adults. A limited study undertaken in Korea revealed a poorer recovery rate for children aged between 4 and 12 with SSHL. In the study, there was a marked variance in recovery rates between younger children and adolescents.
The Symptoms of Sudden Sensorineural Hearing Loss
Many people who have suffered the condition mention that ear pressure and/or tinnitus were the first signs that they suffered. The symptoms can occur immediately all at once or over a period of time, usually in one ear. The severity of the symptoms may vary significantly. In worst case scenarios, permanent deafness may be possible, that is why it needs to be treated immediately. The typical symptoms mentioned by sufferers are:
- The occurrence of sudden noticeable hearing loss
- The absence of an earache
- Hearing loss in only one ear
- Loss of sensation in the outer ear
- Ear pressure
- Ringing in the ears (Tinnitus)
The most obvious symptom is a sudden hearing loss in one ear, in particular, if it is not accompanied by an earache. Some people have also suffered some dizzy spells and slight nausea. Tinnitus is usually reported by most people and dizziness is reported by about 40% of people. Many people say that the earliest symptom is a feeling of pressure deep in the ear and some talk about a pop or loud crackle sound which immediately leads to tinnitus.
Can sudden hearing loss be reversed or cured?
Sudden Sensorineural Hearing Loss can often be reversed, however, it needs to be treated rapidly. Most experts agree that treatment must commence within 48 hours to ensure the optimal chance of recovery. That means that you need to get prompt diagnosis and prompt treatment for SSHL
Treatment of Sudden Sensorineural Hearing Loss
Over the years the common treatment for sudden sensorineural hearing loss has varied. The real problem is that because we are still uncertain of the cause, it is difficult to provide a treatment that we are sure will work. The one treatment that is consistently used and has shown good results is steroid therapy. The treatments used so far have included:
- Systemic steroids
- Intratympanic corticosteroid therapy
- Hyperbaric oxygen treatment
- Antiviral medications
- Vasodilators (open vascular system)
- Carbogen (high levels of oxygen) therapy
- No treatment at all
- Hearing Aids
Corticosteroid therapy (usually orally) is among the few treatments that are accepted across the world for the treatment of SSHL. In recent times, treatments involving intratympanic corticosteroid therapy (injections of intratympanic (through the eardrum) steroids), are being tested to see if they improve hearing recovery. However, a study in 2011 showed no real difference in hearing recovery for oral vs. intratympanic steroid treatment (Rauch et al 2011).
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy is often combined with steroid therapy, in essence, you are put in a hyperbaric chamber and the level of pure oxygen is increased to thoroughly oxygenate your body. This therapy has been proven to decrease repair times for muscular injuries and recuperation in athletes.
The theory for the use of antiviral medication is based on the fact that the herpes simplex virus seems to be connected to SSHL in some cases. While the use of antivirals in early tests in animals looked hopeful, it hasn't proved especially effective in humans.
The use of vasodilators is based on the theory that a cardiovascular event may have caused the problem. Again the theory is valid, however, in practice, it looks like using them may make no difference. There isn't any real hard evidence that they help.
Again, this was a combination treatment that was introduced many years ago, however, the effectiveness of the oxygen treatment has not been conclusively established.
No Treatment at All
The basis for giving no treatment at all was the fact that many people seem to recover from sudden sensorineural hearing loss without intervention. In fact, it has been reported that up to two-thirds of cases just recover.
In cases where other treatments are exhausted and the hearing loss remains, hearing aids are the only long term answer to treating the hearing loss. If the loss is only to one ear, hearing aids and amplification to the ear with hearing loss can be successful. However, not in all cases, sometimes it appears that the damage to the cochlea causes problems with speech resolution.
In cases like this, a specialist hearing aid system called a CROS (Contralateral Routing Of Signal) system is a better option. The CROS system works by wirelessly sending the sound from the bad side to the good ear. Amazingly it works very well and it gives people a sense that they are hearing from both ears.
Posted by Geoff
Geoffrey (Geoff, anything else makes him nervous) Cooling has been involved with the hearing aid industry for over ten years. He has worked in private practice dispensing hearing aids and as a manufacturer's rep. He has written two books and they are both available on Amazon. He loves technology, passing on knowledge and is legendary for many other things, primarily the amount he curses, his dry and mischievous sense of humour and his complete intolerance of people who are full of themselves. Please feel free to connect with him