Sudden Hearing Loss – March 2016

Every day in my clinic I talk to several people who have come in to discuss gradual hearing loss that has finally become somewhat disabling. I can offer these individuals a number of approaches to enhance their communication skills. Hearing loss is inevitable as we age, and as our delicate inner ear structures are continually exposed to the deleterious effects of exposure to loud noises (“acoustic trauma”). In situations where hearing loss has been progressive for months and years, there is no urgency to diagnose and treat, but options are always discussed during our first clinic visit.

On occasion, a patient will be referred for evaluation of a sudden loss of hearing, usually in one ear, that is not caused by any visible infection or blockage. As a rule, these people have suddenly lost actual nerve hearing. This situation is quite urgent, since we ear doctors can often help patients regain at least some of the devastating loss of hearing in an ear if we see the patient in a timely fashion. If too many days or weeks pass after this “sudden hearing loss” occurs, our ability to help patients dwindles. If it is ignored or overlooked too long, the patient likely will never regain the lost hearing. For this reason, I consider sudden unexplained loss of hearing a true medical emergency.

Causes and Treatments

When I see a patient with a sudden loss of hearing, it is important to quickly determine if the cause of this is something simple and correctable. Commonly, patients are referred urgently with sudden loss of hearing, who have a simple ear infection, or a plug of ear wax blocking their ear canal. Both patient and I breathe a sigh of relief if these conditions are present, because we can easily manage them and correct the loss of hearing.

This urgent condition of sudden nerve deafness goes by a number of names, but we Otologists refer to it as “sudden sensorineural hearing loss”, abbreviated SSNHL. The majority of these losses of nerve function are probably caused by either viral infections of the inner ear, or loss of blood supply or “mini-strokes” to a critical area of the nerve centers (“vascular events”). This unexplained sudden nerve deafness (we call it “idiopathic”) must be initially treated with high dose oral steroids, injections of steroids directly into the inner ear (SMEP = steroid middle ear perfusion).

Sudden nerve deafness can be caused by a rupture of a cochlear membrane, resulting in “fistula” (leak of inner ear fluid). This can be brought on by rapid change in pressure, head or ear trauma, straining or lifting. Fistulas are repaired by inner ear surgery.   Chronic inner ear disorders such as Meniere’s Disease can produce a sudden drop of hearing, and treated with either oral steroids or diuretics (water pills). Lastly, there are a number of autoimmune disorders in which a person’s own antibodies attack their inner ear resulting in a sudden drop of hearing. Again, these conditions are generally treated successfully with oral steroids.

More recently, I had seen several middle aged men with sudden nerve deafness in one ear, in whom I believe the cause of their loss may be the use of erectile dysfunction (“E.D.) medications such as Cialis, Levitra and Viagra. “Sudden loss of vision and hearing” are side effects of these drugs, and, although I can’t prove “cause and effect”, I have seen a surprising number of men affected in this way. I have not had good luck treating nerve deafness from ED drugs, and caution these individuals to discontinue their use.

The following are accounts of real patients I saw in the last 2 weeks who were referred with sudden hearing loss:

  1. S., a 50 year old businessman, noted a sudden “pop” in his left ear during descent of his flight into Denver. He had been suffering from a cold for a week. In addition to losing hearing in his left ear, he experienced spinning vertigo with nausea for a day, and now feels “wobbly”. He was seen by a local urgent care center who could not find a visible cause for his hearing loss, and referred him urgently. By the time I saw him in my clinic, he had lost 70% of his hearing in that ear, and I felt he must have suffered a rupture of an inner ear membrane. He felt that his hearing is improving daily, so we decided to not go to surgery immediately to explore his ear for the fistula yet. If his symptoms do not resolve in the next week or so, I will recommend exploration of his middle ear for a perilymph fistula under a general anesthetic.
  2. Z., 75 year old female, woke up a2 weeks ago with no hearing in her right ear. She reported no other symptoms. Her physical exam showed no visible abnormality, yet she had lost 40% of her right sided hearing. We initially treated her with a tapering course of oral prednisone, and, in addition, injected her middle ear with 12 mg of decadron (another type of steroid). She is regaining hearing and we are both guardedly encouraged.
  3. J., a 37 year old mother of 2 and busy attorney, came in with a drop of hearing in her right ear, accompanied by rushing noise and fullness.  Physical exam shows no visible abnormality, and hearing test shows a 30% low frequency loss. She reported to me that her mother had a similar problem with hearing loss and dizziness, and was treated for Meniere’s Disease (which can be inherited).   I immediately started her on a diuretic (water pill) called Maxide, and told her to limit her sodium intake to under 2000 mg a day. There are the standard first line therapies for Meniere’s. Within a few days, she reports improvement, and I will see her in followup in a month.
  4. J., a 22 year old, self referred himself to me for a sudden loss of hearing, after using an “ear candle” to “clean his ear”. His ear canal was packed with melted candle wax mixed with his own ear wax. I removed it easily, and told him to buy candles for use during the holidays, not to stick in his ear.

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