If a patient presents within 72 hours of onset – this is an otological emergency and the patient needs to be referred the same day (working hours) or following day by contacting the ENT on Call via St John’s, Livingston.
If there is unilateral sudden sensorineural hearing loss, and that is in the only hearing ear, systemic steroids could be considered. But please also contact on call ENT as outlined below.
A rapid loss of hearing that occurs suddenly or over a period of up to 72 hours:
- Typically unilateral
- Mean age of presentation 30-60 years
- Estimated incidence in adults of between 5 and 30 cases per 100, 000/year
- Sometimes associated with tinnitus/vertigo
Causes
- Idiopathic – commonest cause
- Infection – viral (e.g. mumps, cytomegalovirus, varicella/zoster), bacterial (syphilis, meningitis)
- Autoimmune – Sarcoidosis, Wegener granulomatosis
- Vascular – Hypercoagulable states
- Tumour – Vestibular Schwannoma, temporal bone metastases
- Trauma – Temporal bone fracture, acoustic trauma, head injury
- Drugs – Aminoglycoside antimicrobials, cisplatin
If patient presents within 72 hours of onset – this is an otological emergency and the patient needs to be referred the same day (working hours) or following day by contacting the ENT on Call via St John’s, Livingston.
A typical case presents with a sudden loss of hearing, associated with high pitched tinnitus and occasionaly associated with vertigo. A Weber test can be helpful if lateralises to the other ear.
Management at the ENT emergency clinic typically involves:
- Relevant history taking to establish a cause
- Otoscopic/Microscopic examination of the ear
- Audiometric assessment
- MRI/CT – inner ear/brain – to exclude a retrocochlear cause like acoustic neuroma
- Targeted Blood studies based on history to ascertain a systemic causes
- Follow up audiometry and referral for hearing aid if needed
Discuss any case over the phone (contacting the ENT on Call via St John’s, Livingston).
Prognosis
Spontaneous recovery from SSNHL varies in studies from 47-63% with the caveat that different studies used different criteria for degrees of recovery. Period of recovery varies from days to weeks. Poor prognostic indicators include:
- Age: <15 and >65 years
- Associated vertigo/imbalance
- High frequency/profound hearing loss
- Bilateral hearing loss
