Description
One typical complaint that gets referred to secondary care for an otolaryngologist's attention is hearing loss. Conductive and sensorineural hearing loss are the two categories of hearing loss. The majority of hearing loss is caused by sensorineural hearing loss (SNHL), which is the most prevalent form. Any cause of hearing loss resulting from a disorder of the central nervous system, auditory nerve, or cochlea is referred to as SNHL. An otolaryngologist, an audiologist, a radiologist, and a speech-language pathologist should be part of a multidisciplinary team that investigates and completes a comprehensive audiometric evaluation for patients with recent onset hearing loss.
Summary Listen
- Sudden sensory neural hearing loss (SSNHL) is a sudden, spontaneous loss of hearing, often without a known cause. It's defined as a 30 decibel or greater sensory neural hearing loss over at least three contiguous audiometric frequencies occurring within 3 days or less. While the exact cause is often unknown, potential etiological factors include infections, autoimmune causes, trauma, vascular issues, and neoplasms, particularly vestibular schwannomas.
- Patients typically experience a sudden loss of hearing, sometimes accompanied by tinnitus, vertigo, or a feeling of fullness in the ear. Elderly, diabetic patients, or those with vertigo or severe deafness initially, have a poor prognosis. Autotoxic drug use is another important consideration. A thorough history, including potential inciting events like head trauma or pressure changes, and a complete head and neck examination are crucial for diagnosis.
- Investigations include audiograms, pure tone speech discrimination, tympanometry, stapedial reflex testing, and MRI to rule out other causes like CP angle tumors or multiple sclerosis. Pathogenesis involves potential vasculitis, antigenic epitopes, or breaks in the membranous labyrinth. Traumatic causes may include perilymph fistula or inner ear decompression sickness.
- Treatment strategies involve addressing underlying conditions and managing symptoms. Steroids, administered orally or intratympanically, are the mainstay of treatment. Antiviral agents and vasodilators have also been explored. In traumatic cases, surgical exploration and patching of perilymph fistulas may be necessary. Hyperbaric oxygen therapy is sometimes used as a salvage therapy.
- Prognosis is influenced by several factors, including age, presence of vertigo, degree of hearing loss, and time elapsed since onset. Prompt diagnosis and treatment are crucial to improve the chances of recovery and minimize long-term complications such as residual deafness or the need for hearing aids. Early intervention and empathy towards the patient are vital.
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