Dr. April Ward

Sudden sensorineural hearing loss is frequently misdiagnosed by both the people who experience it and their primary care providers, which can lead to permanent hearing loss.

Sudden sensorineural hearing loss is defined as hearing loss that occurs suddenly or over a 72-hour period. Symptoms of SSNHL are very similar to symptoms of a wax blockage or congestion, such as a plugged feeling in the ear, loud ringing in the ear and decreased hearing. Most often, only one ear is affected. The plugged feeling is very similar to what you may experience when you have a bad cold or when you have just landed in an airplane, and it is often assumed that the issue will resolve on its own. Physicians also often mistakenly prescribe nasal sprays and decongestants to treat the perceived congestion, which will not have any positive impact on SSNHL. Loud ringing in the ear (known as tinnitus) can also often mask a hearing loss.

Sudden sensorineural hearing loss is a hearing loss that affects the nerve or sensory cells of hearing in the inner ear. If left untreated, SSNHL can lead to permanent hearing loss. The incidence of SSNHL is rare, six in 5000 according to the National Institutes of Health. However, it is thought to be much higher as many cases go unreported. It most commonly occurs in both men and women in their late 40s and early 50s but can also occur at any age.

One way to determine whether a hearing loss in one ear is due to congestion or to a nerve issue is to hum to yourself. If your voice is louder in the “bad” ear, then the hearing loss is most likely due to wax blockage, an ear infection, or congestion. If your voice is louder in the “good” ear, then the hearing loss is most likely sensorineural and requires treatment as soon as possible. However, if it is difficult to determine which ear your voice is louder in, a hearing test is the best course of action. NOTE: do not plug either ear while performing this “self check” as that will affect the results.

It is important that if you or a loved one experience sudden hearing loss or sudden tinnitus that does not resolve within a few hours accompanied by a feeling of pressure in the ear, that you call your primary care provider, your ear, nose, and throat provider, or your audiologist. Let schedulers know that you had a sudden loss of hearing (or onset of ringing in one ear) and that you need an appointment quickly. A comprehensive hearing evaluation by an audiologist should be performed within the first several days of the onset of symptoms to confirm the underlying cause.

Once SSNHL is confirmed, treatment can be started. Treatment typically includes a course of corticosteroids, such as prednisone, to reduce inflammation. An option other than oral corticosteroids is a steroid shot that can be injected by an ear, nose, and throat physician directly into the ear drum. This helps to avoid some of the unpleasant side effects of oral steroids but is just as effective at helping to recover lost hearing.

Time is of the essence in receiving appropriate treatment. If steroids are started more than four weeks after the onset of the hearing loss, the likelihood of recovering the hearing is minimal.

Possible causes of sudden sensorineural hearing loss include infections, head trauma, autoimmune diseases, inflammation, migraine, exposure to certain medications for cancer and severe infections, blood circulation problems, neurological disorders such as MS, and (rarely) a benign tumor on the auditory nerve. Additional tests including blood work, imaging, and balance tests to help determine the cause of the SSNHL. Treatment plans (in addition to the use of steroids) may vary depending on the results of these additional tests.

Dr. April Ward, Au.D., is an audiologist and the director of Idaho Elks Hearing and Balance Center.

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