Nerve Hearing Loss

A sudden loss of hearing is considered an ENT emergency. The most important part of the treatment is to be evaluated by an ENT specialist as soon as possible. The ear must be examined and an audiogram must be performed in order to determine the cause of the sudden change in hearing.

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Many times, the cause of the sudden change in hearing can be easily identified and treated. Common causes include a wax impaction, an ear infection or a foreign body in the ear. At times, there is no obvious cause of the hearing loss. In these cases, the hearing loss is called "idiopathic."

What is Idiopathic Sudden Sensorineural Hearing Loss (ISSHL)?

ISSHL is defined as a loss of at least 30 dB in 3 contiguous frequencies over a time course of 72 hours or fewer. The cause of this disease is unknown, but there are several theories including viral, vascular, traumatic and autoimmune mechanisms.

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What is the treatment for ISSHL?

Treatment of ISSHL by an ENT doctor typically consists of a short (< 4 week) course of oral steroids initiated as soon as possible after onset of symptoms. Other treatments such as antiviral medications have been reported but are rarely done. A MRI study of the nerves in the ear is often required to evaluate for brain tumors that can cause a sudden loss of hearing.

In most studies of the ISSNHL, patient who initiate steroid treatment within the first 72 hours after the onset of the hearing loss have better outcomes. Younger patients (<65) seem to recover better. Low frequency hearing losses recover better than high-frequency losses, and mild-to-moderate hearing losses recover better than severe hearing losses.

In recent years, a new treatment has been suggested called a trans-tympanic steroid injection. This procedure can be performed in the ENT’s office. Steroids are injected directly into the middle ear space. These injections are generally done weekly as long as the patient continues to respond with improved hearing. This treatment is usually offered to patients who fail to respond to standard oral steroid therapy. In some cases, this treatment has been effective at restoring hearing. It is also an option in patients who cannot tolerate oral steroids.

By Joseph Chang, MD

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