Sudden Sensorineural Hearing Loss

Clinical Features

Patients with SSNHL with present with acute onset of sensorineural hearing loss. This is often associated with tinnitus and vertigo.

Ensure to perform both an ear examination, including Rinne’s and Weber’s test, and neurological examinations.

Differential Diagnoses

Ensure to differentiate between a conductive and sensorineural hearing loss, as this will help focus differentials and management:

For a sudden-onset sensorineural hearing loss, differentials include:

• Infective – Viral infections (including HSV, VZV), syphilis
• Inflammatory – Autoimmune diseases, such as SLE or rheumatoid arthritis
• Neurological – Stroke or multiple sclerosis
• Neoplastic – Acoustic neuroma
• Medication – chemotherapy agents, such as cisplatin
• Trauma – temporal bone fracture

Investigations

All patients presenting with acute sensorineural hearing loss should undergo Pure Tone Audiometry (PTA) and Tympanometry (Fig. 2).

Depending on the presentation, patients should then undergo urgent blood tests, including Full Blood Count, Erythrocyte Sedimentation Rate (ESR), Autoantibody Screen, Coagulation Screen, and Syphilis serology

An urgent outpatient MRI scan of the internal auditory meatus should be performed, to assess for the presence of acoustic neuroma.

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Figure 2
Patient undergoing tympanometry with tympanometer probe

Management

SSNHL should be viewed as an otological emergency, with prompt treatment aimed at minimising long term hearing loss, to help improve quality of life and reduce functional impairment.

The mainstay of treatment is with oral steroid therapy. This is often via a weaning regime, given alongside a proton pump inhibitor, over the course of several weeks; the efficacy of treatment is reduced if treatment is delayed, especially after 72 hours from presentation.

Following steroid treatment, patients should return for repeat clinical review and repeat PTA. Should there be minimal or no improvement, salvage intratympanic steroids can be considered. This should ideally be performed 4-6 weeks of symptoms presentation.

In cases of ongoing hearing loss, referral to audiology for hearing aids fitting (Fig. 3), and ensure adequate psychological support provided.

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Figure 3
Fitting of a hearing aid on a patient with hearing loss