Sudden sensorineural hearing loss: Pathophysiology, diagnosis, treatment options, and prognostic factors

Rafael da Costa Monsanto, Ana Luiza Kasemodel, Luiza Mazzola, Marielle Albrechete, Fabio Tadeu Moura Lorenzetti

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Sudden sensorineural hearing loss (or sudden deafness) is characterized as a new onset of unilateral or bilateral hearing loss, in which the symptoms develop within 24-72 h. Estimates of the annual incidence of sudden sensory hearing loss range from 5-30 cases per 100,000 people. Audiometry of these patients show a loss of 20-30 dB in at least three connected frequencies. Review of the literature: Many theories have been proposed to explain the cause of this disease: inflammatory reaction (viral infection of the labyrinth or cochlear nerve), vascular disturbances, autoimmunity, rupture of the membranes, or decreased oxygen flow to the inner ear. Diagnosing the cause of sudden deafness involves a detailed clinical history, audiological, biochemical, vestibular, and imaging tests. The hearing impairment should always be considered as secondary to a specific cause; nonetheless, most cases are classified as idiopathic. The identifiable causes of the sudden deafness include: Infectious diseases, trauma, autoimmune diseases, ototoxic drugs, changes in blood flow, tumors in the vestibulocochlear nerve, neurologic diseases, and inner ear disorders (such as Meniere’s disease). Magnetic resonance imaging is considered the gold standard imaging exam to detect lesions in the inner ear structures, internal auditory canal, and cerebellopontine angle. Since the majority of the cases are idiopathic, the treatment of these cases is essentially empirical. The decision whether to treat or not to treat idiopathic cases is also controversial, since some studies state that 20- 65% of the patients recover the hearing spontaneously without any treatment. Furthermore, no drug has been proven to significantly improve the prognosis of the hearing loss in the idiopathic cases. Based on the proposed pathophysiology, some treatments are described in the literature, including: corticosteroids, vasodilators, carbogen, intratympanic dexamethasone, hyperbaric oxygen, vitamins, gingko biloba extract, and stellate ganglion blockers. If the hearing loss is permanent, hearing aids could be beneficial. The presence of associated vertigo, the severity of hearing loss, the pattern shown in the audiogram, time between onset and treatment, and hearing loss in the contra-lateral ear, when present, indicate worse prognosis. Including tinnitus in the list of prognostic factors is considered controversial, since it is present in about 80% of the cases of sudden deafness. Conclusion: The symptoms of sudden deafness should be promptly recognized, and the search for a possible cause is imperative. Correct diagnosis and treatment could prevent the hearing changes from being permanent.

Original languageEnglish (US)
Title of host publicationHearing Loss
Subtitle of host publicationEtiology, Management and Societal Implications
PublisherNova Science Publishers, Inc.
Pages13-33
Number of pages21
ISBN (Electronic)9781536104035
ISBN (Print)9781536103915
StatePublished - Jan 1 2017
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017 Nova Science Publishers, Inc.

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