Sudden Hearing Loss Clinical Presentation

  • Author: Neeraj N Mathur, MBBS, MS; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 13, 2012
 

History

Sudden sensorineural hearing loss has been called an otologic emergency. Patient evaluation should proceed promptly and expeditiously. Early presentation to a physician and early institution of treatment improves the prognosis for hearing recovery. The immediate goal is discovering a treatable or defined cause of the sudden hearing loss. The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) guidelines strongly recommend clinicians distinguish sensorineural hearing loss (SNHL) from conductive hearing loss (CHL) in patients presenting with sudden hearing loss. Patients should also be assessed for bilateral sudden hearing loss, recurrent episodes of sudden hearing loss, or focal neurologic findings to determine whether the hearing loss is associated with a definable underlying disease.[8]

  • Information about the onset, time course, associated symptoms, and recent activities may be helpful.
  • Past medical history may reveal risk factors for hearing loss.
    • All medications, including over-the-counter products, must be described.
    • Aspirin can cause a reversible sensorineural hearing loss, and the list of aspirin-containing products is extensive.
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Physical

Perform a careful head and neck examination, with special attention to the otologic and neurologic examination.

Tuning fork tests and a fistula test using pneumatic speculum must be performed.

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Causes

  • The term sudden hearing loss encompasses defined causes and ISSHL. In the evaluation of a sudden sensorineural hearing loss, a definite etiology may be uncovered. The following have been associated with sudden hearing loss:
  • The greater number of cases, however, fits into the idiopathic category. ISSHL is the frustrating endpoint for most patients with sudden hearing loss.

Despite the detailed history taking, physical examination, and laboratory investigations, ascertaining the pathophysiology of the events may not be possible; therefore, the cause and treatment of these cases is more presumptive than factual.

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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Neeraj N Mathur, MBBS, MS  Professor, Department of ENT and Head Neck Surgery, Vardhman Mahavir Medical College and Associated Safdarjang Hospital; Professor, Delhi University and Indraprastha University, India

Neeraj N Mathur, MBBS, MS is a member of the following medical societies: Association of Otolaryngologists of India, Cochlear Implant Group of India, Indian Medical Association, National Academy of Medical Sciences, India, Neuro-Otologic and Equlibriometric Society of India, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Michele M Carr, DDS, MD, MEd, PhD  Associate Professor, Department of Otolaryngology, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine

Michele M Carr, DDS, MD, MEd, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Cliff A Megerian, MD, FACS  Medical Director of Adult and Pediatric Cochlear Implant Program, Vice-Chairman and Director of Otology and Neurotology, University Hospitals of Cleveland; Professor, Department of Otolaryngology-Head and Neck Surgery and Neurological Surgery, Case Western Reserve University School of Medicine

Cliff A Megerian, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Association for Research in Otolaryngology, Massachusetts Medical Society, Society for Neuroscience, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: cochlear americas Consulting fee Board membership; Grace Corporation Consulting fee Board membership

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Peter S Roland, MD  Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Alcon Labs Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear Corp Honoraria Board membership; Med El Corp travel grants Consulting; Foresight Consulting fee Consulting

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

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