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Inner Ear, Sudden Hearing Loss: Differential Diagnoses & Workup

Author: Neeraj N Mathur, MBBS, MS, Professor, Department of Ear, Nose and Throat, Lady Hardinge Medical College and Associated Smt SK and Kalawati, Saran Children's Hospital, University of Delhi, India; Professor, Department of Ear, Nose and Throat, BP Koirala Institute of Health Sciences, Nepal
Coauthor(s): Michele M Carr, DDS, MD, MEd, Associate Professor, Department of Otolaryngology, Hershey Medical Center
Contributor Information and Disclosures

Updated: Feb 6, 2009

Differential Diagnoses

Inner Ear, Autoimmune Disease
Inner Ear, Ototoxicity
Inner Ear, Perilymphatic Fistula
Temporal Bone Fractures

Other Problems to Be Considered

Viral infection of cochlea/auditory nerve

Inflammation of cochlea/auditory nerve
Syphilis
Meningitis
Encephalitis

Acoustic neuroma (vestibular schwannoma)
Other cerebellopontine angle (CPA) tumors

Sludging due to hyperviscosity
Polycythemia vera
Macroglobulinemia
Leukemia
Accelerated coagulation
Arteriosclerosis
Aneurysm of anterior inferior cerebellar artery

Hypothyroidism
Diabetes mellitus

Mondini dysplasia
Enlarged vestibular aqueduct

Workup

Laboratory Studies

  • Laboratory studies should be directed by the history and physical examination findings.
    • Fluorescent treponemal antibody-absorption (FTA-Abs) for syphilis
    • Antinuclear antibodies (ANA), rheumatoid factor, and erythrocyte sedimentation rate (ESR) for autoimmune diseases
    • International normalized radio (INR), activated partial thromboplastin time (aPTT), and clotting time for coagulopathy
    • CBC count and differential for infection
    • Thyroid-stimulating hormone (TSH) for thyroid disease
    • Fasting blood glucose for diabetes mellitus
    • Cholesterol and triglycerides for hyperlipidemia

Imaging Studies

  • Approximately 1-2% of patients with ISSHL have internal auditory canal (IAC) or CPA tumors. Conversely, 3-12% of patients with vestibular schwannomas present with sudden hearing loss.
  • Magnetic resonance imaging (MRI) with gadolinium diethylenetriamine-pentaacetic acid (DPTA) enhancement is the criterion standard test for diagnosing CPA masses, especially because a 30-40% false-negative rate exists with auditory brainstem response (if hearing levels permit). The cost issue for MRI has been addressed by performing limited studies using fast spin echo techniques.
  • In young patients, for whom only a small possibility of detecting a vestibular schwannoma exists, a noncontrast temporal bone computed tomography (CT) scan could be obtained. Anatomic defects such as a Mondini dysplasia or enlarged vestibular aqueduct might account for a sudden hearing loss.

Other Tests

  • Audiometry, including pure-tone and speech tests and immittance (tympanometry and acoustic reflex) tests, is mandatory. Testing can be directed by information gleaned from the history and physical examination. Obtaining those laboratory tests for which the results may influence the treatment plan is wise.
  • Auditory brainstem response testing and otoacoustic emissions (OAE) tests may provide additional information regarding the functional integrity of the auditory system.
    • OAE testing can provide information about cochlear function, and the auditory brainstem response can be used to assess auditory nerve function.
    • The auditory brainstem response and OAE results may also assist in diagnosing a functional hearing loss.
  • Vestibular tests are not mandatory and are obtained when indicated by the history and physical examination findings.

More on Inner Ear, Sudden Hearing Loss

Overview: Inner Ear, Sudden Hearing Loss
Differential Diagnoses & Workup: Inner Ear, Sudden Hearing Loss
Treatment & Medication: Inner Ear, Sudden Hearing Loss
Follow-up: Inner Ear, Sudden Hearing Loss
References
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References

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Further Reading

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Keywords

hearing loss, sudden hearing loss, sudden deafness, sudden sensorineural hearing loss, idiopathic sudden sensory hearing loss, ISSHL, hearing problems, hearing

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Contributor Information and Disclosures

Author

Neeraj N Mathur, MBBS, MS, Professor, Department of Ear, Nose and Throat, Lady Hardinge Medical College and Associated Smt SK and Kalawati, Saran Children's Hospital, University of Delhi, India; Professor, Department of Ear, Nose and Throat, BP Koirala Institute of Health Sciences, Nepal
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, Associate Professor, Department of Otolaryngology, Hershey Medical Center
Michele M Carr, DDS, MD, MEd is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

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: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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, 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; GSK Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear corp Honoraria Board membership; Med El corp travel grants Speaking and teaching; Insight vision Consulting fee Consulting

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, 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, Department of Otolaryngology-Head and Neck Surgery, 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 unstricted gift unknown

 
 
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