eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Inner Ear

Inner Ear, Sudden Hearing Loss: Follow-up

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

Follow-up

Further Outpatient Care

Patients who continue to have a significant hearing loss require aural rehabilitation.

Prognosis

  • Fortunately, the spontaneous recovery rates for sudden sensorineural hearing loss are generally good. These rates range from 47-63%, with the caveat that different studies used different criteria for degrees of recovery. Ideally, criteria will be established by which to measure hearing improvement.
  • Negative prognostic factors include the following:
    • Age younger than 15 years or older than 65 years
    • Elevated ESR (>25)
    • Vertigo or vestibular changes evident on ENG
    • Hearing loss in the opposite ear
    • Severe hearing loss
  • Prognostic factors affecting outcome in patients with sudden sensorineural hearing loss have been postulated. Vertigo or imbalance seems to portend a lower recovery rate. Two studies, in addition, found severe vertigo associated with more cases of high-frequency or profound hearing loss. This association could be explained anatomically by the close proximity of the basal turn of the cochlea to the vestibule.
  • Considerable controversy exists regarding the prognosis in sudden hearing loss. Existing studies have not provided answers to questions regarding spontaneous recovery rate, the best therapeutic regimen, prognostic factors in recovery, and the pathophysiology of sudden hearing loss. These are questions that require a randomized controlled clinical trial of adequate size. Given the apparent rate of spontaneous recovery, the prognosis for some hearing recovery for patients with sudden sensorineural hearing loss is moderate. Selection bias is likely to affect most studies of ISSHL because patients with sudden hearing loss and spontaneous recovery within a few days probably do not seek medical evaluation. The true spontaneous recovery rate is unknown.
  • A review of outcomes for the various therapeutic regimens produces conflicting results, again because of differences in reporting. With different inclusion criteria, exclusion criteria, recovery criteria, and duration of follow-up, comparisons between studies are often not valid. Many studies lack control subjects.
    • Several studies using vasodilator therapy as a component of treatment did not show significant differences from placebo. However, in 1996, Fetterman et al reported their best recovery results (63% improved pure-tone average [PTA] by more than 10 dB or speech discrimination more than 15%) when treatment included vasodilators.16 Based on controlled studies, little data support vasodilator therapy.
    • Several studies assessing low molecular weight dextrans and/or pentoxifylline did not demonstrate recovery rates better than placebo. One exception by Redleaf et al in 1995 reported 64% of patients improving.17 In this study, concomitant diatrizoate therapy was also administered, and no placebo arm was used.
    • Corticosteroid therapy has been investigated with varying outcomes. Published recovery rates range from 41-61%. In 1980, Wilson et al demonstrated a significant improvement, finding 61% improved on oral corticosteroids compared to a 32% improvement rate on placebo.18 They also stratified their patient groups by audiometric patterns, and determined that hearing losses from 40-90 dB responded better to steroid therapy; 78% improved.
    • Diatrizoate has not been studied to any great extent. In 1987, Wilkins et al found no significant difference in recovery using diatrizoate in a multidrug regimen compared to spontaneous recovery rates.19 Redleaf et al reported a beneficial effect using diatrizoate and dextran, improving 64% of patients.17 Interestingly, using the hearing recovery criteria of Wilkins et al, recalculated data from the 1995 Redleaf study indicated only a 36% recovery rate to a classification of complete or good.
    • A review of hyperbaric oxygen therapy found a beneficial effect, especially if therapy was instituted within 2-6 weeks of the onset of the hearing loss. Fifty percent of patients improved by 20 decibels. If therapy was delayed, less improvement was found, with no beneficial effect for delays of longer than 3 months.

Patient Education

  • Patients should be educated about the natural history of ISSHL.
  • For excellent patient education resources, visit eMedicine's Ear, Nose, and Throat Center. Also, see eMedicine's patient education article Hearing Loss.
 


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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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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