History

Sudden SNHL 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.

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.

A study by Hung et al indicated that a previous diagnosis of chronic rhinosinusitis is significantly associated with the development of sudden SNHL (adjusted odds ratio for having prior chronic rhinosinusitis = 1.36 in patients with sudden SNHL), particularly in patients aged 44 years or less. For patients over age 60 years, however, the association seemed no longer to exist.^[18]

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.

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:

Infection - Bacterial (eg, meningitis, syphilis), viral (eg, mumps, cytomegalovirus, varicella/zoster)
Inflammation – Sarcoidosis, Wegener granulomatosis, Cogan syndrome
Vascular - Hypercoagulable states (eg, Waldenstrom macroglobulinemia), emboli (eg, postcoronary artery bypass graft [CABG] surgery), postradiation therapy
Tumor -Vestibular schwannoma, temporal bone metastases, carcinomatous meningitis
Trauma -Temporal bone fracture, acoustic trauma, penetrating temporal bone injuries
Toxins - Aminoglycoside antimicrobials, cisplatin

The greater number of cases, however, fit into the idiopathic category. ISSHL is the frustrating endpoint for most patients with sudden hearing loss. However, a study by Passamonti et al indicated that the risk for ISSHL is increased in patients with hyperhomocysteinemia and high levels of factor VIII. The study, which included 118 patients with a first occurrence of ISSHL and 415 healthy controls, found that deficiencies of antithrombin or protein C or S, as well as the presence of cardiovascular risk factors (ie, arterial hypertension, hyperlipidemia, diabetes, smoking), may also increase the risk for ISSHL.^[19]

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

Differential Diagnoses

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Author

Neeraj N Mathur, MBBS, MS, DNB, MAMS, FAMS Professor and Head, Department of ENT, Amrita Hospital and Amrita Institute of Medical Sciences, Faridabad, India

Neeraj N Mathur, MBBS, MS, DNB, MAMS, FAMS 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-Otological and Equilibriometric Society of India, Royal Society of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Michele M Carr, DDS, MD, PhD, MEd Professor, Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Peter S Roland, MD Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Clinical Center for Auditory, Vestibular, and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Chief of Pediatric Otology, Children’s Medical Center of Dallas; President of Medical Staff, Parkland Memorial Hospital; Adjunct Professor of Communicative Disorders, School of Behavioral and Brain Sciences, Chief of Medical Service, Callier Center for 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 Neurotology Society, American Otological Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, The Triological Society

Disclosure: Received honoraria from Alcon Labs for consulting; Received honoraria from Advanced Bionics for board membership; Received honoraria from Cochlear Corp for board membership; Received travel grants from Med El Corp for consulting.

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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Cliff A Megerian, MD, FACS Medical Director of Adult and Pediatric Cochlear Implant Program, Director of Otology and Neurotology, University Hospitals of Cleveland; Chairman of Otolaryngology-Head and Neck Surgery, Professor 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, Triological Society

Disclosure: Nothing to disclose.