Sudden Hearing Loss Clinical Presentation

Updated: Apr 26, 2017
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Presentation

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. [11]

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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:

  • 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. [12]

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.

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