Laboratory Studies

Routine, nontargeted laboratory testing is not recommended.^[1]Laboratory studies should be directed by the history and physical examination findings and can include the following:

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 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.

According to 2012 guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF), computed tomography (CT) scans are not helpful and expose the patient to ionizing radiation. Therefore, CT scans are not recommended in the initial evaluation of patients with presumptive SSNHL.^[1]However, in young patients, for whom only a small possibility of detecting a vestibular schwannoma exists, a noncontrast temporal bone 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

See the list below:

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.

Treatment & Management

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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.