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Sudden Hearing Loss (SHL)

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What is it?

Sudden Hearing Loss is a rapid onset of hearing impairment occurring over a 72-hour period. Most often, there is a decrease in hearing of at least 30 decibels, affecting 3 or more consecutive frequencies. The most common symptom of SHL is a full or blocked ear. There are about 4,000 new cases of SHL reported every year in the United States.

How do we test? Do I need an MRI/labs?

Audiometry is mandatory testing for diagnosis because it will distinguish between SHL and other forms of hearing loss. An MRI may be recommended after a positive SHL diagnosis in order to identify any other conditions that may slow treatment progress or benefit from an alternative option. Laboratory testing for SHL is not routine and may only be recommended on an individual case level.

What is the cause of SHL?

The most common cause of SHL is a virus or viral illness. Many times, the only symptom of the virus is hearing loss. The other common cause of SHL is Autoimmune inner ear disease. However, the specific cause of SHL is only identified in 10-15% of all SHL cases. Therefore, most treatment decisions for SHL are made without knowledge of the cause.

Some other conditions may be associated with SHL, including:

  • Vestibular Schwannoma (a benign tumor on the hearing or balance nerve), 
  • Blood vessel anomalies
  • Meningitis
  • Lyme disease (from a tick bite)
  • Syphilis
  • Ototoxic medications
  • Trauma
  • Herpes zoster oticus (Ramsay-Hunt syndrome)
  • HIV
  • Lead poisoning
  • Genetic disorders
  • MELAS (metabolic encephalopathy, lactic acidosis and stroke-like episodes)
  • Vertebrobasilar vascular disease
  • Cogan syndrome
  • Neoplastic
  • Sarcoidosis
  • Hyperviscosity syndrome

How do we treat?

Oral steroids are often given within the first 14 days of SHL symptoms appearing. The typical starting dose is usually high, with gradual tapering of the dosage as hearing loss improves. Patients need weekly to biweekly hearing tests while on steroids to monitor progress and adjust dosing. Because the initial doses of steroids are high, there is a risk of steroid withdrawal if they are abruptly stopped. So, always consult my office before abruptly stopping steroid therapy. A gradual taper allows for a safe way to come off of steroids.  

What are the side effects or risks of steroids?

Common short term side effects include insomnia, dizziness, weight gain, increased sweating, stomach upset, mood changes, photosensitivity, and high blood sugar. Steroids can often exacerbate acid reflux, so often extra precautions and even medication are needed to prevent problem. Weight gain can be made worse by the increased appetite that most patients feel. Caution and careful dietary restraint are necessities while on the steroids. Mood changes include everything from feeling great to acting grumpy. Warn your loved ones about these possible changes! However, these side effects for short-term use of steroids, are usually mild and easily handled.

Severe risks are rare and are usually associated with long term steroid use. These can include pancreatitis, bleeding, high blood pressure, cataracts, muscle aches, infections, and osteoporosis. Patients with a history of systemic medical conditions may be unable to receive steroid treatment.