Sudden Sensorineural Hearing Loss
SSNHL is a frightening occurrence in which the hearing is lost dramatically, usually in one ear, over a short time period of a few hours to 3 days. The hearing loss is of a nerve type and is often accompanied with significant tinnitus (head noise), and may be accompanied by vertigo (spinning dizziness). SSNHL affects 1 in 10,000 people.
The cause of SSNHL is rarely identified, although a thorough workup by an otolaryngologist or otologist such as Dr. Chandrasekhar is necessary. MRI evaluation is also a necessary portion of the evaluation, along with appropriate hearing and, if needed, balance tests.
Treatment of SSNHL is directed to its cause, if one can be identified. In the vast majority of cases in which the cause is not identified, the disease is renamed idiopathic SSNHL (ISSNHL).
The natural history of ISSNHL is that between 50% and 70% of patients will recover their hearing spontaneously. These are usually patients whose hearing loss is in the mild to moderate range, and not those who experience severe or profound SNHL.
Treatment of ISSNHL is steroid therapy. Oral prednisone at high doses should be prescribed as soon after the problem occurs as possible, unless there is a medical contraindication to this treatment, such as hypertension or diabetes or other immunocompromised states. Intratympanic (IT) injection of steroids is an excellent alternative to oral steroid use in those patients, as it penetrates the inner ear effectively in animal studies and has shown its usefulness in clinical (human) studies. IT steroids are also given in conjunction with oral steroids in certain instances.
IT steroid injection is an office procedure with minimal discomfort and even less risk to the patient. Dr. Chandrasekhar has been at the forefront of both animal and human studies of this treatment modality.
Often, patients with ISSNHL are also given antiviral drugs and other medications to boost circulation. Although these are, in general, safe, their efficacy is not yet proven.
Patients with ISSNHL have an overall better chance at hearing recovery if:
- They are neither very young (below 18) or very old (above 65)
- They do not have vertigo at onset of ISSNHL
- They have a mild to moderate degree of hearing loss
- They receive treatment within the first 7 to 14 days of ISSNHL.
If you are worried about SSNHL, please make sure you are seen by an otolaryngologist and receive a hearing test as soon as possible, so that treatment can be instituted in a timely fashion.
You can read more about ISSNHL in Dr. Chandrasekhar’s published literature:
- Chandrasekhar SS: Intratympanic Dexamethasone for Sudden Sensorineural Hearing Loss: Clinical and Laboratory Evaluation. Otol & Neurotol 2001;22:18-23.
- Chandrasekhar SS, Rubinstein RY, et al: Dexamethasone Pharmacokinetics in the Inner Ear. Otolaryngol Head Neck Surg 2000 Apr; 122:521-8.
- Chandrasekhar SS: Sudden Sensorineural Hearing Loss. In Essentials of Otology and Neuro-Otology, A De La Cruz & MA Arriaga, editors.
- Chandrasekhar SS: Intratympanic Therapy for Hearing Loss. In: Ear Surgery, R Wiet, editor.
- handrasekhar SS, Saunders JE: Sudden Hearing Loss – Programmed Instruction, 2nd edition, 2007, published by American Academy of Otolaryngology-Head and Neck Surgery Foundation.
- Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, Brown SR, Fife TD, Ford P, Ganiats TG, Hollingsworth DB, Lewandowski CA, Montano JJ, Saunders JE, Tucci DL, Valente M, Warren
BE, Yaremchuk KL, Robertson PJ; American Academy of Otolaryngology-Head and Neck Surgery. Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg. 2012 Mar;146(3 Suppl):S1-35.
- Svrakic M, Pathak S, Goldofsky E, Hoffman R, Chandrasekhar SS, Sperling N, Alexiades G, Ashbach M, Vambutas A. Diagnostic and prognostic utility of measuring tumor necrosis factor in the peripheral circulation of patients with immune-mediated sensorineural hearing loss. Arch Otolaryngol Head Neck Surg. 2012 Nov 1;138(11):1052-8.
- Pelosi S, Chandrasekhar SS. Intratympanic Steroid Use for Hearing Salvage in Vogt-Koyanagi-Harada Syndrome. Ear Nose Throat J 2011 Dec; 90(12): 574-7.