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Sudden Hearing Loss
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Sudden sensorineural hearing loss, or sudden deafness, is formally defined as acute loss of hearing of 20 decibels or more in three contiguous (adjacent) frequencies on an audiogram (hearing test) occurring within three days or less. It may be accompanied by tinnitus (ringing in the ear) or vertigo (spinning dizziness) and may affect one ear or both.

Patients may notice that sounds on one (or occasionally both) sides sound muffled, causing difficulty understanding conversation, TV, or in group settings.  The ear may also feel full or stopped up and there may be ringing or noise in the ear.  Sometimes this condition will improve spontaneously within a short time (minutes to hours), but if it does not, it is time to seek medical attention.  Often there is no obvious cause or precipitating event. 

The diagnosis is made when other causes for hearing loss have been excluded, including acute otitis media (pus in the middle ear), serous otitis media (fluid in the middle ear), wax impaction, Meniere’s disease, or trauma.  The leading theory is that sudden sensorineural hearing loss is caused by a viral, vascular, or immune-mediated condition.  

A thorough evaluation by an ENT physician, such as Dr. Paul Shea at the Shea Clinic, is necessary to definitively diagnose sudden hearing loss.  You will need a complete audiogram, as well as possibly other tests, and a thorough examination.  An evaluation by your primary care provider or an emergency physician is NOT sufficient.  

True sudden sensorineural hearing loss is considered an otologic emergency, and it is recommended that you see an ENT physician at the soonest possible opportunity if you suspect that you may have this condition.  Early detection and treatment will significantly improve your chances for a complete recovery.  If the proper treatment is begun within a short time, usually considered 30 days or less from the onset of the hearing loss, studies have shown that the outcome in terms of hearing recovery is likely to be better. 

In 1-2% of cases, sudden hearing loss may be the result of a benign tumor on the balance nerve, called a vestibular schwannoma or acoustic neuroma.  An MRI of the brain with contrast is necessary to rule out this condition and is part of the workup for sudden sensorineural hearing loss.

Despite having a prompt and thorough evaluation, often the specific cause for sudden hearing loss cannot be determined.  However, treatment can still be effective in improving or restoring hearing if it is begun within a specific time frame, usually considered to be thirty days from the onset of the hearing loss.  After this, the hearing loss may become permanent and irreversible.  

Treatment options for sudden hearing loss depend on the underlying cause.  The currently accepted treatment for sudden sensorineural hearing loss is steroids (dexamethasone or prednisone) taken orally or injected directly into the ear (intratympanic perfusion), or both.  The physicians at the Shea Clinic have a great deal of experience treating sudden hearing loss, and we recommend you make an appointment with us at the earliest possible opportunity if you believe you may have this condition.   

Not all hearing loss is sudden, and not all sudden hearing loss is sensorineural (nerve damage).  Hearing loss may develop gradually over time in one or both ears.  This type of hearing loss should be evaluated as well, and a specific cause should be sought.  Treatment may include medication, surgery, or a hearing aid.  

The other major category of hearing loss, besides sensorineural, where loss of nerve endings in the inner ear leads to an inability to convert sound into electrical signals, is conductive hearing loss, which means hearing loss caused by the inability of sound to reach the inner ear for some reason.  It is very important to determine whether hearing loss is conductive or sensorineural (nerve damage) because the treatment is different.  

The specialists at the Shea Clinic, like Dr. Paul Shea, will perform a thorough and comprehensive evaluation to investigate your hearing loss and recommend the most appropriate course of action.  


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