Sudden Sensorineural Hearing Loss

Although most types of hearing loss are nonurgent problems, sudden sensorineural hearing loss (SSNHL) deserves special note because it is considered "otologic emergency." Any patient complaining of sudden hearing loss requires prompt evaluation. An obvious cause such as cerumen impaction or middle ear fluid can be treated appropriately and routinely. If a cause is not identified, sudden sensorineural hearing loss should be suspected and prompt ENT referral arranged. SSNHL is thought to be secondary to vascular, thromboem-bolic, viral, or autoimmune causes. It may also be the result of ototoxicity. Without treatment, hearing returns in one third of patients, partial hearing returns in one third, and there is no improvement in the remaining third. Early intervention with oral corticosteroids (and possibly antivirals, directed at the herpesvirus [Awad et al., 2008]) appears to improve outcomes, although few controlled studies have been done. The Cochrane Collaboration believes that there is a lack of good-quality evidence to support the use of steroids and that more research is needed (Wei et al., 2006). Finally, for patients who do not respond to systemic steroids, controlled studies do support the use intratympanic infusion of corticosteroids, demonstrating improved outcomes (Xenellis et al., 2006). Intratympanic steroids are also appealing for patients with contraindications to oral steroids (e.g., "brittle diabetics")

Hearing Aids Inside Out

Hearing Aids Inside Out

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