Sudden sensorineural hearing loss, widely known as sudden deafness, is sudden onset hearing loss that develops within 72 hours and mostly affects one ear. Hearing impairment occurs as a result of damage to the inner ear, where the sensory organ of hearing is located, or damage to the hearing nerve. People diagnosed with sudden hearing loss can also experience other symptoms, such as tinnitus or ringing in the ears, dizziness, and vertigo.
About half of the patients suffering from this condition will spontaneously recover their hearing. People can fully or partially regain their hearing within one or two weeks of its onset. However, early diagnosis and treatment can lead to a better chance of hearing recovery; 85% of patients who received prompt treatment will see hearing improvement. Hearing loss severity is another prognostic factor associated with hearing recovery.
The annual incidence of sudden deafness can range between 11 and 77 per 100,000 people. Nonetheless, the exact incidence of the disease might be much higher, as it is associated with a high spontaneous recovery rate, and people often do not seek treatment. Although individuals can be diagnosed at any age, it more frequently affects people between 43 and 53. The estimates of incidence rise with increasing age. Males and females are equally susceptible to suffering from sudden hearing loss.
In about 90% of the cases, the exact cause of hearing loss cannot be determined; therefore, it is also known as idiopathic hearing loss. There are a group of determinants that are considered to be associated with its origin, including viral or bacterial infections, metabolic or cardiovascular diseases, autoimmune diseases, neurological conditions, ototoxic medication, trauma such as head injury, etc.
Role Of Audiologists In Diagnosing And Treating Sudden Hearing Loss
Audiologists play an essential role in diagnosing sudden hearing loss. By conducting a thorough hearing test, they are the first to diagnose the degree and type of patient’s hearing impairment. In addition, audiologists, along with Ear, Nose, and Throat physicians, are involved in the sudden hearing loss treatment and management team.
Audiologists Play A Crucial Role
Sudden sensorineural hearing loss is a medical emergency; hence, timely detection and treatment are associated with a better prognosis. Patients who are suspected to have this condition should immediately make an appointment with an audiologist to undergo a comprehensive audiological evaluation. Receiving early medical attention can increase the probability of hearing recovery, while delayed treatment for more than two weeks might be rendered ineffective.
Explanation Of Initial Symptoms Of Sudden Hearing Loss
People experiencing sudden hearing loss often notice the hearing problem when they wake up in the morning. In some cases, they will discover that their hearing differs while using headphones or the phone with their affected ear. Others may be alarmed by a sudden and notable “pop” before the hearing damage. Nine out of ten patients report hearing loss in only one ear. These symptoms can be accompanied by ear fullness, dizziness, and tinnitus.
Importance Of Prompt Diagnosis By An Audiologist
Diagnosing sudden hearing loss on time gives the opportunity to start the treatment as soon as possible. Thus, the patients will have a better chance of regaining their hearing and avoiding the consequences of delayed treatment, including permanent hearing damage. Unfortunately, some people postpone their visit to an audiologist, assuming their sudden hearing loss is due to other conditions such as ear wax, a sinus infection, allergies, etc.
Diagnostic Tests Used To Evaluate Hearing Loss
Sudden hearing loss is diagnosed after conducting a hearing test called pure tone audiometry. Patients should seek medical attention to check their hearing within a few days of hearing loss onset.
During the audiometric exam, the audiologist checks the patients’ hearing threshold at different frequencies, which is how loud the sound needs to be so they can hear it. Sudden sensorineural hearing loss will be confirmed in case of a hearing loss greater than 30 decibels (decibels measure sound intensity) in at least three contiguous frequencies that occurred within a 72-hour period. People with hearing loss of more than 30 decibels will hear conversational speech as a whisper. Additional audiological evaluations such as tuning fork tests (Weber and Rinne), tympanometry, and auditory brainstem response testing can assist in ruling out other conditions and confirming the diagnosis.
Once this diagnosis is made, the physician may require additional tests such as blood tests, balance tests, and imaging (magnetic resonance imaging and computer tomography of temporal bone). In some instances, these exams can be valuable for identifying the underlying cause of the hearing disorder.
Role Of Audiologists In Interpreting Test Results
Other than conducting pure tone audiometry and determining the degree and type of hearing loss, the audiologist is also responsible for ruling out other causes of sudden hearing impairment. These causes include conductive hearing loss, that is, hearing loss as a result of ear obstruction, most commonly ear wax or fluid, and in these cases, the treatment plan is different.
Sudden Hearing Loss Treatment Options
Common Treatment Options For Sudden Hearing Loss
Although the effectiveness of sudden hearing loss treatment is still debatable, it is recommended to immediately start steroid therapy, especially in case of idiopathic sudden deafness, as this is associated with better outcomes. The mechanism of action is based on reducing swelling and inflammation. Corticosteroids can be prescribed orally or by intratympanic (through the eardrum) injections. The latter was proven to be equally effective compared to oral steroids. Additionally, with these injections, people can avoid the side effects of oral steroids. Evidence suggests that their combination can lead to better recovery. Another option for sudden hearing loss management is hyperbaric oxygen therapy; however, there is limited data regarding its effectiveness.
The management plan might differ when an underlying cause of sudden deafness is identified. Additional antibiotics must be given if the hearing loss develops due to bacterial infection. Antiviral treatment will be prescribed against viral infections such as herpes simplex. If the patient is taking an ototoxic medication, they will be advised to discontinue that particular drug and switch to another one, or dose adjustments will be made. As for the autoimmune diseases that might cause hearing disorders, medications should be prescribed to suppress the immune system.
Despite the high possibility of spontaneous recovery and the effectiveness of steroid therapy, some people may not fully regain their hearing and end up having single-sided deafness or unilateral hearing loss. These patients would complain of having difficulties locating the source of the sound. Sudden hearing loss treatment for this kind of permanent damage includes hearing aids and hearing implantable devices such as cochlear implants.
Patients with some residual hearing left who were unresponsive to steroid treatment can benefit from using a hearing aid. This device will amplify the sound. Individuals presenting with severe to profound hearing impairment should be considered candidates for cochlear implants, which are designed to stimulate the auditory pathways directly; thus, the sound will be perceived by people.
Explanation Of Hearing Aids And Cochlear Implants
The hearing aid is an electronic device that has a primary function to make sounds louder. It assists people with hearing impairment in speech comprehension, communication, and daily life activities. The mechanism of this hearing device is based on receiving sounds from the outside, converting these sound waves into electrical signals that will be amplified so that the sounds will become audible for hearing aid users.
People who have sensorineural hearing loss, including those left with irreversible hearing damage after experiencing sudden hearing loss, can benefit from hearing devices. However, there are some limitations, such as hearing aids cannot be effective if the hearing impairment is too damaged.
The cochlear implant is a surgically inserted electronic device to improve hearing that functions with more advanced mechanisms. Compared to hearing aids, they do not amplify sounds; instead, they pass over the injured region and directly stimulate the hearing nerve by its signals, which travel to the brain and are perceived as sounds. The cochlear implant journey can be quite challenging for many people, as it requires continuous care, including speech therapy, other than surgery. However, this option is a game-changer for people with severe and profound hearing loss.
Once the decision is made to opt for hearing aids as the optimum option for sudden hearing loss management, the patients must make an appointment with an audiologist for a hearing aid fitting. The audiologist assesses the patient’s hearing needs and recommends a hearing device according to their hearing loss. The audiologist also assists patients in choosing a hearing aid after taking into account their hearing test results, preferences, lifestyle needs, and budget. Afterward, a hearing aid fitting is conducted.
During the fitting, the audiologist makes sure that the patient is comfortable with the hearing aid and that it fits perfectly. They will take some measurements to find an appropriately sized earpiece. They will conduct additional tests, known as real ear measures, to confirm that the device is appropriately programmed to improve their hearing. Based on the patient’s feedback while checking different sounds, they will make some volume adjustments.
The audiologist also assists in how to operate their hearing aids and switch programs to adjust the background noise. The patients will get advice on how to clean and maintain the device. Thus, an individualized treatment approach by the audiologist during fitting is a key point and can significantly enhance a patient’s experience with hearing aids.
Counseling and Support Services Provided by Audiologists
- Emotional and psychological impact of sudden hearing loss
Sudden hearing loss treatment should start as soon as the diagnosis is made to avoid permanent hearing loss and its challenges. People with this condition can face difficulties in their social life, as they have problems understanding speech, particularly in an environment with background noise; they will also complain of impaired sound localization. All these factors can lead to poor communication, possibly social isolation, and higher depression levels.
People with sudden hearing loss have poorer mental health status than the general population. This difference is more predominant among young and middle-aged patients compared to the elderly population. The emotional impact of sudden hearing loss includes anxiety, irritability, and agitation. Hearing loss can sometimes be accompanied by tinnitus, which also can be associated with emotional distress. Hence, all these contribute to poor quality of life among people experiencing sudden deafness.
- Services Provided By Audiologists To Individuals And Their Families
The audiologist’s role is not limited to diagnosing sudden hearing loss and being part of the management team. In addition, they should be involved in supporting individuals and their families to overcome the burden of sudden deafness. Throughout the treatment, the audiologists should maintain excellent communication and relationships with their patients, which will significantly improve their compliance with the treatment regimen. Patients should be thoroughly informed about their condition, treatment options, and possible outcomes.
The counseling should also address the importance of continuous communication between the patients and their families. Many individuals avoid conversations due to poor hearing and affected speech comprehension, which can lead to isolation and increase the likelihood of depression. Thus, the audiologists encourage them to be patient and teach them techniques to improve their communication skill during this period. This way, they can receive emotional support from their loved ones and feel part of society, motivating them to fight the disease and achieve a speedy recovery.
Patients are also advised to try different activities to divert their attention from the hearing loss and to not fixate on that. Older people are encouraged to be engaged in recreational activities to decrease their stress levels. Middle-aged people can benefit from early return to their daily activities such as employment. Regarding the young population, the counseling can focus on promoting healthy lifestyle behaviors and sharing successful recovery cases.
Sleep is another important factor that can be greatly impaired as a result of sudden hearing loss, particularly among patients suffering from tinnitus. Medications should be prescribed to people with sleeping difficulties, as improving sleep quality can contribute to quick and complete hearing recovery.
- Importance Of Follow-up Care Provided By Audiologists
Although sudden deafness has increased recovery percentage, especially among patients who have started prompt treatment, audiologists must highlight the importance of follow-up care. Some patients might need several hearing tests to follow their progress. In some cases, changing the treatment plan can be necessary.
Ongoing care is crucial for patients who haven’t completely regained their hearing and started using hearing aids. Adjusting to hearing aids takes time and requires a great deal of patience. There might be a need for multiple appointments with an audiologist for hearing aid fitting. Hence, continuous support is another determinant for successful sudden hearing loss treatment.
Special Considerations for Pediatric Patients
Sudden hearing loss among the pediatric population has a low incidence, and most cases are idiopathic. Therefore, there are few studies and limited data related to sudden hearing loss treatment among children. They are vulnerable to this disease as the current diagnosis and treatment guidelines are based on adult population findings, who may have different causes of hearing loss. Due to the lack of a standardized treatment plan for sudden hearing loss, pediatric patients are administered oral steroids, and if its effectiveness is poor, intratympanic steroid injections are given. This approach is similar to one used for adults.
Early detection and intervention are of high importance for children, particularly for one to six age groups, as they are in the active period of speech and language development. Treatment delays can result in detrimental effects for children, such as permanent hearing disorders and impaired cognitive and speech development. This, in turn, can cause severe psychiatric, behavioral, and social consequences not only for children but also for their family members.
Making an accurate diagnosis of sudden hearing loss is another challenge for the pediatric population. Pure tone audiometry is a subjective hearing test; thus, children need to closely collaborate with the audiologist to report the precise results. Sometimes, there might be a need for additional hearing tests, including tympanometry, conventional audiometry, and auditory brainstem response testing, which can require sedation or general anesthesia.
Treatment Plans That Consider Emotional, Development, And Educational Factors
There are a lot of similarities between adult and pediatric patients related to the audiologist’s role. First and foremost, the successful treatment plan starts with diagnosing sudden hearing loss correctly. Pediatric audiologists are familiar with the techniques to obtain accurate findings during pure tone audiometry. They use appropriate communication skills to encourage children to cooperate and give proper responses.
In addition, audiologists provide counseling and guidance to parents on how to be involved in their children’s treatment, support their children, and communicate with them. The audiologists ensure that the hearing impairment does not greatly hinder children’s development and education by encouraging parents to continuously motivate their children to study and participate in different activities.
The audiologists are also actively involved in follow-up care. They conduct a hearing test to monitor hearing change after each treatment step.
Recap Of The Role Of Audiologists In The Effective Treatment Of Sudden Hearing Loss
Audiologists are the key players in achieving a successful outcome for patients suffering from sudden hearing loss. Their initial function is to recognize symptoms and properly diagnose sudden deafness by conducting a hearing test.
They are competent to interpret the audiological results to identify the type and degree of hearing loss. Audiologists work in collaboration with Ear, Nose, and Throat physicians to develop an appropriate management plan for individuals with sudden deafness. They are also committed to providing emotional support and continuous care to patients and their families.
Importance Of Seeking Care From A Qualified Audiologist For Sudden Hearing Loss
Sudden hearing loss is a serious medical condition requiring immediate attention from a qualified audiologist. Seeking early audiological attention allows starting the treatment during the window period for effective outcomes. This way, the audiologist can successfully assist them to restore their hearing.
Sudden hearing loss treatment is challenging and requires a lot of effort. Audiologists’ contribution to diagnosing, management, follow-up care, and psychological support is incomparable. Audiologists should develop the treatment plan based on the patient’s individual needs, which is of utmost importance during assistance with medication regime, selection of suitable hearing aids, and ongoing care. Personalized care provided by qualified audiologists can lead to a higher likelihood of recovery and significantly alleviate the social and economic burden of sudden hearing loss.
Dr. Lusine Mamikonyan is an ENT physician with a public health background. She graduated from Yerevan State Medical University and earned her Master's in Public Health from the American University of Armenia. She is experienced in conducting various audiological evaluation tests, providing treatment, and working with hearing aids and patients with cochlear implants. Besides medicine, she enjoys reading, dancing, and spending time with family and friends.