Sudden Sensorineural Hearing Loss: A Guide to Causes, Treatment, Problems, and Coping Strategies

CARE OF THE PROFESSIONAL VOICE

Acomprehensive description of the various types of hearing loss singers can experience, authored by Drs. Amanda Hu and Robert Sataloff, appears in an earlier issue of the Journal of Singing. In it, the following types of hearing loss are discussed: Conductive (CHL), Sensorineural (SNHL), Mixed (MHL), and Occupational (OHL).¹ Sudden Sensorineural Hearing Loss (SSNHL) is a designated type of Sensorineural Hearing Loss (SNHL). This article discusses the definition of SSNHL, causes, treatment, problems resulting from SSNHL onset, and coping strategies during treatment and after treatment. Portions of the article are written from a personal perspective, since I was diagnosed with SSNHL in January 2015 and treated until March 2015.

DEFINITION OF SSNHL

Unlike many cases of hearing loss that progress over a span of time, SSNHL can manifest within a matter of seconds or progress over several days. Incidence of SSNHL is estimated to be 1 in 5,000 Americans each year.² Any age group can be affected, but incidence seems to be higher in the fifth and sixth decades of life.³ Onset manifests unilaterally in most cases; bilateral or simultaneous bilateral onset is infrequent.⁴ Associated symptoms with SSNHL onset are tinnitus (ringing in the ear), aural fullness (plugged ear), and vertigo (dizziness). Loss can be frequency range and pantonal.⁵ Considered an ear emergency, SSNHL requires early intervention. Patients with this condition have a short window to begin treatment. Delaying treatment for longer than two to four weeks after onset results in irreversible hearing loss.⁶

In my case, SSNHL onset occurred while practicing singing. Sound in the left ear suddenly became muffled. Inserting a wax solvent into the ear several times did not resolve the plugged feeling by the following morning. Believing there might be embedded wax or water in the ear, I went to a walk-in clinic. Blood pressure had spiked to 150, which was abnormal for me. The nurse said she saw a bit of fluid in the ear but no wax. She prescribed a nasal spray and a course of prednisone in case of infection. I was scheduled to judge a competition for the next two days. During the competition, which was over a weekend, there was no improvement in hearing. Stressing that hearing had suddenly changed and not returned despite treatment, I was able to get an appointment with an ENT on the fifth day after SSNHL onset. The audiometry results (Figure 1) show speech discrimination as 100% in the right ear. Left ear speech discrimination is 12%. Loss of hearing in the left ear is diagnosed as severe to moderately severe at 90+dB.

CAUSES OF SSNHL

In a research study of SSNHL published in 2010, researchers divided into two research groups. The first group examined 23 articles in which multiple etiologies (causes) were identified; the majority were idiopathic (unknown cause). The second group evaluated SSNHL patients with specific diagnostic tests. The results revealed 71% of the cases to be idiopathic. Other diagnoses ranged from 2.2% to 12.8%, with infectious disease having the highest percentage after idiopathic. Attempts to pinpoint a specific cause or causes for SSNHL in this study remained unconfirmed.⁷

Since most causes of SSNHL onset are generally idiopathic, patients may undergo screenings and/or treatment for several possible disorders. They are as follows: viral ear infection, vascular impairment, autoimmune disease, inner ear problems, and central nervous system abnormalities. In the latter, an MRI is the most useful method for identifying temporal bone or intracranial pathology when SSNHL is the primary symptom.⁸ I was referred to a rheumatologist for testing for autoimmune disease and underwent an MRI after SSNHL diagnosis.

SSNHL studies at Radebeul Hospital in Germany from January 2004 to December 2009 led to an interesting discovery. Of 489 SSNHL patients with a male to female ratio of 1:1.24, a slight predominance of left side hearing loss in female as opposed to male patients was discovered. Although the cause was unclear, researchers proposed the slight predominance of sudden deafness in the left ear...