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acoustic neuroma

Sudden Sensorineural Hearing Loss—A Medical Emergency

Teaser: 

Dr. Pradeep Shenoy, MD, FRCS, FACS, DLO,1 Stéphanie Bellemare-Gagnon, MPA, Aud (C)2

1ENT & Neck Surgeon, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.
2Entendre Plus Hearing, Hearing and Balance Clinics.

CLINICAL TOOLS

Abstract: Sudden hearing loss—usually unilateral and rarely bilateral—can be associated with tinnitus and vertigo. In most cases it is idiopathic, although various explanations such as infective, vascular, and immune causes have been postulated. We have reviewed the literature and what follows is a survey of current research and suggested treatments for sudden hearing loss.
Key Words: sudden sensorineural hearing loss (SSNHL), tinnitus, pure tone audiogram (PTA), acoustic brainstem response audiometry (ABRA), viral neuritis, vascular insufficiency, oral steroids, intratympanic steroids, antiviral treatment, hyperbaric oxygen therapy (HBOT), MRI brain, acoustic neuroma.
All patients with SSNHL should be assessed by taking a thorough history and performing a complete examination to identify any specific disease.
PTA should be performed in all patients.
Targeted laboratory investigations should be performed after the initial assessment.
All patients should have an MRI of the brain if a CT SCAN of the brain is contraindicated; ABR testing should also be considered.
If a specific cause for SSNHL is found, the patient should be managed accordingly.
If SSNHL is idiopathic in nature, patients may be offered a course of oral steroids.
If oral steroids are contraindicated, IT steroid therapy could be considered as a primary or salvage therapy.
Use of antivirals, HBOT, vasodilators, and vasoactive agents are not currently supported by the research.
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