Severe acute sensorineural hearing loss is not very common and general practitioners are not expected to encounter but only a few cases throughout their lives. This makes it very difficult to find the best way to deal with it. Only few patients have a specific cause such as trauma from an explosion or damage from intense pressure, which injured the cochlea. Others may have suffered meningitis or mumps. Severe infections of the middle ear or cholesteatoma can move into the inner ear. An acoustic neuroma can become noticeable by causing sudden hearing loss. Some patients may have suffered from a herpes infection and except from a few bubbles in the ear and the floor of the mouth they may have vertigo, facial nerve paralysis and hearing loss. The combination of all these symptoms is called Ramasay-Hunt Syndrome.
There are other rare explanatory statements, but, generally, for most cases of sudden sensorineural hearing loss there cannot be a specific cause. In these cases, doctors usually consider that the situation is caused by a virus or a blood clot that affects the blood supply to the inner ear. There is no satisfactory evidence to support any of the above reasons as true, but the second seems to have some more light. The inner ear has a single small artery (the labyrinthine artery) that supplies blood and most body parts have two in such a way that when one is blocked, the other is responsible to continue the blood supply. The labyrinthine artery splits to feed the cochlea and the vestibular labyrinth separately. Artery occlusion at different points may theoretically cause deafness, dizziness, or both. Although this is a very attractive case and is the basis for many treatments, there is no evidence that this is the cause. For this reason, most cases of sudden sensorineural hearing loss are classified as idiopathic, i.e., with no known cause.
Thus, for a situation with no known explanation, no treatment can be found on a rational basis. Indeed, in formal studies no form of treatment has been proved more effective than to make no therapeutic effort whatsoever- provided that other possible underlying causes have been excluded. Without any treatment, 60-70% of patients will recover fully or nearly, usually within the first week. Bad prognostic factors are:
- Hearing loss in the range of 8 kHz
- Hearing loss greater than 70dB averagely around the frequencies of 1.2 and 4 kHz.
- Vertigo along with hearing loss
Of course, this does not mean that patients should not be treated therapeutically. Sudden hearing loss is a serious condition that disrupts a person, since hearing is the first warning system of the body and its loss causes great anxiety and distress. Any remaining hearing is usually disrupted and the unpleasant recruitment of hearing is often. If tinnitus is developed, then the problem becomes worse. We take a full history, to make a careful examination and order the appropriate tests to rule out an underlying disease. Many ENT surgeons prefer to advise patients to rest and relax and possibly take some medication because of the disruptive nature of the problem. If there is no recovery, supportive measures and rehabilitation of hearing may be offered.