More on Sudden Sensorineural Hearing Loss (SSNHL)

Recently, we wrote about guidelines for working with patients who experience  Sudden Sensorineural Hearing Loss (SSNHL).  SSNHL is an often-devastating syndrome that takes its victim by surprise and all too often persists even after attempts at treatment.  

The Audiologist-Patient relationship is fragile and fraught, in part because of patients’ fears and in part because of the limited scientific information the Audiologist can offer:

…the audiologist meets the patient for the first time as the result of this sudden, devastating  event.  There is no time to get to know one another.  The patient is terrified, probably has little if any knowledge of audiology, and enters the relationship is a decidedly defensive position.  Unlike typical counseling … that accompanies acquired hearing loss, the audiologist’s professional response in the case of sudden loss must be at once highly diagnostic and highly supportive.

Perhaps without exception, patients are concerned with two questions:

  1.  What caused this?
  2.  Will my hearing recover?

Audiologists’ ability to answer either question is limited: recovery is a wait-and-see proposition, as covered in our last post.  As for causes, what is know is listed below. It is clear from this list that most cases of SSNHL cannot be causally linked but when the cause is known, the problem is not due solely to a problem in the inner ear.   another ref:

  • 12.8%:  systemic infections (e.g., meningitis, syphilis, or HIV infection)
  • 4.7%:  diseases of the ear (e.g., cholesteatoma)
  • 4.2%: trauma (e.g., blast trauma, skull-base fracture)
  • 2.8%: cardiovascular disease
  • 2.2%:  paraneoplastic involvement of the inner ear

Over 70% of SSNHL cases cannot be linked to a cause. These cases, called   “Idiopathic Sudden Sensorineural Hearing Loss” (ISSNHL) are attributed to effects of unknown viral, vascular, or immunological disturbances.

SSNHL represents one of the few true emergency situations that Audiologists face in practice management. A good policy is to see the patient as soon as possible for diagnostic audiologic evaluation, using a test battery that does NOT include acoustic reflex or acoustic reflex decay testing, due to the fragile condition of the ear.

Weekly audiologic monitoring commences, along with adequate counseling time, until the otologist, audiologist, and patient feel that hearing has stabilized.  Hearing aid(s) may be considered at that time, with the caution that acclimatization to amplification through the injured ear is a slow, unpredictable, and highly individual process.

1 Comment

  1. Funny that while we cannot pinpoint the etiology of the SSNHL, we are quick to say that the middle ear and/or the cochlear chamber is fragile. Therefore we cannot do tympanometric testing. and we still are unable to point the source of viral/ immunologic pathology that has intervened.
    It does appear the cochlear bone is infected first, and this infection has spread rapidly into the stria vascular membrane paralyzing the vascular supply into the micro capillaries. This infected blood quickly travels into the ganglia where nerve death occurs almost simultaneously. Yes, a pressure test of the ME cavity will cause vertigo which could be due to proximal contact with the cochlear bone, and therefore a confirmation of the location of infection/ inflammation.

    What say anybody?

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