Sudden hearing loss or sudden deafness
Sudden hearing loss or also known as sudden deafness is defined as a sensorineural hearing loss of more than 30 dB in three or more consecutive frequencies that occurred in less than 72 hours. Many patients notice hearing loss instantly upon waking in the morning, others notice it simply within hours. Loss severity varies from one patient to another and usually affect only one ear.
Associated with hearing loss, patients usually present tinnitus (noise in the ear) and up to 40% have vertigo.
Epidemiology
Sudden hearing loss is estimated to occur in 5-20 per 100,000 people / year, accounting for 1% of all sensorineural hearing loss. It occurs in the same proportion in men and in women, it can affect any age, but the most frequent age of presentation is from 40 years.
Causes of sudden hearing loss
There are many causes associated with sudden hearing loss, including:
o Infections
o Vascular problems
o Cochlear hydrops
o Masses
o Trauma
o Metabolic disorders
o Hematological changes
o Neurological disorders
o Immune disorders
o Toxic
o Idiopathic (cause unknown). For this, different theories have been postulated, such as:
1. Labyrinthitis of viral origin
2. Labyrinthitis due to vascular compromise
3. Immune-mediated inner ear disease
4. Rupture of intracochlear membranes
Unfortunately in most cases (70%) and despite an exhaustive search for possible causes, none are found.
Diagnostic
The diagnostic evaluation begins with a complete clinical history in search of antecedents that allow us to orient a possible cause. The physical examination includes otoscopy in which we can rule out transmissible causes such as a wax plug or serous otitis media. Tests such as acumetrics, impedanciometry and, most important of all, tonal audiometry, confirm sensorineural hearing loss.
Additional information can be provided by logoaudiometry, Otoacoustic Emissions (OAE) and brainstem auditory evoked potentials (PEACT).
Complementary tests: blood tests are usually carried out in order to diagnose systemic diseases of metabolic, autoimmune origin, or of infectious origin such as syphilis or Lyme disease, as suspected.
It is also recommended to request a cranial MRI in order to rule out an acoustic neuroma (benign tumor that usually manifests with hearing loss) present in 2% of cases.
Treatment of sudden hearing loss
Since in most cases a cause is not found, the treatment of this pathology remains controversial. On the other hand, it has been seen that approximately a third of patients recover their hearing spontaneously.
It is recommended to start treatment as soon as possible once it is diagnosed and the response to it is variable.
Among the most widely accepted treatments given their efficacy are: systemic corticosteroids at high doses, intratympanic corticosteroids alone or in association with systemic corticosteroids and as a rescue in case of not obtaining a favorable response. Hyperbaric oxygen therapy has also been shown to be effective, especially when started in the first 6 weeks after the onset of symptoms.
Forecast
There are several factors that favor hearing recovery, such as age, patients under 15 years of age and those over 65 have a worse prognosis, as well as a delay in the start of treatment, severity of hearing loss, association of other symptoms such as vertigo.
Finally, the patient should be followed for at least 12 months with audiometric controls and in the event of partial recovery or no recovery of hearing, the benefits of prosthetic or implant adaptation can be considered.
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