Sudden sensorineural hearing loss

Sudden sensorineural hearing loss (SSNHL) is a sudden, unexplained loss of hearing in one or both ears, typically occurring within a 72-hour period.

Epidemiology

1. Incidence: SSNHL affects approximately 5-20 per 100,000 people per year.

2. Age: SSNHL can occur at any age, but it's most common between 40-60 years old.

3. Sex: Both males and females are equally affected.

Pathophysiology

The exact cause of SSNHL is often unknown, but possible mechanisms include:

1. Viral infections: Viral infections, such as herpes simplex or influenza, may trigger SSNHL.

2. Vascular disorders: Reduced blood flow to the inner ear or cochlea may contribute to SSNHL.

3. Immune system disorders: Autoimmune diseases, such as rheumatoid arthritis or lupus, may increase the risk of SSNHL.

4. Trauma: Head trauma or barotrauma (e.g., scuba diving) may cause SSNHL.

Symptoms and signs

1. Sudden hearing loss: Hearing loss in one or both ears, often accompanied by a feeling of fullness or pressure.
2. Tinnitus: Ringing, buzzing, or other sounds in the affected ear(s).
3. Vertigo: Dizziness or balance problems.
4. Ear fullness: Feeling of fullness or pressure in the affected ear(s).

Investigations

1. Pure-tone audiometry: Measures hearing thresholds to assess the extent of hearing loss.
2. Speech audiometry: Evaluates speech recognition and comprehension.
3. Otoacoustic emissions (OAEs): Measures the inner ear's response to sound.
4. Imaging studies: CT or MRI scans to rule out other conditions, such as acoustic neuroma or stroke.
5. Blood tests: To identify potential underlying causes, such as autoimmune disorders or infections.

Management Approach

1. Prompt medical attention: Seek medical attention within 72 hours of symptom onset.
2. Corticosteroids: Oral or intratympanic (through the eardrum) corticosteroids to reduce inflammation.
3. Antiviral medications: In cases where a viral infection is suspected.
4. Hyperbaric oxygen therapy: To improve blood flow and oxygenation to the inner ear.
5. Cochlear implants: In cases where hearing loss is severe and permanent.
6. Rehabilitation: Auditory rehabilitation, including hearing aids, speech therapy, and counseling.

Prognosis

Spontaneous recovery

Approximately 50% of patients experience spontaneous recovery within 2-3 weeks.
Treatment outcomes

Prompt treatment can improve outcomes, but the effectiveness of treatment varies depending on the underlying cause and severity of hearing loss.

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