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Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss is hearing loss that results from damage to either the cochlea or the cochlear nerve.

Treatment for Sudden Sensorineural Hearing Loss

Treatment with antiviral agents and vasodilators can be offered. The efficacy is difficult to determine.

The inflammation that develops and certain kinds of cell-releasing enzymes that break up protein are initially destructive. Later, the reparative phase begins. The basis for steroid treatment is to limit the initial destructive phase.

Steroid treatment should be given as soon as possible. As with everything in medicine, there is no guarantee that this will work. There are three ways of delivering steroids to the inner ear.

Oral

We recommend treatment with prednisone at a very high dose initially that gradually tapers over nine days. The side effects of prednisone treatment are mood disturbances, insomnia, blood sugar alterations in diabetics, and gastric hyperacidity. Not everyone develops all or any of these side effects. Diabetic patients need to check their blood sugar frequently during treatment. I recommend steroids be taken with food. Maalox or Mylanta should be taken for any acid related symptoms.

Intratympanic

A more powerful way of delivering the steroid is to inject it into the middle ear through the tympanic membrane.  From here the steroid diffuses through the round window membrane and enters the inner ear. The procedure is done in the office. This is a relatively painless procedure that involves anesthetizing the tympanic membrane with injection thereafter. A repeat audiogram is done two weeks later. If there is improvement, a repeat injection is offered.

There is a 1% chance of a persistent 1 mm perforation at the injection site. This may require patching the eardrum. Patients may experience temporary disequilibrium that may last 30 minutes. No patients had loss of additional hearing or persistent disequilibrium.

Decadron Perfusion of the Inner Ear

A sponge containing decadron (a steroid) is placed over the opening to the inner ear.

This is the most powerful way of delivering steroid to the inner ear. This involves general anesthesia for one hour. During the procedure the eardrum is elevated and the round window membrane is perfused with high-dose steroid. An absorbable pad soaked in concentrated steroid is left at the round window membrane.

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