Sudden sensorineural hearing loss
Sudden sensorineural hearing loss is unilateral hearing loss occurring within 72 hours, most often idiopathic, that is an otologic emergency because delayed treatment worsens recovery.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Sudden-onset sensorineural hearing loss: a decline in hearing arising over hours to within 72 hours, caused by disorders of the cochlea, auditory nerve, or central auditory pathway rather than the outer or middle ear.
- Epidemiology
Adult-onset hearing loss overall: genetics is implicated in hearing loss broadly and plays a role in 25% to 50% of adult-onset hearing loss.
- Risk factors
Ototoxic medication exposure: aminoglycosides, tetracycline, chemotherapeutic agents (cisplatin, carboplatin, vincristine, 5-fluorouracil, bleomycin), high-dose aspirin, and NSAIDs are recognized…
- Pathophysiology
Cochlear or retrocochlear origin: sensorineural hearing loss reflects a deficit or injury of the cochlea, the vestibulocochlear nerve, or the central auditory pathways, in contrast to conductive…
- Clinical features
Sudden unilateral hearing loss: the hallmark is hearing loss that develops within 72 hours, more often affecting one ear, often noticed on waking or when using a telephone on the affected side.
- Differential diagnosis
Vestibular schwannoma (acoustic neuroma): a benign Schwann cell tumor of the vestibular or cochlear nerve; the most concerning cause of unilateral sensorineural hearing loss, especially with…
- Diagnosis
Confirmed by audiometry: sudden sensorineural hearing loss is established by audiometric confirmation of a sensorineural hearing deficit; there is no formal severity-staging system, so the workup…
- Management
Start oral prednisone as soon as possible after symptom onset: prednisone 1 mg/kg orally once daily (typically 60 mg/day, up to a maximum of 60 to 80 mg/day) for 10 to 14 days, then taper over 5 to 7…
- Complications
Permanent unilateral or bilateral hearing loss: the loss may not recover, particularly with delayed treatment initiation or when the underlying cause is unidentified.
- Prognosis
Earlier treatment predicts better recovery: initiation of oral corticosteroids within 2 weeks of symptom onset is associated with better recovery than delayed initiation, underscoring the urgency of the 72-hour referral window.
- Prevention
Avoid or minimize ototoxic drug exposure: use non-ototoxic alternatives when possible and monitor patients receiving aminoglycosides, cisplatin, carboplatin, vincristine, 5-fluorouracil, bleomycin…
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Hearing loss
Hearing loss is evaluated with the Weber and Rinne tuning fork tests to sort conductive from sensorineural loss at the bedside, then confirmed with audiometry; treatment ranges from cerumen removal or hearing aids to urgent oral prednisone and otolaryngology referral for sudden sensorineural loss.
- Vestibular schwannoma (acoustic neuroma)
Vestibular schwannoma is a benign Schwann-cell tumor of CN VIII in the internal auditory canal/cerebellopontine angle that presents with slowly progressive unilateral sensorineural hearing loss and disequilibrium rather than true vertigo. Diagnosis rests on asymmetric audiometry followed by contrast-enhanced MRI, and management is a size- and growth-driven choice among observation, stereotactic radiosurgery, and microsurgical resection.
- Vestibular neuritis and labyrinthitis
Vestibular neuritis and labyrinthitis are presumed viral or post-viral inflammatory disorders of the vestibular nerve or labyrinth causing sudden-onset, continuous vertigo lasting days, with labyrinthitis distinguished by added cochlear symptoms of hearing loss and tinnitus. The essential diagnostic task is excluding a posterior-circulation stroke at the bedside using the HINTS exam before treating with short-course vestibular suppressants, early corticosteroids, and vestibular rehabilitation.
- Tinnitus
Tinnitus is the conscious perception of sound without an external source, most often subjective (heard only by the patient) and linked to hearing loss, noise exposure, or an ototoxic drug. Management treats any identified cause first (stop the ototoxic agent, treat hearing loss), since no drug cures tinnitus itself, then adds sound therapy, hearing aids, or cognitive behavioral treatment for persistent symptoms.
- Noise-induced hearing loss
Noise-induced hearing loss is a preventable sensorineural hearing loss from cochlear hair-cell injury, either sudden after a single very loud blast (acute acoustic trauma) or gradual from cumulative occupational or recreational exposure (chronic noise-induced hearing loss), with high-frequency loss first and no restorative drug therapy once established.
- Vertigo
The false sensation of self or environmental movement, classified as peripheral (inner ear or vestibular nerve) or central (brainstem or cerebellum) based on history, nystagmus pattern, and the bedside HINTS exam. Peripheral vertigo is managed with repositioning maneuvers or vestibular suppressants; central vertigo requires urgent stroke evaluation, since it can be the sole presenting symptom of a posterior circulation stroke.
- Chronic suppurative otitis media
Chronic suppurative otitis media is continuous otorrhea through a perforated tympanic membrane for more than six weeks without systemic symptoms. Management starts with topical fluoroquinolone ear drops and aural toilet, escalating to systemic antibiotics or tympanoplasty for refractory disease or cholesteatoma.