Treatment of sensorineural hearing loss (SNHL)

Sensorineural hearing loss (SNHL) can be caused by acute or chronic conditions.

Sudden sensorineural hearing loss (SSHL), commonly known as sudden deafness, occurs in an unexplained, rapid loss of hearing- usually in one ear- either at once or over several days. It should be considered a medical emergency. (National Institute on Deafness and other communication disorders (NIDCD), 2015)

Causes for SSHL

• Acustic trauma (e.g. explosions, exposure to excessively loud noise)
• Infectious diseases
• Trauma, such as head injury
• Ototoxic drugs (e.g. gentamycin, furosemide, cisplatin, NSAIDS)
• Blood circulation problems (e.g. stress situations at work or in private life)

Less than 20% of the patients diagnosed with SSHL have an identifiable cause.

Treatment

Corticosteroids are the treatment of choice for SSHL, especially in cases where the cause is unknown. The treatment with steroids for SHHL is usually prescribed in pill form. Alternatively, direct injection of steroids behind the eardrum into the middle ear (intratympanic corticosteroid therapy) has been used widely by ENT-specialists (Rauch SD et al. Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial. JAMA. 2011 May 25;305(20):2071-9.) This treatment is an option for people who can’t take oral steroids.

Chronic causes for SNHL are exposure to very loud noise over a longer period of time, autoimmune inner ear disease (e.g. Cogan’s syndrome), neurologic diseases (e.g. Multiple sclerosis), hearing loss that runs in the family (inherited hearing loss), malformation of the inner ear, disorder of the inner ear (Meniere’s disease), otosclerosis and tumors.

Treatment

Bilateral progressive hearing loss over several month (autoimmune inner ear disease, AIED) is managed medically with long-term corticosteroids (Alexander TH et al. Safety of high-dose corticosteroids for the treatment of autoimmune inner ear disease. Otology& Neurootology. 2009 30:443-8). Despite efforts in research AIED disease is a chronic, incurable disorder that causes progressive disability to both hearing and balance.

Fluctuating sensorineural hearing loss maybe from unknown cause or associated with Meniere’s disease. Low sodium diet, diuretics and corticosteroids may be used in the treatment protocol.

Sensorineural hearing loss from tumors in the inner ear canal (acoustic neuroma) may qualify for surgical removal of the tumor or radiation of this benign tumor.

Irreversible sensorineural hearing loss is the most common form of hearing loss and may be managed best with hearing aids. There are a variety of hearing aids on the market and the technical development is marching at a great pace. Cochlea implants can be considered under certain circumstances if a deafness in one or two ears is present.