Sudden Sensorineural Hearing Loss: Why Fast Action Matters

A True ENT Emergency

Imagine waking up and realizing one ear isn’t working. Sounds are muffled or gone, replaced by a loud ringing, whooshing, or buzzing. Maybe there’s mild pain or pressure.

This could be sudden sensorineural hearing loss (SSNHL) - a condition that requires immediate medical attention.

What is SSNHL?

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) defines SSNHL as:

A hearing loss of 30 dB HL or more, affecting at least three contiguous frequencies, developing within 72 hours.

Most cases affect one ear and occur in adults in their 40s and 50s.

Possible Causes

In the majority of cases, no exact cause is identified making it “idiopathic.”
However, the leading theories suggest:

·       Viral inflammation - possibly reactivation of dormant herpes viruses.

·       Vascular compromise - a brief interruption of blood flow to the inner ear.

·       Benign tumors - such as vestibular schwannomas, present in about 3–10% of the population.

Why Timing Is Critical

Early intervention is the most important factor in recovery. Treatment within the first 1–2 weeks offers the best odds of regaining hearing.
Unfortunately, many people wait weeks or months, thinking symptoms will pass…a delay that can lower recovery chances.

First Steps if You Suspect SSNHL

1.     Get a hearing test immediately - Ideally, an audiogram should be performed within 48 hours.

2.     ENT evaluation - Many ENT offices have on-site audiology. Independent audiology clinics or validated online screening tools can also help in urgent situations.

A quick office tuning fork test can give clues, but it’s not a substitute for a full audiogram.

Treatment Options

1. High-dose oral steroids - First-line therapy recommended by AAO-HNS guidelines

·       Pros: Widely available, effective.

·       Cons: Possible side effects include mood changes, sleep disturbance, elevated blood sugar, and stomach irritation.

2. Intratympanic steroid injections - Steroids are delivered directly into the middle ear.

·       Pros: Equally effective as oral steroids.

·       Cons: Risks include pain and rare eardrum perforation.

·       Note: Combining oral and intratympanic steroids may provide an extra ~9 dB improvement, especially in severe cases

3. Hyperbaric Oxygen Therapy (HBOT) - Increases oxygen delivery to the inner ear.

·       Best results: When started within 2-4 weeks.

·       Evidence: Particularly helpful in severe or profound loss, and in improving low-frequency hearing

·       Limitations: Rarely covered by insurance; may cost up to $1,000 per session.

What About Supplements or Alternative Therapies?

·       N-Acetylcysteine (NAC): Not currently recommended by AAO-HNS, though small studies suggest possible benefit in high-frequency recovery.

·       Prostaglandin E1: May improve blood flow to the cochlea, but evidence is insufficient.

·       Caffeine reduction: May improve circulation by preventing vasoconstriction.

·       Aspirin: No proven benefit; onset of effect is too slow to help in SSNHL.

Imaging Considerations

Even if hearing improves, an MRI may be advised to rule out a vestibular schwannoma or other retrocochlear pathology. While rare (1–5% incidence), these findings can influence long-term management.

Prognosis

With prompt treatment, many patients experience partial or complete recovery. Factors linked to poorer outcomes include:

• Older age

• Pre-existing hearing loss

• Severe initial hearing loss

• Presence of vertigo at onset

• Chronic conditions such as hypertension, diabetes, obesity, or high cholesterol

Key Takeaways

·       Don’t wait - hearing loss lasting more than a few hours needs urgent evaluation.

·       Act within 48 hours for the best chance at recovery.

·       Steroid therapy is the mainstay - oral, intratympanic, or both.

·       HBOT may be worth exploring for severe cases.

·       Lifestyle factors like caffeine reduction may help recovery.

References:

1.     Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg. 2019;161(1_suppl):S1–S45. doi:10.1177/0194599819859885

2.     Stachler RJ, Chandrasekhar SS, Archer SM, et al. Clinical practice guideline: sudden hearing loss. JAMA Otolaryngol Head Neck Surg. 2020;146(5):421–425. doi:10.1001/jamaoto.2020.0157

3.     Bennett MH, Kertesz T, Yeung P, Lehm JP. Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus. Cochrane Database Syst Rev. 2022;10:CD004739. doi:10.1002/14651858.CD004739.pub4