Hearing Injury Emergency Hearing Testing

Hearing Emergency

 

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), sudden sensorineural hearing loss (SSHL) occurs at the rate of approximately 4,000 new cases each year. Audiologists and ENT physicians evaluate these cases, but typically weeks to months after the most effective treatments should have been provided. This is because SHL is an obscure condition not well known by the public or most medical professionals.

 

It is accepted that sudden hearing loss typically occurs within 3 days’ time. With the exception of obvious ear wax in the canal or an ear infection, SSHL is an ear problem that affects the inner ear or acoustic nerve and should not be discounted, especially if there is ringing in the ear or dizziness. Typically, there is no substantial pain, although discomfort from the sensation of pressure in the ear may occur.

 

Sudden hearing loss is typically found only in one ear, but may occur in both. A sudden change in both ears is extremely rare and represents a serious health issue requiring an immediate trip to the emergency room. Although the degree of hearing change varies, rarely do individuals have a sudden pop and immediate hearing loss. Most patients report that they noticed a loss in one ear upon awakening in the morning. Some identify the loss when listening on the telephone and switching ears, listening with one ear on a pillow, or listening to television while plugging one ear at a time.

 

In a number of recent studies, patients with sudden hearing loss were evaluated for the causation. The results identified cases associated with viruses, high blood pressure, high cholesterol, autoimmune disease, stroke, tumors, and ear trauma, which ranged from sneezing to a fractured skull. Remarkably, a small percentage was associated with pregnancy and other obscure conditions. Even with the best diagnostic capabilities, other than obvious medical problems, most cases remain of unknown origin.

Potential Treatments

 

The treatment can be a single medication or combinations designed to reduce inflammation, treat a possible virus, and increase blood circulation into the inner ear. In cases of bacterial infection, antibiotics may also be prescribed and for Meniere’s disease a diuretic and low salt diet may be recommended by the ENT physician. Some researchers have reported that hyperbaric oxygen treatments, although the current literature shows a lower level of efficacy. However, in most cases, steroid treatment is almost always recommended if not medically contraindicated as in patients with diabetes. The key to maximizing the treatment of SSHL is preliminary hearing testing at the onset to demonstrating if the loss is from a middle ear or from inner ear damage. Without testing the treatment is typically for middle ear fluid or an allergy and the opportunity to recover hearing diminishes for every 24 hours after the initial insult. Hearing testing avoids a misdiagnosis and inappropriate treatments.A moderate number of patients recover without treatment. However, current wisdom would suggest that SSHL be treated at the onset because the rates of recovery are remarkably better than no treatment at all. The approach to treatment typically centers on viral and vascular causations and means to reduce inflammation and increase blood circulation. An MRI may also be ordered in some cases. Because of the type of neural changes that occur in the ear, treatment options are best when started within the first 24 to 48 hours. Some neurotologist will start the patient on oral medication, but also provide an injection of steroid behind the ear drum.

 

A moderate number of patients recover without treatment. However, current wisdom would suggest that SSHL be treated at the onset because the rates of recovery are remarkably better than no treatment at all. The approach to treatment typically centers on viral and vascular causations and means to reduce inflammation and increase blood circulation.  An MRI may also be ordered in some cases.  Because of the type of neural changes that occur in the ear, treatment options are best when started within the first 24 to 48 hours.  Some neurotologist will start the patient on oral medication, but also provide an injection of steroid behind the ear drum.

 

Residual Hearing Loss

 

The real gamble is whether the hearing will recover back to normal, partially, or not at all. Some ears will not completely recover and will benefit from properly fitted hearing aids. In some cases, the hearing loss renders the affected ear not aidable because the ear cannot tolerate sound loudness and reverberates, or there is severe distortion. However, in cases where standard amplification does not work, a bone anchored hearing aid (BAHA, cochlearamericas.com), CROS and BiCROS hearing aids, or a cochlear implant (medEl.com) can be very effective in restoring communication.

 

Taking Action

 

Regardless of the causation of SSHL, the best opportunity for treatment is a hearing test at the onset.  Testing should be conducted on an emergency basis to identify the type of hearing loss as inner ear or not (i.e. ear wax or middle ear fluid). This must be followed by a consultation with an ENT physician the same day who will diagnose the condition, start treatment, and maximize the recovery.  Should residual hearing loss with dizziness occur, further diagnostic hearing and balance evaluations should be conducted to identify the extent of the disorder and need for vestibular rehabilitation therapy.  If permanent hearing loss is the outcome, a variety of hearing options can reduce the effects of communication and improve quality of life.

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