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BackTable / ENT / Podcast / Episode #87

Sudden Sensorineural Hearing Loss

with Dr. Sujana Chandrasekhar

In this episode of BackTable ENT, Dr. Shah and Dr. Agan interview Dr. Sujana Chandrasekhar, a private practice neurotologist, about diagnosis and treatment of patients with sudden sensorineural hearing loss (SNHL).

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Sudden Sensorineural Hearing Loss with Dr. Sujana Chandrasekhar on the BackTable ENT Podcast)
Ep 87 Sudden Sensorineural Hearing Loss with Dr. Sujana Chandrasekhar
00:00 / 01:04

BackTable, LLC (Producer). (2023, January 31). Ep. 87 – Sudden Sensorineural Hearing Loss [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Sujana Chandrasekhar discusses Sudden Sensorineural Hearing Loss on the BackTable 87 Podcast

Dr. Sujana Chandrasekhar

Dr. Sujana Chandrasekhar is an otologist / neurotologist practicing at ENT and Allergy Associates in New York City.

Dr. Ashley Agan discusses Sudden Sensorineural Hearing Loss on the BackTable 87 Podcast

Dr. Ashley Agan

Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.

Dr. Gopi Shah discusses Sudden Sensorineural Hearing Loss on the BackTable 87 Podcast

Dr. Gopi Shah

Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.

Show Notes

First, Dr. Chandrasekhar explains the formal definition of sudden hearing loss, which is a loss of 30 dB over 3 consecutive frequencies over 72 hours, and notes that it is usually unilateral. She explains that the time from hearing loss presentation to ENT referral is usually delayed, as many patients attribute their hearing loss to a cold, the flu, or allergies. Frequently, they are also told over phone to take nasal sprays or prescribed amoxicillin. However, severe / profound hearing loss with or without tinnitus and vertigo necessitates immediate ENT consultation. Upon initial presentation, she usually gets a thorough health history, review of systems, and medication list from the patient. Common causes of SNHL include: pregnancy and other thrombotic states, stroke, injected or intravenous drugs, high dose aspirin, PDE-5 inhibitors, and COVID-19 infection. She also describes how she uses the physical exam to distinguish between conductive and sensorineural hearing loss. First, she checks the outer ear and visualizes the tympanic membrane to look for external pathologies. Then, she utilizes the Weber and Rinne tests on every patient.

Next, she explains her further workup for patients determined to have SNHL. She emphasizes the need for retrocochlear examination to check for vestibular schwannoma, which is best done through MRI. If patients have MRI contraindications, a CT temporal bone with contrast paired with auditory brainstem response (ABR) testing may be an alternative option. Dr. Chandrasekhar explains that a single ABR test has a low specificity for vestibular schwannomas, missing up to 15-20% diagnoses. She also notes that patients with audiograms showing low frequency hearing loss have a better prognosis than those with high frequency hearing loss. Additional symptoms to look for are otalgia, erythema, healing vesicles, facial palsy, and blebs on the tympanic membrane. These symptoms may point to an infectious cause, such as syphilis, Lyme disease, and herpes zoster. Additionally, children may have syndromic causes of SNHL.

Dr. Chandrasekhar also explains her treatment options for SNHL of different severities. For patients with mild and moderate hearing loss, she prescribes an oral prednisone taper, which patients can stop taking if hearing comes back. Intratympanic steroid injections with dexamethasone may be implicated if patients with moderate SNHL do not respond to oral prednisone. She explains her steroid injection technique as well as tips for how to make patients more comfortable during and after the procedure. For patients with severe SNHL, she emphasizes the importance of self-training to listen in the affected ear, starting to wear hearing aids early, and considering BAHA devices. Then, the doctors discuss the value of additional therapies for SNHL, such as acupuncture, hyperbaric oxygen, papaverine, and B vitamins. Finally, she speaks about intratympanic stem cell injections to regrow inner hair cells as an exciting future treatment of sudden hearing loss.

Resources

Transcript Preview

The patient doesn't know whether they have sensorineural loss or conductive loss or mixed loss. They don't. They just know they can't hear. When you start with sudden hearing loss, a really nice way, I think, to think about it is to follow the patient's path as they access healthcare. They wake up, or they're in the middle of a conversation, and they suddenly can't hear, generally out of one ear. It's extraordinarily rare to have bilateral sudden sensorineural hearing loss.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Articles

Sudden Sensorineural Hearing Loss Treatment

Sudden Sensorineural Hearing Loss Treatment

Causes of Sudden Sensorineural Hearing Loss (SSHL): Many Potential Etiologies, One Otologic Emergency

Causes of Sudden Sensorineural Hearing Loss (SSHL): Many Potential Etiologies, One Otologic Emergency

Evaluating Sudden Sensorineural Hearing Loss (SSHL) Symptoms

Evaluating Sudden Sensorineural Hearing Loss (SSHL) Symptoms

Topics

Hearing Loss Condition Overview
Learn about Otology on BackTable ENT

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