Sensorineural hearing loss


Sensorineural hearing loss

Description, Causes and Risk Factors:

ICD-10: H90.5

Abbreviation: SNHL.

Sensorineural hearing losses (SSHL) are medical emergencies. You need to see your ear specialist (preferably an otologist or neuro-otologist) immediately.

By definition, you have SNHL if you have a hearing loss that occurs within three days (often within minutes or an hour or two) and your hearing loss is greater than 30 dB over three adjacent octaves (test frequencies).

Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain. SNHL can also result from immunologic diseases such as Cogan's syndrome and Lupus and from various autoimmune conditions.

According to one recent study, Herpes simplex virus type 1 (HSV-1) seems to be the most likely culprit. In animals inoculated in their inner ears with HSV-1, all the animals rapidly lost their hearing. Other viruses thought to cause SNHL loss may include adenovirus, cytomegalovirus (CMV), infectious mononucleosis, influenza, measles, mumps, parainfluenza, rubella and rubeola.

Other miscellaneous causes of SNHL include endocrine disorders such as hypothyroidism and diabetes, exposure to pesticides, certain snake bites, encephalitis, leukemia, meningitis, multiple sclerosis and syphilis.

Risk Factors:

    Illnesses.

  • Drugs that are toxic to hearing.

  • Hearing loss that runs in the family (genetic or hereditary).

  • Aging.

  • Head trauma.

  • Malformation of the inner ear.

  • Exposure to loud noise.

  • Viral cochlear labyrinthitis

  • Viral vestibular labyrinthitis.

  • Cochleovestibular labyrinthitis

  • Viral neuritis, auditory nerve.

  • Viral polyneuropathy (including Ramsay-Hunt syndrome).

  • Viral-induced meningoencephalitis.

  • Hypercoagulability states.

  • Vasospasm.

  • Meningitis, labyrinthitis secondary to chronic ear infection or surgery.

  • Syphilis, primary through tertiary stages.

  • Relapsing polychondritis.

  • Lupus erythematosus.

  • Polyarteritis nodosa (Kussmaul's disease).

  • Multiple sclerosis

  • Migraine.

  • Vestibular schwannoma (acoustic neuroma).

  • Metastatic cancer.

  • Paraneoplastic disorders.

Most of the time, SNHL cannot be medically or surgically corrected. This is the most common type of permanent hearing loss.

Symptoms:

Sensorineural Hearing Loss in Babies:

    Failure to respond to any sound may mean congenital deafness.

  • No utterances of any sound from the baby or no babbling at all.

  • Sounds, if any, are quiet and soft, distorted or not clear.

  • Less to reach high tones, inaudible.

  • No sounds for “s, f and z” are heard.

  • Speech is hard to understand when there is noise at the background.

Sensorineural Hearing Loss in Adults

    Tinnitus.

  • Vertigo, or what is commonly felt as dizziness or loss of balance.

  • Difficulty in hearing even if the sound is already high or loud.

  • Slow to respond and understand.

Diagnosis:

The evaluation of the patient with SNHL should include a history and review ofsymptoms, otologic and neuro-otologic examination, audiologic testing, and laboratory studies.

Audiologist will perform the following tests:

    Auditory Brain Stem Response (ABR) test.

  • Regular (Behavioral) Audiological Evaluation.

  • Auditory Processing.

  • Tympanometry.

  • Otoacoustic emissions (OAEs).

Laboratory studies:

    CBC/ESR.

  • Glucose and glycosylated hemoglobin (HbA1C).

  • Cholesterol/triglycerides.

  • T3, T4, TSH.

  • PT, PTT, serum filterability tests (if available).

  • VDRL (Venereal Disease Research Laboratory test), FTA-ABS (fluorescent treponemal antibody absorption (test))

  • HIV antibody.

  • Lyme disease antibody titer (Borrelia burgdorferi antigen).

  • Acute and convalescent viral antibody titers (onset, 1 month, and 3 months).

Other Tests:

    MRI with gadolinium.

  • Electronystagmography with calorics and positional testing.

Treatment:

At the present time, there is no truly successful therapy for people with SNHL because even after treatment, you still will likely have considerable hearing loss. In fact, some ear specialists choose not to treat sudden sensorineural hearing loss at all, citing spontaneous recovery rates of 32-70%. The wearing of a hearing aid is the most common treatment for sensorineural hearing loss.

Studies indicate that the current practice doctors use — called the "shotgun" approach — giving steroids, vasodilators, diuretics, antihistamines, anticoagulants, carbogen, antivirals, etc. and hoping that one or the other will do some good, was found to be no more effective than doing nothing at all.

If you have a clear history of SNHL associated with diving, straining, altitude change (flying) or recent ear surgery, see your ear specialist immediately as surgery is often necessary to fix the problem.

If you had a mild-to-moderate hearing loss in the mid frequencies (1,000-2,000Hz), you hearing will likely come back on its own within two weeks-whether you have any treatment or not. In other words, current treatments don't work and are unnecessary.

If your hearing loss was profound (greater than 90 dB), you only have a 25% chance of getting your hearing back, regardless of the treatment you receive.

If your hearing loss is less than 90 dB and not limited to the mid-frequencies, then immediate treatment with steroids (within 10 days) has a 78% chance of restoring your hearing (or at least some of it). The only treatment that has proved effective (supported by double-blind trials) is corticosteroid treatment-usually Prednisone or Prednisolone. This generally works if you have a hearing loss in only one ear, your loss is a moderate loss across many frequencies and you are younger than 40. Apparently this study was not entirely accurate since it was not randomized and thus may have produced exaggerated results.

Although positive results have been reported favoring systemic steroids, steroids injected through the eardrum, magnesium, vitamin E and hyperbaric oxygen, there are no randomized, blinded studies supporting the efficacy of any of these treatments.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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