Journal Reading

Sudden Sensorineural Hearing Loss :

A review of Diagnosis, Treatment and Prognosis

Muhammad Arif, S.Ked

Nurul Hasanah S, S.Ked
Putri Pebryanty, S.Ked
Yuni Novita, S.Ked

Supervised by :
dr. Harianto, Sp.THT-KL
dr. Ariman Sukri, Sp.THT-KL
dr. Asmawati Adnan, Sp.THT-KL
dr. Yola Zenia, M. Biomed., Sp.THT-KL

Clinical Clerkship of ENT Departement

Faculty of Medicine University of Riau
Arifin Achmad General Hospital
2018
 INTRODUCTION

Sudden sensorineural
hearing loss (SSNHL) :
Sensorineural hearing loss of 30 Db or
greater

Over at least three contigous audiometric

frequencies

Occuring over 72 hour

 EPIDEMIOLOGY

5-20 PER
100.000 Peak incidence
5th – 6th
decade

Most cases are

unilateral
2% bilateral
Identifiable causes of
SSNHL
SSNHL which fully manifests
over time
 Theories of etiology of
Idiopathic SSNHL

Unknown etiology of SSNHL  Idiopathic

MOST WIDE THEORY :

Vascular compromise

Cochlear membrane
rupture

Viral infections
 Vascular compromise

Blood supply of Injury

cochlea arises of the 2
small terminal arteries
Vascular insults of
cochlea
 Risk Factor

Cigarette
smoking

RISK FACTOR : hypertension

hyperlipidemia
 Cochlear membrane
rupture

Reissner’s sudden
Streneous activities /
increased intracranial membrane hearing loss
pressure + “pop”
rupture sensation

However most idiopathic

SSNHL do not remember
“popping” sensation prior to
onset of hearing loss
• Goodhill : proposed that these patients had hearing loss due to
perilymphatic fistulae

perilymphatic fistulae
 Viral infections

• Viral infection within the inner ear  Cochlear inflammation

• Probable viruses are :
Herpes
CMV
simplex

Influenza
Mumps
B

Enterovirus Rubeola
 Natural History

• Many of the discoverable causes of SSNHL cause permanent hearing

loss due to damage to hair cells or other inner ear structures.
• One study found that 45% of patients with idiopathic SSNHL
spontaneously regained hearing levels in the affected ear within
10dB of the contralateral ear
• Rates of hearing recovery for idiopathic hearing loss are additionally
affected by:

hearing
loss Duration
severity

Age at
presentation
 Evaluation

• Patients presenting with SSNHL should undergo a workup

Pure tone audiometry

Stenger Test

Auditory Brainstem Respons (ABR)

Electronystagmography (ENG)

Blood & Serologic Tests

Radiographics
 TREATMENT

In cases in which a cause of SSNHL is discerned, the

appro- priate treatment for that condition is administered

Controversy remains surrounding the necessity and

options for treating idiopathic SSNHL.
Spontaneously resolves in 45% to 65% of patients

Numerous agents have been investigated for the treatment of idiopathic

SSNHL

98% of U.S. otolaryngologists reported treating idiopathic SSNHL with oral

steroids; additionally, 8% of otolaryngologists reported the use of
intratympanic steroids
IT-steroid application leads to higher perilymph levels of
steroids than systemic administration

Rausch and colleagues have recently shown that IT

application of corticosteroids is not inferior to systemic
steroids for idiopathic SSNHL with thresh- olds less than 70
dB HL
50% of 104 otolaringologists reported using antiherpetic therapy
(acyclovir, famciclovir, etc.) in combination with corticosteroids
for the treatment of idiopathic SSNHL
 PROGNOSIS

Prognosis of SSNHL due to a discernable etiology depends:

• heavily on that disease process

• its duration

• specific impact on cochlear structure

• treatment options
For idiopathic SSNHL, 45% to 65% of patients will regain their preloss hearing
thresholds even without therapy, with average gains of 35 dB

Demographics

Depends on Duration of hearing loss

a variety of
risk factors:
Associated symptoms

Audiogram characteristics
SSNHL is a common complaint in Although most cases of SSNHL are
audiologic and otolaryngologic idiopathic, a number of treatable
practice conditions can underlie SSNHL.

Conclusion

Efforts to discern these conditions

Prognosis for hearing recovery is
should be part of the diagnostic
based on several factors
evaluation