Sudden Sensorineural Hearing Loss

A Diagnostic and Therapeutic Emergency

Andrew D. P. Prince, BA; Emily Z. Stucken, MD

Disclosures

J Am Board Fam Med. 2021;34(1):216-223.. 

In This Article

Abstract and Introduction

Abstract

The family physician's role in recognizing and managing sudden sensorineural hearing loss (SSNHL) is crucial. A recently updated otolaryngologic clinical practice guideline has been released for this emergency syndrome, but dissemination is limited to a specialty journal. As a result, the guidelines may not be widely available in the primary care setting where patients often present. We provide this focused review to clarify and disseminate SSNHL guidelines for the frontline family physician.

Introduction

Sudden sensorineural hearing loss (SSNHL) is a medical emergency in which patients experience a sudden (within 72 hours) drop in hearing that is sensorineural in nature, not the result of mechanical blockage from fluid or wax buildup. Prompt recognition is critical as there is a window of time in which medical interventions may be successful in restoring hearing and/or reducing tinnitus, thus providing significant improvement in patient quality of life.[1] Although SSNHL can result from a variety of identifiable causes (neoplastic, infectious, autoimmune, neurologic, ototoxicity), 90% of cases are idiopathic.[2–4] SSNHL affects 5 to 27 per 100,000 people annually, with about 66,000 new cases per year in the United States.[4–7] The incidence, debilitating consequences of missed diagnosis and management, and the scarcity of randomized controlled trials led the American Academy of Otolaryngology–Head and Neck Surgery to develop a clinical practice guideline (CPG) that was recently updated in 2019 to assist providers in appropriately managing this condition.[7,8]

The CPG for SSNHL is intended for all clinicians who diagnose or manage patients aged 18 years and older that present with sudden hearing loss. The CPG is focused specifically on idiopathic SSNHL—hearing loss that is rapid in onset, not due to conductive pathology, and not explained by an identifiable cause. Despite intense efforts to disseminate CPGs, previous studies have shown that uptake of recommendations in CPGs is limited and adherence to certain key action statements is low.[9–11] The need to disseminate the guidelines beyond the otolaryngology community is crucial, as the majority of patients with SSNHL are first evaluated by nonotolaryngologists, with 15,000 to 66,000 patients visiting family medicine clinics, urgent care centers, and emergency rooms for assessment of this complaint annually.[7] To our knowledge, this is the first report specifically aimed at disseminating the guidelines for SSNHL into the family medicine literature, with a goal of achieving broader adherence to the CPG.

The family physician's role in recognizing and managing SSNHL is pivotal. In their role at the frontline, family physicians can provide the highest quality assessment, management, and patient centered care. Timely recognition of SSNHL by the initial evaluating physician affects the availability of treatment options, as well as the success rates of treatment. Improved awareness, clarity, and dissemination of CPGs is critical to improve adherence and the quality of clinical care.[7,10] We describe a case report of a typical patient presenting with SSNHL, followed by a summary of the current CPG to equip the frontline family physicians with tools for managing sudden hearing loss.

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