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

Case Report

A 64-year-old man with hypertension presents to his family medicine physician complaining of blocked hearing in his left ear for 1 day. He noticed a loud ringing sound and the feeling of the left ear being plugged. He has not had any dizziness, pain in his ear, or drainage from his ear. He denies any recent trauma, noise exposures, respiratory illness, change in medications, or other neurologic symptoms.

On physical examination, the left external ear and ear canal are unremarkable. The left tympanic membrane is normal in appearance and no definite middle ear effusion can be seen. A vibrating 512-Hz tuning fork placed on the midline of the forehead is perceived louder in the right ear. Cranial nerve examination is otherwise intact, and there are no other abnormalities noted on a complete head and neck examination nor focal neurological examination.

The family physician is concerned that the patient may be experiencing SSNHL and discusses the diagnosis, natural history, treatment options, and current evidence regarding this condition. The patient and physician jointly decide to try a course of oral steroids as initial therapy, and the patient is prescribed 60 mg prednisone daily for 10 days, followed by a 7-day taper. The family physician also orders magnetic resonance imaging (MRI) brain/internal auditory canal protocol with gadolinium and places an urgent referral to an otolaryngologist for a hearing test and further evaluation.

The otolaryngology office schedules the patient for an urgent audiogram and evaluation by an otolaryngologist the following day. The audiogram demonstrates a significant drop in sensorineural hearing levels throughout the frequency spectrum. After discussion, the patient elects to complete his oral steroid therapy before any further intervention is taken. He has a partial response to therapy 2 weeks after onset of symptoms, and he elects to undergo an intratympanic (IT) injection at this time. At followup 1 week later, his hearing has returned to his baseline level.

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