A young boy aged 14 yrs came to me along with his father on a regular OP day. In a casual tone, his father told me that his boy is not able to hear well in his right ear since six months. I was shocked. Six months! That’s a long time. I probed further. I asked, “Have you shown him to any doctor?”. He replied that he got his sons’ ears cleaned, post which he said there was a mild improvement in the hearing, but that was the end of it. I tried talking to the kid, “Was your hearing loss sudden or did it happen over a period?” He replied that he slept one night and on waking up in the morning, he was suddenly deaf in his right ear. My face turned pale as I already knew what the problem he had was; what was even more hurting was that the window for my involvement had already passed.
There are very few emergencies in ENT, and I put Sudden hearing loss as one among them.
Why is Sudden Hearing loss (SHL) an emergency?
Sensory organs (like our inner ear) which are mainly customised components of our nervous system are susceptible to insults, and not always do they recover despite our best efforts leading to some permanent damage. In Sudden hearing loss, the earlier the ENT doctors intervention, the higher are the chances for recovery. 85% of the patients see some form of improvement in hearing on an early involvement of ENT doctor.
What is Sudden hearing loss?
Sudden hearing loss is an unexplained sudden loss of hearing that occurs at once or over a span of few days. Sudden hearing loss can be accompanied by ringing sounds in the ear(tinnitus) and imbalance (dizziness). In 90% of patients reporting sudden hearing loss, the problem is seen in one ear. The patient may realise the loss of hearing all of a sudden when he wakes up in the morning or when he uses his ear for the first time in the day such as when he puts his phone to the ear. Some patients complain that they heard a popping sound in the ear following which there was complete silence in the ear.
What are the causes of sudden hearing loss?
In 90% of patients having sudden hearing loss, the reason cannot be found. In 10 – 15% of patients the sudden hearing loss can be caused by either of the following
- Bacterial or viral infections
- Use of ototoxic drugs – drugs which can negatively affect the inner ear sensory cells
- Inner ear diseases such as Meniere’s
- Trauma to head
- A tumour on the 8th cranial nerve which carries sound from ear to the brain
- Neurological diseases such as multiple sclerosis
- Blood circulation problems
How is SHL diagnosed?
Doctors will ask for a hearing test known as Pure tone audiogram where the hearing loss can be measured qualitatively and quantitatively. A 30-decibel loss or more in a minimum of three continuous frequencies on an audiogram is indicative of sudden hearing loss. Your doctor may also ask for specific scans or lab investigations to rule out diseases which might have caused SHL secondarily.
How is Sudden hearing loss treated?
Once, the diagnosis of sudden hearing loss is established, Your doctor may prescribe oral steroids to reduce inflammation, swelling in the inner ear. The more focused latest form of treatment would be intra tympanic steroid injections where the steroid is directly delivered to the inner ear by sending a tiny needle through the eardrum. The eardrum is visualised with a microscope or an endoscope. This outpatient procedure is well tolerated with little to no discomfort. Also, Intratympanic steroid therapy can be administered to patients in whom oral steroids cannot be given such as those having hypertension, diabetes, etc.
Sudden hearing loss can sometimes be misinterpreted by the patient as ear block caused by common cold, allergies or ear wax. This misinterpretation delays the consultation with doctor causing valuable loss of time. So next time, you sense an ear block, remember the saying – “It is always better to be Safe than Sorry” – and visit a nearby ENT doctor.