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Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss
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Clinical Practice Guideline: Sudden Hearing Loss (Update).

Sujana S Chandrasekhar1,2,3, Betty S Tsai Do4, Seth R Schwartz5

  • 11 ENT & Allergy Associates, LLP, New York, New York, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|August 2, 2019
PubMed
Summary

Sudden hearing loss requires prompt evaluation to distinguish sensorineural from conductive types. This guideline update emphasizes timely diagnosis and evidence-based treatments, including corticosteroids and intratympanic therapies, to improve outcomes for sudden sensorineural hearing loss.

Keywords:
evidence-based medicinehyperbaric oxygenintratympanic steroidspractice guidelinessudden hearing losssudden sensorineural hearing loss

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Area of Science:

  • Otolaryngology-Head and Neck Surgery
  • Audiology
  • Neurology
  • Emergency Medicine

Background:

  • Sudden hearing loss (SHL) is a critical symptom often accompanied by tinnitus or vertigo, necessitating urgent medical attention.
  • Sudden sensorineural hearing loss (SSNHL) affects approximately 5-27 per 100,000 individuals annually in the US, with over 66,000 new cases each year.
  • Prompt diagnosis and management of SSNHL are crucial for improving hearing recovery and patient quality of life.

Purpose of the Study:

  • To provide clinicians with evidence-based recommendations for evaluating and managing patients with sudden hearing loss (SHL), focusing on idiopathic sudden sensorineural hearing loss (ISSNHL).
  • To improve diagnostic accuracy, facilitate prompt intervention, and reduce variations in management for SHL.
  • To enhance hearing and rehabilitative outcomes for patients experiencing SSNHL.

Main Methods:

  • A systematic literature review was conducted, incorporating updated evidence and reviewing the prior clinical practice guideline.
  • The guideline update group included multidisciplinary representation from otolaryngology, audiology, emergency medicine, neurology, and consumer advocacy.
  • Key Action Statements (KASs) were updated based on new literature and evidence profiles.

Main Results:

  • Strong recommendations include distinguishing sensorineural from conductive hearing loss, educating patients, and counseling on audiologic rehabilitation.
  • Strong recommendations against routine head CT scans and laboratory tests for presumptive SSNHL.
  • Recommendations for prompt audiometry, evaluation for retrocochlear pathology (MRI/ABR), and offering intratympanic steroid therapy for incomplete recovery.

Conclusions:

  • Clinicians should prioritize distinguishing hearing loss types and initiating timely, evidence-based interventions for SSNHL.
  • Routine imaging and lab tests are not recommended; focus should be on audiometry and specific evaluations for retrocochlear pathology.
  • Treatment options like corticosteroids and intratympanic steroids, along with audiologic rehabilitation, are key components of managing SSNHL.