Hearing loss is a very common condition (2), usually unilateral (3), and without a recognizable trigger (4). The degrees of severity range from a slight hearing loss (9) to complete deafness (5). A real acute hearing loss starts in the inner ear, (10) but a sudden hearing loss can also occur in other ways (7). In some patients, the hearing loss is completely restored (8). In others, it remains for life (6).
Here you can read all the important information on the topic: What are the symptoms of sudden deafness? What to do about abrupt hearing loss? How long does sudden deafness last?
- What is hearing loss? A sudden, usually unilateral loss of the abilities for hearing with no recognizable trigger. It is a form of sensorineural hearing loss.
- Symptoms: reduced hearing or complete deafness in the affected ear, tinnitus, feeling of pressure or cotton wool in the ear, dizziness, furry feeling around the auricle, possibly hypersensitivity to sound, etc.
- Causes & risk factors: The exact causes of acute hearing loss are unknown. However, various triggers and risk factors are suspected, such as inflammation or circulatory problems in the inner ear, autoimmune diseases, obesity, diabetes mellitus, high blood pressure, smoking, stress, mental stress.
- Treatment: mainly with cortisone (preferably as tablet or infusion, sometimes also as an injection into the ear). In individual cases, other procedures may be considered, such as hyperbaric oxygen therapy. In the case of a mild hearing loss, treatment is often not necessary at all.
- Prognosis: Favourable if the hearing loss is only mild or only affects the low or medium frequencies. The prognosis worsens as the hearing loss progresses. Unfavorable prognosis if the sudden deafness is accompanied by severe hearing loss from the outset and/or is accompanied by balance problems.
Symptoms Of Hearing Loss
Hearing loss (acute hearing loss, ear infarction) is defined as a sudden reduction or even complete loss of hearing without any recognizable cause. In most cases, a sudden hearing loss only occurs on one side. Sometimes, however, both ears are affected.
The real acute hearing loss is a form of sensorineural hearing loss. In the cochlea of the inner ear, the sound waves that are transmitted and amplified via the middle ear are converted into electrical nerve signals. From there, they travel to the brain and thus to consciousness. In the event of a hearing loss, the signal conversion in the cochlea is disturbed.
In principle, sudden deafness can occur at any age and in both sexes. However, it is very rare in children. The age of most of those affected is around 50. One in eight people in the United States(13 percent, or 30 million) aged 12 years or older has hearing loss in both ears, based on standard hearing examinations. About 2 percent of adults aged 45 to 54 have disabling hearing loss. The rate increases to 8.5 percent for adults aged 55 to 64 (1)
Forms of acute hearing loss
Hearing loss can be categorized according to severity: A mild acute hearing loss causes only a mild hearing loss, whereas severe forms on the affected side can lead to hearing loss and even deafness.
On the other hand, cases of sudden deafness can be classified according to the frequency range affected: In the cochlea, different sections are responsible for different frequencies during signal conversion. Low, medium, or high sounds are therefore each converted in separate sections of the cochlea. If only a single one of these areas is affected in a sudden hearing loss, this can lead to the following forms of the disease:
- Tweeter hearing loss
- Mid-range hearing loss
- Low-frequency hearing loss
However, acute hearing loss is not always present in such an isolated form. Several frequency ranges can also be affected. If the conversion is disturbed in all frequency ranges, one speaks of pantonal sudden deafness.
Symptoms Of Hearing Loss
The typical sign of sudden hearing loss is the sudden and painless hearing loss described above. Depending on the form and severity of the disease, the patient may perceive certain pitches with the affected ear less well or not at all. Often, however, other symptoms accompany this condition, such as
- Tinnitus (ringing in the ears)
- The feeling of pressure or cotton wool in the ear
- furry feeling around the auricle (periaural dysesthesia)
Sometimes, after the appearance of this condition, the hearing ability is not (only) reduced, but (additionally) disturbed in some other way. For example, some patients experience sounds and noises on the affected side as excessively loud. This hypersensitivity to sound is called hyperacusis. Other patients report an altered perception of sound (dysacusis). Sometimes sounds are also perceived lower or higher on the affected side than on the healthy side (diploacusis).
A mild hearing loss is sometimes not even noticed by those affected. It is then often only noticed in the course of certain hearing tests. If its symptoms are severe, however, the quality of life can be considerably impaired.
Hearing Loss Consideration As An Emergency
This condition is not considered an emergency that requires immediate medical attention. How urgent a visit to the doctor is, depends on its severity, any accompanying symptoms, and previous illnesses as well as the individual suffering of the patient. In most cases, this condition can be treated on an outpatient basis. Only in severe cases or when the disease is progressing should patients be admitted to hospital as inpatients.
Causes And Risk Factors Of Hearing Loss
So far, the causes of the appearance of this condition, remain unbeknownst. However, experts suspect that the following factors could trigger it:
- Circulatory disorders of the cochlea
- Malfunction of certain cells in the cochlea
- Inflammation of the inner ear
- Autoimmune diseases
- Endolymphatic hydrops (pathological increase of a certain fluid in the inner ear)
The endolymphatic hydrops is not considered a real hearing loss by many ENT specialists. It is caused by a congestion of the natural inner ear fluid and usually affects the low sound frequencies in isolation. As a rule, it usually resolves spontaneously within a short period of time, so no special treatment is required.
In addition to the factors mentioned, obesity, diabetes mellitus, high blood pressure, and smoking are discussed as risk factors. In addition to these physical triggers, psychological factors also seem to play a role in its appearance: stress and mental strain could, therefore, be possible causes thereof.
Other causes of acute hearing loss
When the hearing ability is acutely reduced, there is not always a real existence of this disease behind it. It can also have the following reasons:
- Foreign bodies, or water in the ear
- Displacement of the external auditory canal or eardrum by “earwax” (cerumen)
- Injuries to the eardrum or the ossicles in the middle ear
- Fluid accumulation, bleeding or suppuration in the middle ear
- A pressure difference between the middle ear and the external auditory canal is not equalized (lack of pressure equalization, for example in an airplane)
Diagnosis And Examinations
If someone is showing possible signs of this condition in an acute way, a visit to a doctor is advisable: a specialist can determine the extent and nature of it and rule out other possible causes for its appearance.
To do this, the doctor will first have a detailed conversation with the patient in order to establish his or her medical history (anamnesis). He will ask, for example, when the condition started to appear, whether the patient suspects a particular trigger, and whether he is taking any medication. The doctor will also ask about any accompanying symptoms (dizziness, a feeling of pressure in the ear, etc.) and previous illnesses.
This is followed by a general ear, nose, and throat examination (ENT medical examination). By means of otoscopy (ear microscopy), the doctor can look into the ear canal and eardrum and examine them for possible damage. A hearing examination is also important:
In the Weber experiment, the doctor strikes a tuning fork and places it on the patient’s crown. The patient should now indicate on which side he hears the sound of the vibrating tuning fork louder.
In the hearing test using sound audiometry, the ENT physician plays sounds in different frequencies to the patient (via loudspeaker or headphones). Then the volume is gradually reduced until the patient can just hear the tone in question (“hearing threshold”). In this way it is possible to determine which frequency range the condition affects and how pronounced it is.
In the so-called tympanometry, a special probe is inserted into the external auditory canal to check the function of the middle ear. In addition, routine examinations for (suspected) acute hearing loss include a test of the sense of balance and a blood pressure measurement.
Further examinations in individual cases
In individual cases, further examinations may be useful to clarify this disease. Some examples: By measuring the otoacoustic emissions (OAE), the function of the inner ear can be tested. If the physician suspects that the hearing loss is not caused by sudden deafness but by certain infections (Lyme disease, cytomegaly, HIV etc.), appropriate blood tests will provide clarity. In order to exclude a certain tumor in the brain (cerebellar bridge angle tumor) as the cause of the hearing problems, a magnetic resonance imaging (MRI) may be necessary.
Since the actual causes of this condition are not known, there is no causal therapy for it. However, there are some treatment options that are known to have certain effects in the treatment of acute cases (medication with prednisolone or other “cortisones”). In addition, there are other procedures, but their effectiveness is controversial among experts.
Tip: Every patient should seek advice from his treating physician about the various possibilities and risks of treatment. Together they should then decide which therapy seems to be the most promising in the case at hand.
Treatment – yes or no?
A mild hearing loss that hardly affects the patient does not necessarily have to be treated. Sometimes, one waits a few days and these symptoms can spontaneously disappear on its own. I had these symptoms myself by May 2020 and it disappeared alone. However, it is not possible to predict in individual cases whether and when this will happen.
Immediate treatment is recommended for severe hearing loss, damaged ears, or additional dizziness.
Cortisone In The Treatment
High-dose glucocorticoids (“cortisone”), such as prednisolone, are primarily recommended for the treatments of acute cases: The active ingredients are usually administered as tablets or infusions, over several days at a dosage of 250 milligrams per day. Because drugs can be effective throughout the body when administered as tablets or infusions, this is called systemic therapy. It can cause side effects in different parts of the body, such as elevated blood sugar levels.
If the systemic cortisone therapy does not help sufficiently, the doctor can also inject the cortisone directly into the ear (intratympanic application). In this case, the drug develops its effect practically only locally, which avoids systemic side effects. However, intratympanic cortisone application can result in pain, dizziness, an injury to the eardrum (perforation of the eardrum), or inflammation of the middle ear.
The effectiveness of glucocorticoids in acute cases could be based on the anti-inflammatory and decongestant properties of the drugs, experts suspect.
Other treatments available
Sometimes, in acute cases, drugs that dilate the blood vessels (vasodilators) or improve the flow properties of the blood (rheologics) are recommended. Due to the lack of proof of efficacy and the possible side effects, however, such preparations are not (or no longer) recommended by the professional societies for the treatment of this condition.
The same applies to antiviral drugs such as acyclovir, which are also sometimes used to treat it. No benefit of this treatment has been found in studies so far.
Hyperbaric oxygen therapy is another treatment method that some doctors believe can help in cases of the acute disease: Patients must enter a special pressure chamber where they inhale pure oxygen. This is supposed to improve hearing. The effectiveness of this treatment is controversial.
Usage Of Headphones And Speakers
If you use speakers, set the volume quite low. A child can be very sensitive to very high volumes in speakers. Nowadays, there are HiFi devices such as the wireless speakers Devialet that can output a very high level of decibels in a small size. Preferably, use headphones to isolate the sound instead of utilizing speakers and drown the environment with a very high volume.
Rest and stop smoking
In general, experts recommend plenty of rest after the appearance of this disease. Apparently, stress plays an important role in its development. That is why patients are usually put on sick leave by their doctor for some time.
In addition to recovery, complete abstinence from nicotine is also very advisable in the event of this condition.
Prognosis And Course Of The Disease
The course and prognosis of this condition depend strongly on how severe it presents itself is at the beginning, whether it progresses and in which frequency range it occurs:
- The best prognosis is a sudden loss of hearing that only affects the low or medium frequency range or is only associated with a slight presence of the disease.
- If it progresses further, the prognosis worsens.
- In general, the prognosis is poor if the sudden hearing loss causes deafness from the outset. However, there are also cases in which a severe condition is completely cured by treatment.
- The prognosis is usually unfavorable even in patients in whom the condition is accompanied by balance disorders.
It is not possible to predict how this disease will develop in individual cases. Nor is it possible to estimate the duration of it. In principle, a mild condition, in particular, can heal spontaneously after a few days. A severe one, on the other hand, is often followed by long-lasting or even lifelong hearing problems.
Risk of relapse
Patients have an approximately 30 percent risk of suffering once again this condition sooner or later (relapse). People with existing risk factors such as high blood pressure or persistent stress are particularly at risk. In addition, especially patients with this disease in the low or medium frequency range tend to relapse.