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Sudden Sensorineural Hearing Loss
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
7 sections · 111 slides
Overview
- Scope of this presentation
- Definition of sudden sensorineural hearing loss
- Incidence of SSNHL
- Functional and psychological burden
Aetiology
- Historical theories of causation
- Yield of the aetiological workup
- Distribution of aetiologies
- Systemic conditions associated with SSNHL
- Sudden sensorineural hearing loss etiologies and risk factors
- Sudden sensorineural hearing loss etiologies and risk factors (continued)
- Two anatomical levels of causation
Cochlear aetiologies
- Viral infection as a proposed mechanism
- Proposed mechanisms of viral cochlear injury
- Limitations of serologic testing
- Seroconversion rates across studies
- COVID-19 and SARS-CoV-2
- COVID-19 vaccination and SSNHL risk
- Bacterial meningitis and hearing loss
- Otitis media and middle ear effusion
- Cochlear blood supply and the vascular theory
- Proposed mechanisms of labyrinthine artery occlusion
- SSNHL and stroke risk
- Neurological features that demand urgent workup
- Autoimmune inner ear disease
- Systemic autoimmune diseases reported with SSNHL
- Bilateral labyrinthitis in Cogan syndrome
- Immunologic findings in inner ear autoimmunity
- Autoimmune serology in SSNHL
- Temporal bone histopathology: vascular evidence
- Temporal bone histopathology: viral evidence
- Experimental and modern histological findings
- Cellular stress pathways and apoptosis
Retrocochlear and other causes
- Cerebellopontine angle tumours
- Enhancing lesion in the left internal auditory canal
- Indications for retrocochlear imaging
- Trauma and perilymphatic fistula
- Meniere disease
- Ototoxicity
- Genetic susceptibility to ototoxic injury
Presentation and evaluation
- Typical presentation
- Accompanying symptoms
- History and otoscopic examination
- Distinguishing sensorineural from conductive loss
- Pure-tone audiogram with air and bone conduction
- Laboratory testing in SSNHL
- Magnetic resonance imaging in SSNHL
- Inner ear signal change in left sudden hearing loss with vertigo
- Three-dimensional FLAIR and prognosis
Treatment
- General approach to treatment
- Natural history and spontaneous recovery
- Prognostic factors for hearing recovery
- Comorbidity and hearing recovery
- Corticosteroids: the evidence base
- Wilson 1980 randomised trial
- Cinamon 2001 randomised trial
- Nosrati-Zarenoe 2012 randomised trial
- Meta-analyses of steroid versus placebo
- Rationale for corticosteroid effect in the cochlea
- Relative actions and dosing equivalencies of corticosteroids
- Bioavailability and cochlear penetration
- High-dose systemic steroid regimens
- Adverse effects of systemic corticosteroids
- Intratympanic versus oral steroid: Rauch 2011
- Guideline position on intratympanic steroids
- Combined systemic and intratympanic therapy
- Magnitude and safety of combined therapy
- Round window membrane structure
- Round window niche obstruction
- Prolonging drug contact with the round window
- Microwick delivery
- Drug distribution within the scala tympani
- Hyperbaric oxygen therapy
- Antiviral therapy
- Vasodilators and haemodilution agents
- 2012 AAO-HNS clinical practice guideline on sudden hearing loss
- 2012 AAO-HNS clinical practice guideline on sudden hearing loss (continued)
Current practice
- Initial assessment in practice
- First-line systemic steroid regimen
- Intratympanic dexamethasone injection technique
- Choosing between the treatment options
- Follow-up and rehabilitation
- Management algorithm for sudden sensorineural hearing loss
- Key points to carry away
- Treatment points to carry away
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- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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