It may begin with a fleeting feeling of blockage or pressure inside the ear, and perhaps sudden tinnitus, leading the sufferer to believe that the cause is merely a buildup of wax, allergy, or congestion. But behind these seemingly simple symptoms, a medical emergency may be hidden, known as sudden sensorineural hearing loss, which often affects one ear.
The causes of about 90% of cases of this disease remain unknown, while estimates indicate that about 66,000 cases are recorded annually in the United States alone.
According to the US National Institute on Deafness and Communication Disorders, the similarity of symptoms to common problems – such as earwax or congestion – may prompt patients, and sometimes doctors, to underestimate the seriousness of the condition, leading to a delay in diagnosis and the start of treatment.
Here lies the danger of sudden hearing loss, as specialists confirm that it is a medical emergency that requires accurate and rapid evaluation, especially during the first seven days, as the chances of regaining hearing for those who receive treatment early increase by about 5 times compared to those who receive it late.
Tinnitus is also a common sign associated with the condition, as it appears in between 80% and 90% of those affected, and it is believed that the brain may try to compensate for the lost auditory signals by generating internal sounds.
To learn more deeply about the nature of the disease, the reasons for considering it a medical emergency, and the importance of early diagnosis and intervention, Al Jazeera Net spoke to Dr. Effat Abdel Fattah, ENT consultant.
Accurate hearing system
Dr. Effat says that the hearing process depends on a very precise system that begins with the outer ear, then passes through the middle ear, and ends with the inner ear and the auditory nerve, which is responsible for transmitting nerve signals to the brain.
Any defect affecting one of the parts of this system may lead to hearing impairment or loss to varying degrees.
Hearing loss is mainly classified into two types: conductive hearing loss and sensorineural hearing loss, and the two types may combine in the patient in what is known as mixed hearing loss.
Conductive hearing loss
Conductive hearing loss occurs as a result of a problem in the outer or middle ear that prevents sound waves from traveling normally to the inner ear.
Among its most prominent reasons:
- Ear canal blockage with wax.
- Middle ear infections.
- Perforated eardrum.
- Hearing ossicle disorders.
Sensorineural hearing loss
Sensorineural hearing loss results from a defect or damage to the tiny auditory cells within the cochlea or the auditory nerve.
This type may be associated with several factors, including aging, chronic exposure to noise, some diseases and genetic factors, in addition to the use of medications that may have harmful effects on hearing.
According to Dr. Effat, this type requires a comprehensive audiological and medical evaluation to determine its degree and the extent of its impact on the person’s ability to communicate, and hearing aids may help in some cases. While cochlear implantation may be an option in other cases, according to the nature of the hearing loss and the patient’s needs.
When does hearing loss become sudden?
Dr. Effat explains that sudden sensorineural hearing loss is classified as a medical emergency, because it results from a rapid decline in the function of the inner ear, especially the cochlea or the auditory pathway, and therefore speedy diagnosis and initiation of treatment are among the most important elements in dealing with it.
It is called “sudden” because it occurs within a very short period of time. The traditional medical definition refers to a sensorineural decrease in hearing of 30 decibels or more across 3 adjacent frequencies over a period of 72 hours or less.
But Dr. Effat stresses that these numbers are used to define the condition medically, and do not mean that the patient must wait 72 hours before seeking help. He says, “If a person notices a clear and sudden loss of hearing, especially in one ear, it is best to see a doctor as soon as possible.”
Does genetics play a role?
Regarding the disease’s connection to genetic factors, Dr. Effat explains that most cases of sudden hearing loss are not considered a direct hereditary disease transmitted from father or mother to children.
There is research examining the possibility of genetic predispositions that make some people more susceptible to infection, but this is different from considering the disease as genetic in itself.
Are cases becoming more widespread?
As for talk about the increasing number of infected people, Dr. Effat warns against asserting that the incidence of the disease has increased without strong and consistent epidemiological data confirming this.
He believes that the noticeable increase in diagnosed cases may partly reflect improved detection and reporting of the disease, as a result of increased awareness, availability of audiometric tests, and ease of access to health care services.
On the other hand, some patients still do not reach a diagnosis in the first place, especially when they believe that what they are suffering from is just wax or a temporary blockage in the ear.
Therefore, an increase in the number of diagnosed cases does not necessarily mean that the incidence of the disease in the community has actually increased.
Possible causes
There is still no single confirmed cause that can explain most cases of sudden sensorineural hearing loss, but doctors put forward a number of possible hypotheses, including:
- Inflammatory or immune mechanisms.
- Disturbances of microcirculation within the cochlea.
- Some viral agents.
However, none of these explanations apply to all patients, and therefore a large percentage of cases are classified as sudden idiopathic sensorineural hearing loss.
Dr. Effat confirms that there is no single virus that can be considered the usual cause of the disease, nor is there a single explanation that applies to all infected people.
He adds that classifying the condition as idiopathic does not mean reducing its seriousness, but rather it means that medicine was unable to prove a single clear cause for the injury in this particular patient.
Therefore, according to Dr. Effat, it is not recommended to perform a random set of viral or immune tests for each patient, but rather the tests should be directed according to the medical history and the results of the clinical examination.
It may affect young and healthy people
It is also a common mistake to believe that sudden hearing loss only affects the elderly or those with chronic diseases.
Dr. Effat confirms that the condition may appear in young people, athletes, and people who are in good health, and it is not necessary for the patient to have diabetes, high blood pressure, or an immune disease.
The appearance of the disease may be very sudden, as the person wakes up in the morning to find that the hearing in one of his ears has become clearly weaker compared to the previous day.
Can it be prevented?
Dr. Effat says that there is still no guaranteed method that can prevent most cases of sudden hearing loss, mainly due to the inability to determine the cause in a large percentage of patients.
But this does not mean neglecting general measures that help protect hearing health, including:
- Maintaining blood vessel health.
- Control diabetes and high blood pressure.
- Avoid smoking.
- Protect the ear from intense noise.
These procedures are important for hearing health and general health, but they do not provide a guarantee that prevents sudden hearing loss. Therefore, the most important measure when symptoms appear is not to delay diagnosis.
Corticosteroids are at the forefront of treatment
Regarding the currently available treatment options, Dr. Effat explains that corticosteroids represent the basic treatment that the doctor discusses with the patient, and can be used as a primary treatment during the first two weeks from the onset of sudden hearing loss, after evaluating the condition and ruling out causes that require a different treatment.
If sufficient improvement is not achieved, corticosteroid injection into the middle ear represents an important option as a rescue treatment, and guidelines usually recommend offering this option within a period ranging between 2 and 6 weeks from the onset of symptoms.
Hyperbaric oxygen therapy can also be used in some patients in addition to cortisone, either in the early stage or as a rescue treatment in some cases.
But Dr. Effat stresses that hyperbaric oxygen is not a “magic treatment” and does not guarantee the restoration of hearing in all patients.
At the same time, modern research is moving towards developing more efficient means of delivering drugs to the cochlea and keeping them there for longer periods, in addition to studying regenerative and gene therapies and treatments that target inflammatory and vascular mechanisms.
There are promising preliminary results for some new drug formulations, but Dr. Effat stresses the need to differentiate between a treatment that is still promising and under research and a treatment that has already become a proven medical standard.
He also points out that some medications may sometimes be used routinely, such as antivirals or vasodilators. Current guidelines do not recommend their routine use to treat sudden sensorineural hearing loss.
Not just wax
At the conclusion of his speech, Dr. Effat stresses that the most important message to the patient is not to ignore any sudden decline in hearing, especially if it occurs in one ear, and not to assume that the cause is just wax or a temporary blockage.
It is recommended to conduct a hearing examination and see an ear, nose, and throat doctor as soon as possible, instead of waiting a week or two to see if the problem will disappear on its own.
Although hearing restoration is not guaranteed in all cases, early diagnosis and intervention give the patient the best possible chance of improving hearing.
Dr. Effat says that sudden hearing loss in one ear requires urgent evaluation, and that early diagnosis and appropriate treatment can make a fundamental difference in quality of life and ability to communicate.
Tinnitus is a burden that goes beyond the ear
The repercussions of hearing disorders and tinnitus are not limited to the ability to hear sounds, as tinnitus is linked to high rates of a number of psychological and social problems, including:
- Depression.
- Psychological pressures.
- Social isolation.
- Suicidal thoughts in some patients.
Although there is no definitive cure for tinnitus yet, a number of interventions may help patients reduce its impact and improve their ability to live with it, including cognitive behavioral therapy (CBT), tinnitus retraining, sound therapy, and hearing aids, in addition to modern therapeutic techniques that are still under development.