Treatment for Sudden Hearing Loss - Medical Experts

Sudden sensorineural hearing loss is a sudden onset of inner ear hearing loss that typically begins on one side. Sound waves are no longer processed correctly in the inner ear. If no identifiable cause is found during the investigation, the diagnosis is idiopathic sudden hearing loss. Not every case of acute hearing loss is therefore sudden hearing loss.

Accompanying ear noises such as tinnitus may occur; however, the sudden loss of hearing remains the defining feature. If ear noises are present without hearing loss, another ear disorder may be the cause. The exact cause of sudden sensorineural hearing loss is unknown. Stress and infections are neither proven triggers nor established risk factors.

• Mild hearing loss: If the condition is mild, it may be advisable to wait a few days, subject to a doctor’s assessment.
• Severe hearing loss: An examination and the start of treatment are recommended within 1 to 2 days.
• Other ear conditions: In such cases, too, an assessment should be carried out within 1 to 2 days.
• Severe vertigo: When accompanied by hearing loss, it requires medical attention on the same day.

A feeling of pressure, earache or numbness on their own do not indicate what is happening in the affected ear. ENT diagnostics, an examination of the external auditory canal and a hearing test are crucial. This allows an assessment to be made as to whether there is an identifiable cause for the symptoms.

The chances of recovery can only be attributed to a limited extent to treatment. In an estimated 32 to 65 out of every 100 people affected, sudden hearing loss resolves even without medical treatment. The prognosis is more favourable in cases of mild hearing loss in the low or mid-frequency ranges and where there is no dizziness.

It is not known with any certainty how many people cortisone actually helps to improve their hearing. In a randomised trial, high-dose systemic glucocorticoids were no more effective than a lower-dose treatment regimen, but caused more side effects.

If the initial treatment has not been sufficiently effective, injections into the middle ear may possibly improve hearing slightly. The evidence for this is inconclusive. Nor is there any reliable evidence to suggest that a combination of tablets and injections offers an advantage over systemic therapy alone.

No special preparation is required for the ear examination. It is helpful to provide a detailed medical history, i.e. a discussion with the doctor about the onset and progression of your symptoms. You should be able to describe how long you have had the hearing loss and whether there might be an external trigger.

• Pre-existing conditions: Please list any existing health problems.
• Medicines: Please list all medicines you take regularly.
• Onset of symptoms: Describe as precisely as possible when the hearing loss began.
• Accompanying symptoms: Report any tinnitus, dizziness or other abnormalities.

Before prescribing cortisone tablets, the doctor must be informed about any other medicines you are taking, as interactions are possible. An ENT examination, including a hearing test, carried out before any treatment is attempted, will reveal the severity of the hearing loss and whether there is another underlying cause.

A key part of the assessment is pure-tone audiometry. This hearing test shows which frequency ranges are affected and the severity of the inner ear disorder. It helps to distinguish sudden hearing loss from other forms of hearing loss.

Cortisone is usually administered as a tablet. An intravenous drip is rarely used. If tablets do not provide sufficient relief or cause severe side effects, the doctor may inject the active ingredient directly into the middle ear.

1. First, the doctor examines the ear and assesses hearing ability.
2. The tablets are taken for a few days. If there is insufficient improvement, the course of treatment may be extended.
3. For an injection into the ear, a local anaesthetic is administered. The doctor then inserts a fine needle through the eardrum.
4. The injection takes just a few seconds and is repeated around 4 to 6 times at intervals of a few days.

The treatment can often be carried out on an outpatient basis. Hospitalisation may be considered, for example, in cases of very severe hearing loss or if outpatient treatment proves ineffective.

With tablets, side effects can occur throughout the body. These include elevated blood sugar levels, sleep disturbances and mood swings. It is not known for certain how frequently these symptoms occur specifically during treatment for sudden hearing loss.

Temporary dizziness may occur during an injection into the ear. In one study, 33 patients reported this, corresponding to around 11 per cent of the group receiving an injection into the middle ear alongside additional systemic treatment.

The hole in the eardrum caused by the needle usually heals itself. Very rarely, it remains open. If this happens, it can impair hearing or increase the risk of infection.

After an injection into the middle ear, patients should lie on the untreated side for about 20 minutes. This ensures that the medication remains in the treated ear.

Subsequent hearing tests will show whether hearing has improved and, if so, in which frequency ranges. Subjective perception alone is not sufficient for this, as changes may be noticeable to varying degrees depending on the pitch of the sound.

If permanent hearing loss remains, a hearing aid may help. In the event of almost complete deafness, a cochlear implant may be an option. This implant is not intended for acute treatment, but rather to manage severe, permanent hearing loss.

Several treatment options are offered as alternatives or complementary measures. For some, no benefit has been proven; for others, the effectiveness has not been sufficiently researched.

Statutory health insurance covers the assessment of sudden hearing loss. However, glucocorticoid therapy for idiopathic sudden hearing loss – whether in tablet form, as an infusion or as an injection into the ear – is generally not covered.

A single glucocorticoid infusion usually costs self-paying patients around 10 to 40 euros. This amount applies only to one infusion and cannot be applied to the more commonly used tablets or the injection into the ear.

Those with statutory health insurance should receive a written cost estimate before undergoing any treatment they have to pay for themselves. They must also give their written consent to the treatment at their own expense. This should clearly list the planned individual services and the total costs.

For those with private health insurance, reimbursement depends on the terms of the individual policy. Privately insured patients should submit the cost estimate before treatment begins and clarify whether the costs will be covered.

The diagnosis and management of sudden hearing loss fall within the field of ear, nose and throat (ENT) medicine. Specialist training to become an ENT doctor includes hearing tests and intratympanic therapy, i.e. the administration of medication through the eardrum.

Before recommending a course of treatment, the practice should examine the ear and test hearing. Pure-tone audiometry must identify which frequencies are affected and how severe the hearing loss is.

These questions may be helpful during the initial consultation:

• What is a realistic outcome that the proposed treatment can achieve in my case?
• What are the reasons for choosing tablets or an injection into the ear?
• What alternatives are there, and how well-established is their effectiveness?
• What total costs am I likely to have to cover myself?

You can find specialists in sudden hearing loss treatment at the end of this text.