The Difference Between Sudden Idiopathic Hearing Loss and Otitis Media

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When a patient calls with the complaint of sudden hearing loss, how is your staff trained to handle these patients? Do they offer the next available appointment, or is the patient squeezed into your schedule?

Winter is the season in which we most often see sudden, idiopathic hearing loss. A patient that calls with the complaint of a sudden hearing loss should be considered medically urgent — a same-day emergency.

Two types of sudden hearing loss

There are two primary types of sudden hearing loss: conductive hearing loss and sensorineural hearing loss (SNHL). The general practitioner might confuse a sudden conductive hearing loss with a sudden SNHL since some of the complaints may be the same.

However, each hearing loss manifests quite differently. The most common cause of a sudden conductive hearing loss is a head cold. This type of sudden loss is most often bilateral, and the patient may complain that their ears feel plugged. Sudden conductive hearing loss may take one to two days to occur.

Sudden SNHL is most often unilateral and can occur within minutes or an hour. In many cases, the patient notices the hearing loss each morning upon waking. Often these patients are treated as if they have fluid in the middle ear, and no diagnostic testing is done for weeks or even months, which then significantly reduces the chance of any recovery.

Quick diagnosis and treatment are keys to recovery

Studies confirm that the sooner a patient is seen and therapy initiated for sudden SNHL, the better the recovery. If a patient is treated within the first seven days, the chance of recovery is 56%; if treated 30 or more days later, the chance of recovery drops to 27%. If treated within 72 hours, the prognosis improves even more. Idiopathic sudden SNHL has an estimated incidence of between 5 and 20 per 100,000 persons per year, with higher rates for those between 50 and 60 years old.

If sudden SNHL is suspected, the patient should be referred for an immediate audiological evaluation, and it may be warranted to start them on medication at this initial appointment. The current standard treatment for idiopathic sudden SNHL hearing loss is a course of oral corticosteroid (prednisone or methylprednisolone).

The audiogram is the diagnostic foundation and provides prognostic information. Serial testing provides documentation of the progression or resolution of the hearing loss and response to treatment. Studies show that patients with profound hearing loss have significantly decreased recovery rates compared to all other groups (22% with complete recovery). Other studies have shown that patients with mid-frequency hearing loss, particularly when hearing at 4000 Hz is worse than 8000 Hz, have an excellent prognosis.

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