Clinicians assessing sudden hearing loss should distinguish sensorineural hearing loss from conductive hearing loss when a patient first presents with symptoms, according to an updated clinical practice guideline.
The update from the American Academy of Otolaryngology–Head and Neck Surgery also clarifies terminology, changing the term sudden sensorineural hearing loss to mean idiopathic sudden sensorineural hearing loss to emphasize that more than 90% of sudden sensorineural hearing loss is idiopathic, and to avoid confusion. The updated guideline was published Aug. 1 by Otolaryngology–Head and Neck Surgery.
The guideline update group made strong recommendations that differed from the initial clinical practice guideline for clarity and timing of intervention. In addition to assessing hearing loss at first presentation, clinicians should educate patients with sudden sensorineural hearing loss about the natural history of the condition, benefits and risks of medical interventions, and limitations of evidence about efficacy. Patients who have residual hearing loss and/or tinnitus should be counseled about possible benefits of audiological rehabilitation and other measures.
The guideline update group made strong recommendations against head CT and routine lab testing in the initial evaluation of a patient with presumptive sudden sensorineural hearing loss. They also strongly recommend against routinely prescribing antivirals, thrombolytics, vasodilators, or vasoactive substances to patients with sudden sensorineural hearing loss.
Other changed recommendations include the following:
- Clinicians should assess patients with presumptive sudden sensorineural hearing loss through history and physical examination for bilateral loss, recurrent episodes, and/or focal neurologic findings.
- Clinicians should obtain audiometry within 14 days of symptom onset to confirm the diagnosis.
- Clinicians should evaluate patients for retrocochlear pathology by obtaining an MRI or auditory brainstem response.
- Clinicians should offer intratympanic steroid therapy when patients have incomplete recovery from sudden sensorineural hearing loss two to six weeks after onset of symptoms.
- Clinicians should obtain follow-up audiometric evaluation for patients at the conclusion of treatment and within six months of completion of treatment.
The guideline update group also said that clinicians may offer corticosteroids as initial therapy to patients with sudden sensorineural hearing loss within two weeks of symptoms. Hyperbaric oxygen therapy may be combined with steroids within two weeks, or as salvage therapy within one month of onset.
“The incidence of this symptom [sudden hearing loss], the debilitating consequences of missed early diagnosis and management, the presentation of the patient to a variety of health care providers, the abundance of small series and case reports regarding treatment, and the paucity of randomized controlled trials (RCTs) assessing interventions created a pressing need for the original evidence-based guideline to aid clinicians in managing SSNHL [sudden sensorineural hearing loss] in 2012 and for this update now,” the guideline stated.