Always exclude conductive hearing loss in patients presenting with new sudden hearing loss

Conductive hearing loss must be ruled out when evaluating for sudden sensorineural hearing loss (SSNHL) in patients who present with new hearing loss. Patients with idiopathic sudden SSNHL (SSNHL with no identifiable cause despite adequate investigation) must be distinguished from those with nonidiopathic SSNHL. These recommendations are a part of the updated clinical practice guidelines for sudden hearing loss, published August 1 in the journal Otolaryngology–Head and Neck Surgery.

The key action statements as per the guideline are as follows:

  • When a patient first presents with sudden hearing loss, conductive hearing loss should be distinguished from sensorineural.
  • Patients with presumptive SSNHL should be examined for bilateral SHL, recurrent episodes of SHL, and/or focal neurologic findings through history and physical examination.
  • Clinicians should not order routine CT scan of the head or routine laboratory tests in the initial evaluation of a patient with presumptive SSNHL.
  • In patients with SHL, audiometry should be done as soon as possible and within 14 days of symptom onset.
  • An MRI or auditory brainstem response (ABR) are recommended to evaluate patients with SSNHL for retrocochlear pathology.
  • Patients should be educated about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy.
  • Corticosteroids may be offered as initial therapy to patients with SSNHL within 2 weeks of symptom onset.
  • Hyperbaric oxygen therapy may be used as initial treatment in combination with steroids within 2 weeks of onset of SSNHL; as salvage therapy, hyperbaric oxygen therapy may be given along with steroids within 2 weeks of onset of SSNHL.
  • Intratympanic steroid therapy for salvage is recommended when patients have incomplete recovery from SSNHL 2 to 6 weeks after onset of symptoms.
  • Do not prescribe antivirals, thrombolytics, vasodilators, or vasoactive substances to patients with SSNHL.
  • Follow-up audiometric should be done at the end of treatment and within 6 months of completion of treatment.
  • Patients who have residual hearing loss and/or tinnitus should be counselled about the possible benefits of audiologic rehabilitation and other supportive measures

(Source: Otolaryngol Head and Neck Surg. Published online August 1, 2019)

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