Updates on methods to treat sudden hearing loss

Sudden sensorineural hearing loss (SSNHL) is a devastating problem that affects 15,000 people annually worldwide. Controversies remain regarding causation and treatment since 32% to 70% of patients recover hearing spontaneously; a recurrence rate of up to 28% exists regardless of treatment. All patients, whether they recover hearing or not, must undergo retrocochlear workup, as up to 4% of patients with SSNHL will be found to have a vestibular schwannoma. The current 'gold standard' of treatment for SSNHL is systemic steroid therapy in the dosage equivalent to prednisone 1 mg per kg per day for 7 to 10 days. Other treatments have been advocated but not been proven effective. Intratympanic application of steroids is a relatively new modality that shows promise for targeted, effective therapy while avoiding systemic steroid side effects. This treatment and its techniques are described in detail. SSNHL is an otologic emergency. Important prognostic factors are: severity and pattern of hearing loss, presence of vertigo, age of patient, time after onset, and elevated erythrocyte sedimentation rate (ESR). Audiometric monitoring is essential.