By Dr Annabelle Leong
What do you do if you suddenly discovered you had lost your hearing? Do you need emergency treatment to help you recover your hearing?
If you’re experiencing sudden sensorineural hearing loss, it’s crucial to see an ENT specialist in Singapore as soon as possible to begin treatment. This condition typically occurs when the inner ear—the nerve center for hearing—becomes inflamed. Immediate intervention with high-dose oral steroids is often necessary to maximize the chances of recovery.
Research shows that cases involving partial hearing loss tend to recover more successfully than those with complete or total loss. It’s important not to dismiss this as something minor, like earwax buildup, as sudden hearing loss is a true ENT emergency. I personally encounter 3-4 cases of sudden hearing loss each month, highlighting that it’s more common than many might assume.
Swift action can make all the difference in preserving your hearing.
NARROW WINDOW OF OPPORTUNITY FOR TREATMENT OF SUDDEN HEARING LOSS:
There is a narrow window of opportunity for sudden hearing loss to improve. Studies show that the first 72 hours make up the golden window, i.e. the best time to start treatment to maximise recovery. If the sudden hearing loss has not been treated early enough, then the chances for hearing recovery decrease with time. Many patients also suffer vertigo and dizziness together with the loss of their hearing, because all these symptoms are inner ear-related.
WHAT ARE THE POSSIBLE CAUSES OF SUDDEN HEARING LOSS?
Many cases of sudden hearing loss are idiopathic where we just don’t know the cause. But many are probably also caused by viral infections of the inner ear.
Although sudden hearing loss tends to affect just one ear, it can also rarely affect both ears, which is even more distressing. In patients with both ears affected by sudden sensorineural hearing loss, we suspect an auto-immune cause so we would run some special blood tests to screen for conditions such as lupus and rheumatoid arthritis.
Patients experiencing sudden hearing loss, whether temporary or permanent, should undergo an MRI scan of their inner ears (MRI IAM) to rule out the possibility of an acoustic neuroma—a small, benign tumor that develops on the balance nerve within the inner ear. As this tumor grows, it can place pressure on the nearby hearing nerve, often leading to sudden hearing loss. Early detection through imaging is crucial for accurate diagnosis and effective management.
Sudden hearing loss can sometimes be the first sign of Meniere’s disease, a condition that typically manifests with recurring symptoms such as a sensation of fullness or blockage in the ear, episodes of vertigo and dizziness, tinnitus (ringing or noise in the ear), and a sudden decline in hearing. Meniere’s disease can develop at any age and often arises without clear triggers. However, factors like high salt intake, excessive caffeine consumption, and elevated stress levels are believed to increase the risk.
In the elderly, we worry that sudden hearing loss may be a symptom of stroke or ischaemic event in the brain (due to poor blood supply). Again, the advice is to seek urgent treatment here, including an MRI brain scan.
Some studies suggest a potential link between vaccination and an increased risk of sudden hearing loss, particularly with the Covid vaccine. However, while any vaccine could theoretically pose this risk, the likelihood appears to be similar to the rate of sudden hearing loss associated with viral infections.
What Are the Best Treatments for Sudden Hearing Loss?
A search of the internet will reveal a long list of many medications which have been tried as treatment for sudden hearing loss. This usually means a lot of stuff is just useless for hearing recovery, including aspirin, gingko, blood pressure elevators and so on. However, the one group of medications which does seem to have some benefit is the steroid group.
Steroids are typically prescribed as an oral course of tablets at a dose of approximately 1 mg/kg, with a maximum daily limit of 60 mg to minimize side effects such as hypertension, mood swings, insomnia, acute gastritis, and, in rare cases, steroid-induced psychosis. High doses are usually administered for a few days, followed by a gradual tapering over 1-2 weeks to reduce potential adverse effects.
For individuals with diabetes, oral steroids may not be the ideal choice as they can disrupt blood glucose control. Instead, we recommend intratympanic steroid injections—directly administered to the eardrum—as a safer, targeted local therapy. This approach effectively avoids the systemic side effects associated with oral steroids while delivering precise treatment.
I think it’s all about trying to help you recover your hearing as early and as much as possible, while weighing the risks of oral steroids too in every patient with sudden hearing loss.
Intratympanic steroid injections are often used as a salvage treatment when oral steroids fail to improve hearing recovery. However, many patients opt to begin intratympanic injections simultaneously with their oral steroid regimen. These injections are significantly safer than oral steroids but typically require a series of 3-4 treatments over a period of time. While some ENT specialists administer the injections on alternate days, others may recommend daily sessions, tailoring the approach to the specific needs and preferences of each patient.
CONCLUSION
Sudden hearing loss is a medical emergency that requires urgent attention. Seeking prompt treatment is crucial to maximize your chances of recovering your hearing. If you experience new symptoms such as hearing loss, a blocked ear, dizziness, or tinnitus, don’t ignore them. Tinnitus—often described as a ringing or noise in the ear—can sometimes serve as an early warning sign of impending sudden hearing loss. Act quickly to protect your hearing and overall well-being.
