Sudden Hearing Loss and Vestibular Nerve Damage

Sudden sensorineural hearing loss & auditory nerve damage

Dear Dr.
Zheng,
My mother (52 years old) has been diagnosed with sudden sensorineural hearing loss, and I have some questions.
On July 9th, we stayed overnight at Alishan, and the next morning, July 10th, my mother reported experiencing tinnitus.
We thought it was just due to changes in air pressure, so we continued hiking.
Later that evening, we arrived in Tainan, and on July 11th, in the early morning, she suddenly felt extremely dizzy and vomited three times in the bathroom.
We rushed to the emergency room, where the doctor primarily administered IV fluids and medications to alleviate her dizziness and nausea.
Blood tests and a CT scan of her head and neck were performed, and the doctor concluded that everything was normal.

By noon, we hurried back to Hsinchu to see an otolaryngologist, who recommended a hearing test.
The outer and middle ear were found to be normal, with her left ear showing 16 dB (difficulty hearing high frequencies) and her right ear showing 92 dB (complete loss across all frequencies).
The doctor suspected inflammation of the eighth cranial nerve and has prescribed steroids and antiviral medication.
1.
Given that my grandmother has lymphoma, I am concerned that my mother's hearing loss may also be due to lymphatic compression.
Although the CT and blood tests showed no abnormalities, I am still worried.
2.
My mother has often mentioned difficulty hearing me in the past.
I would like to know what the typical hearing levels (in dB) are for sudden sensorineural hearing loss.
I am concerned that she may have had pre-existing hearing issues that went unnoticed, which could have led to missing the critical treatment window, resulting in her recent worsening condition.
3.
Besides regular follow-ups and steroid treatment, are there any other treatment options we could consider? Should we refer her to a neurologist for further evaluation?
4.
How long does it typically take for dizziness to resolve? After recovery, will she need to continue medication to prevent a recurrence of vestibular nerve inflammation?
Thank you for your assistance, Dr.
Zheng.
Sincerely,
Lin
July 12, 2023

Lin, 20~29 year old female. Ask Date: 2023/07/12

Dr. Zheng Jueyi reply Otolaryngology

1.
Sudden sensorineural hearing loss is generally not related to lymphoma.

2.
Sudden sensorineural hearing loss is defined as a hearing loss of more than 30 dB at three consecutive frequencies within three days.
Whether there was a pre-existing hearing impairment that has worsened or if it is a new onset of hearing loss can only be confirmed through a detailed medical history or by comparing with previous audiograms.

3.
If standard treatments are ineffective, intratympanic steroid injections or hyperbaric oxygen therapy may be considered.
Regarding the need for referral to a neurologist, it is recommended to discuss this directly with an otolaryngologist.

4.
The recovery period for dizziness can range from several weeks to months.
Generally, after recovery, there is no need for ongoing medication to prevent recurrence of vestibular neuritis.

Reply Date: 2023/07/12

More Info

Sudden hearing loss (SHL) is a condition that can be alarming and distressing, especially when accompanied by symptoms such as tinnitus (ringing in the ears) and vertigo (dizziness). Your mother's recent diagnosis of SHL, along with the associated symptoms, raises several important considerations regarding her health and potential treatment options.

1. Concern About Lymphoma and Hearing Loss: It is understandable to worry about the possibility of lymphatic pressure affecting your mother's hearing, especially given your family history. However, it is important to note that sudden hearing loss is typically not associated with lymphoma unless there are specific findings indicating a mass effect or other complications. The normal results from the CT scan and blood tests are reassuring. Sudden hearing loss often results from viral infections, autoimmune conditions, or vascular issues rather than direct pressure from lymphatic tumors. It would be prudent to continue monitoring her condition and maintain open communication with her healthcare providers.

2. Understanding the Severity of Sudden Hearing Loss: Sudden hearing loss is defined as a rapid loss of hearing, typically occurring over a period of three days or less, affecting three consecutive frequencies by 30 dB or more. In your mother's case, the right ear's hearing threshold of 92 dB indicates profound hearing loss, while the left ear's 16 dB suggests mild impairment. If she has had difficulty hearing prior to this incident, it is possible that there was a pre-existing condition that has now worsened. Regular hearing assessments and audiograms can help track any changes in her hearing ability over time.

3. Treatment Options Beyond Steroids: The standard treatment for SHL often includes corticosteroids to reduce inflammation and promote recovery. If there is insufficient improvement, other options may include intratympanic steroid injections or hyperbaric oxygen therapy, which some studies suggest may be beneficial in certain cases. Referral to a neurologist may be warranted if there are concerns about the underlying cause of the hearing loss, particularly if there are neurological symptoms or if the hearing loss does not improve with standard treatment.

4. Recovery from Dizziness: The duration of recovery from vertigo can vary widely, ranging from a few weeks to several months, depending on the underlying cause. In many cases, vestibular rehabilitation therapy can be beneficial in helping patients regain balance and reduce dizziness. After recovery, ongoing medication is typically not required unless there are recurrent episodes of vestibular neuritis or other underlying conditions that need to be managed.

In summary, it is crucial to maintain regular follow-ups with her ENT specialist and possibly involve a neurologist if her symptoms persist or worsen. Early intervention is key in managing sudden hearing loss, and while the prognosis can vary, many patients experience significant recovery with appropriate treatment. Encourage your mother to report any new symptoms or changes in her condition promptly, as this can help her healthcare team provide the best possible care.

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