Sudden hearing loss: Do You Need Urgent Treatment?

If you are suffering from sudden hearing loss, you should definitely see your ENT specialist in Singapore as soon as possible!

Early treatment means starting high dose oral steroids as early as possible, to help you recover your hearing. I see about 3-4 cases of sudden hearing loss every month and such patients are naturally very distressed about their sudden hearing loss. The concern is what happens if they don’t get their hearing back! In sudden hearing loss, the inner ear nerve centre has become inflamed. Early treatment with steroids is indicated to treat the inflammation promptly.

WHEN DO YOU NEED TO START TREATMENT OF SUDDEN HEARING LOSS?

Sudden hearing loss should be treated within the first 72 hours if possible. This golden window of opportunity is the best time to start treatment to maximise recovery of your hearing loss.  The chances for hearing to recover sadly reduce with time. The peak time for hearing recovery in sudden hearing loss is within the first 2 weeks after it has occurred. Tinnitus (inner ear noise), vertigo and dizziness are common partner symptoms of sudden hearing loss.

WHY DID YOU SUFFER SUDDEN HEARING LOSS?

Many cases of sudden hearing loss are unknown. But many are probably also caused by viral infections of the inner ear, after influenza or Covid infections.

Rarely, sudden hearing loss can affect patients in both ears! In such unusual cases, we usually suspect an auto-immune cause such as lupus and rheumatoid arthritis. Pregnant women also appear to carry a higher risk of sudden hearing loss, likely due to hormonal changes. Some patients also have other medical problems such as diabetes, high cholesterol and hypertension. Such health conditions may affect the delicate inner ear blood supply.

All patient with sudden hearing loss should be screened with an MRI scan of their inner ears to rule out the presence of a small inner ear tumour, called an acoustic neuroma. An acoustic neuroma is a benign nerve tumours arising from the balance nerve in the inner ear. As it grows bigger, it begins to exert pressure on its delicate neighbour, the hearing nerve, resulting in sudden hearing loss.

We should remember that occasionally, sudden hearing loss may be the first presentation of Meniere’s disease. This interesting condition typically presents with recurrent episodes of blocked ear, vertigo and dizziness, tinnitus (inner ear noise) and sudden hearing loss. Some patients have a family history of Meniere’s disease. High levels of salt, caffeine and stress are also recognised as triggers of attacks of Meniere’s disease.

What about vaccination leading to sudden hearing loss? The evidence remains unclear but some studies have suggested that vaccination carries a slightly higher risk of suffering sudden hearing loss, particularly the Covid vaccine. Whether this risk of sudden hearing loss after vaccination is any higher than that due to viral infection itself, remains to be seen.

HOW CAN WE TREAT SUDDEN HEARING LOSS?

Doctors have tried all sorts of medications for many years to help hearing recovery after sudden hearing loss. Guess what? None have been proven to work with strong evidence base. However, steroids possess the strongest evidence for increasing the chances of hearing recovery. Steroids may be given as oral tablets or as intratympanic eardrum injections under local anaesthesia.

We usually prescribe the high dose steroids for a week then taper down gradually over the next 1-2 weeks. I would not go higher than 60 mg daily for very long because steroids may lead to elevated blood sugar levels, high blood pressure, fluid retention, mood swings, insomnia, acute gastritis.

WHAT ABOUT INTRATYMPANIC STEROID INJECTIONS FOR SUDDEN HEARING LOSS?

If you are diabetic, then oral steroids aren’t the best option. Oral steroids will increase your blood sugar to sudden sharp spikes with difficulty maintaining blood glucose control. A course of intratympanic steroid injections into your eardrum may be more appropriate as targeted therapy into your inner ear. Intratympanic steroid injections are quite safe, without any systemic side effects.

Although intratympanic steroid injections may be offered as salvage therapy after oral steroids have failed, many patients would start intratympanic steroid injections straight away. Yes, simultaneously as their oral steroids! Why would they start both oral and intratympanic steroids at the same time? Well, I suspect most people would really try everything they could as early as possible just to get their hearing back! I would do the same thing too if I were in their shoes. Intratympanic steroid injections are much safer than oral steroids, but you do need at least 3-4 injections over a period of time, usually given on alternate days.

In Singapore, intratympanic steroids injections are Medisave claimable as”day surgery” procedures and usually covered by insurance.

CONCLUSION

So I hope you have understood why sudden hearing loss needs to be urgently treated: All we want to do is to allow you the best chance of recovering your hearing. Please don’t ignore any new symptoms of hearing loss, blocked ear, dizziness or tinnitus. Seek help from your friendly ENT specialist in Singapore early!

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