Now hear this: Don’t ignore sudden hearing loss

You have a brief window to seek treatment.

Everyone's hearing naturally declines with age, and people often have one ear that hears better than the other. But if hearing loss appears suddenly in one ear for no apparent reason, you may have experienced sudden sensorineural hearing loss, or SHL, a kind of nerve deafness.

There are about 66,000 new cases of SHL per year in the United States, according to research in the August 2019 issue of Otolaryngology — Head and Neck Surgery. But these numbers are hard to come by, since the condition may be underdiagnosed.

"The main reason is that people don't view it as a serious problem and don't get the medical care they need. This delay increases the risk of permanent hearing loss," says Dr. Steven Rauch, an Ear, Nose and Throat specialist with Harvard-affiliated Massachusetts Eye and Ear.

Unknown causes

It is not known what causes SHL, but experts point to several possible reasons: a viral infection, an immune system malfunction, an inflammatory injury to the ear, or blocked blood flow to the ear — or even some combination of these.

SHL can affect people of all ages, although it tends to occur most in the 50s and 60s. It usually strikes one ear. You may hear a "pop" or feel like your ear is clogged. "Your hearing often does not go away all at once, either," says Dr. Rauch. "It is a gradual decline over several minutes or even hours, like air leaking from a tire."

Besides hearing problems, SHL can affect your balance, which increases your risk of falls. SHL also could be a sign of a small stoke or tumor. SHL gets ignored because the symptoms feel familiar, like a head cold or earwax or water in the ear. People try to treat it with cold or sinus medicine, swimmer's ear drops, or cleaning their ears. "They think it's just an annoying stuffy ear that will go away, so they put it on the back burner until it's too late," says Dr. Rauch.

SHL or just a stuffy ear? Humming can tell

How can you know the difference between a regular stuffy ear and sudden hearing loss? Try this test:

Hum aloud to yourself. With normal hearing, you hear the sound equally in both ears. If you do this when you have a new loss of hearing in one ear, the humming will shift to one side or the other.

For example, if your right ear is affected and the hum is louder in that ear, then the hearing loss is more likely a conductive loss, and probably due to blockage from a cold or built-up ear wax. (You can simulate this effect by humming while you cover your right ear.)

However, if the humming is louder in the left ear, it suggests the right ear hearing loss is due to recent nerve damage, and that requires prompt medical attention.

Treatment and duration

But time is of the essence to save your hearing. "You have about a 10- to 14-day window to treat SHL; otherwise the hearing loss becomes permanent," says Dr. Rauch. "So make sure to see your doctor, or get a referral to visit an ear, nose, and throat specialist if your hearing goes away for longer than a day."

However, even with timely treatment, you may not regain your full hearing. "In most cases, mild SHL may recover, but people with moderate or severe hearing loss make a total recovery only in about 20% of cases, even with prompt treatment," says Dr. Rauch.

SHL is treated with corticosteroids over a two- to three-week period. You can take the drugs orally or via an injection through the eardrum. Corticosteroid pills, such as prednisone, are taken at the same dose every day for 14 days, and then the dose tapers off for the final week. Alternatively, ear injections are given twice a week for two weeks.

Oral steroids are more comfortable to take but can have side effects like an upset stomach, higher blood pressure, mood swings, and insomnia. Injections generally have no systemic side effects, but they can be uncomfortable, and people have to visit their doctor to get them. Some doctors recommend both oral and injected steroids in hopes of increasing the recovery rate.

"Remember that if you are used to normal hearing and it suddenly blocks up, that is never okay," says Dr. Rauch. "The sooner you get it checked out, the better. If it is SHL, every day you delay reduces your chance of recovery."

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