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Sudden sensorineural deafness is an otological emergency that requires immediate attention.
Presentation:
Sudden loss of hearing
Possible tinnitus
Note: although hearing loss may occur with wax impaction, it can be distinguished from sudden deafness as it rarely leads to complete deafness.
Causes:
Unknown
Possibilities:
- Vascular occlusion
- Viral infection
- Acoustic neuroma
Examination findings:
tuning form tests suggest dead ear
Investigations:
Serial audiometry
MRI internal auditory meatus to exclude acoustic neuroma
Management:
Bed rest
Carbogen (CO2 / O2 mixture of high CO2 content – causes vasodilatation)
Steroids
Outcome:
30% complete recovery
30% partial recovery
30% no change
Note: perilymph fistula may present with a similar history.
Usually there is a preceeding event associated with a sudden change in pressure. Vertigo and tinnitus are also typical features, but not always present.