Sudden Sensorineural Hearing Loss (SSHL)

What is Sudden Sensorineural Hearing Loss?

Sudden sensorineural hearing loss (SSHL) is a type of sudden hearing loss that occurs suddenly. It usually happens due to some external cause such as loud noise or injury. It may occur at any age but it’s most common between the ages of 20 and 30 years.[1] [2][3]

It affects mostly men and women equally[4]. About 70% of those affected are male and 30% female.[5]

The average time from onset to first symptoms is 3 months,[6] however it may take up to 12 months.[7]

Symptoms include: tinnitus, ringing in the ears, difficulty concentrating and sometimes even vertigo. Some people have no symptoms at all. However they still need to be monitored regularly.

There are different types of sudden sensorineural hearing loss. They are:

Tinnitus – ringing in the ears is the most common symptom of SSHL. Tinnitus is not necessarily painful, but it does make life difficult when trying to hear well enough to do work or other activities. People with tinnitus may experience difficulties with concentration and memory as well as difficulty hearing others around them. They may also have sleep problems, anxiety, and depression.

Treatment for tinnitus involves a combination of counseling, sound therapy, and medication. Sometimes tinnitus cannot be cured but it can be managed so that the person does not suffer as much. There are many support groups available for people who suffer from tinnitus and their families.

Infections – this type of SSHL is an acute hearing loss caused by a sudden infection. The most common viruses and bacteria that cause this condition are: influenza (flu), meningitis, tuberculosis, and syphilis. These viruses and bacteria usually attack the delicate hair cells inside the inner ear. This leads to a gradual hearing loss which worsens over days or weeks.

Some people develop sudden sensorineural hearing loss after an ear injury. This can be anything from a minor injury like an insect flying into the ear to something more traumatic like an explosion. It is important to get treatment for this type of hearing loss as soon as possible.

Treatments for these causes of sudden hearing loss are different from other causes of sudden hearing loss, and can include antibiotics and antiviral drugs, depending on the cause. It is also important to prevent further damage by not exposure the ear to loud noises.

Autoimmune diseases – there are several autoimmune diseases that can lead to sudden sensorineural hearing loss. The most common one is autoimmune inner ear disease (AIED). In this condition, the body’s immune system attacks the inner ear hair cells in the same way it attacks other organs like the thyroid, pancreas, joints, and skin.

A rarer cause of SSHL which affects young women is an autoimmune condition known as Drug-Induced Lupus. This condition is similar to AIED but more severe. It attacks a wider range of organs and can be life-threatening.

Treatments for these conditions are different from other causes of sudden hearing loss. Antibiotics and antiviral drugs may be used to treat the underlying condition, and a corticosteroid such as prednisone may be used to suppress the immune system. In some cases stem cell therapy or a bone marrow transplant may be required.

Tumors – tumors are abnormal growths of tissue. There are two types of tumors that can cause sudden hearing loss. The first type is known as an acoustic neuroma and the second is a vestibular schwannoma.

An acoustic neuroma is a type of benign tumor that develops from the nerve that connects the inner ear to the brain. It causes a slow but progressive hearing loss. This type of tumor develops most often in people over the age of 50 and usually only affects one ear.

A vestibular schwannoma is a type of benign tumor that develops from the nerve that connects the inner ear to the brain. It causes a sudden, rapid hearing loss that typically affects both ears. This type of tumor also develops from the nerves that control balance, which may cause dizziness, vertigo, and nausea. This type of tumor develops most often in people in their 40s and 50s.

Treatments for tumors vary depending on the type and location of the tumor. Surgery is sometimes an option to remove a tumor, although this may be too dangerous in the case of an acoustic neuroma since part of the nerve must be removed along with the tumor. Radiation and chemotherapy are other treatment options, although these do not work as well on tumors such as acoustic neuromas.

Ménière’s disease – this condition involves a sudden increase of pressure in the fluid of the inner ear. This can cause both temporary and permanent hearing loss as well as episodes of spinning and dizziness (vertigo).

The exact cause of Ménière’s disease is not known. It tends to run in families and is thought to be caused by a problem with how fluid is drained from the inner ear. It affects both men and women of all ages, although it is more commonly diagnosed in people between the ages of 20 and 50.

The exact treatment for Ménière’s disease is not well-understood. Medications and dietary changes to reduce fluid retention may help reduce symptoms. In severe cases, a surgical procedure known as a labyrinthectomy may be done to remove the vestibular section of the inner ear. This procedure cures Ménière’s disease 100% of the time, but hearing loss will occur in the operated ear.

Head trauma – head trauma can cause a condition known as a cerebellopontine angle syndrome (CPA). This condition causes tinnitus, vertigo, and a progressive, permanent hearing loss. It is thought to be caused by damage to the hearing and balance nerve that transmits signals from the inner ear to the brain.

The exact cause of CPA is not known, but it typically occurs following some type of head trauma such as a car accident or a sports-related injury. It is most common in people between the ages of 30 and 50 and more common in men than in women.

There is no cure for CPA, treatment focuses on managing the symptoms. A procedure to drain excess cerebrospinal fluid (CSF) from around the inner ear may be done in an effort to reduce the buildup of pressure. In some cases a bone anchored hearing aid (BAHA) or a cochlear implant may be used in an effort to restore hearing.

Vestibular neuronitis – also known as the labyrinthitis, this condition is an inflammation of the inner ear. This inflammation can cause a temporary or permanent hearing loss and/or a spinning sensation (vertigo). It generally affects both ears equally and may be caused by an infection or injury to the inner ear.

The symptoms of vestibular neuronitis typically start suddenly and last between three days and two weeks. It most commonly occurs in people between the ages of 20 and 40 and is more common in women than in men.

Treatments for vestibular neuronitis include rest, medicinal supplements, and avoidance of things that may trigger a spinning sensation (such as moving your head or looking up). In some cases surgery may be an option to drain fluid from around the inner ear.

Multiple sclerosis (MS) – this is an autoimmune disease that affects the central nervous system. It typically presents between the ages of 20 and 40 and is more common in women than in men.

In MS, the body’s immune system begins to attack the myelin that surrounds and protects the nerves. The damage to the myelin causes a wide variety of symptoms including vision problems, slurred speech, tremors or jerking, and balance problems.

Multiple sclerosis can also cause tinnitus, dizziness, and a loss of balance. It can also lead to hearing loss or a loss of vision if the optic nerve is damaged. Like many of the conditions on this list, there is no cure for multiple sclerosis and treatment focuses on managing the symptoms.

Vertigo can be triggered by exposure to sudden changes in position such as looking up or looking down, bending over, or turning the head. In addition to treating the underlying cause, there are a number of self-care tips recommended for treatment. These include not driving until you no longer experience symptoms, avoiding places with a lot of motion (crowds, amusement parks, movies), and elevating the head of the bed.

Meniere’s disease – this is a disorder that affects the inner ear. It causes episodes of dizziness, sometimes followed by vomiting, and can cause temporary hearing loss. Meniere’s disease can be triggered by stress or changes in pressure.

Because the cause of Meniere’s disease isn’t well understood, treatment focuses on alleviating the vertigo and associated symptoms. Medications, stress-management techniques, and a low-salt diet may help. A procedure known as a labyrinthectomy (surgical removal of parts of the inner ear) is sometimes used to treat severe cases that don’t respond to other treatments.

Ménière’s disease can be caused by a number of factors including allergies or too much stress. Unlike many conditions on this list, Ménière’s disease typically starts later in life, with the average age of onset between the ages of 40 and 65. Meniere’s is three times more common in women than men.

Acoustic neuroma (vestibular Schwannoma) – this is a tumor that develops from the vestibular Schwann cells in the inner ear. It typically grows very slowly, and most people experience symptoms for several years before a diagnosis is made.

There is typically a gradual onset of symptoms such as mild nausea and dizziness. As the tumor grows, these symptoms become more severe and can also include episodes of extreme dizziness and imbalance.

Treatments focus on removing the tumor either through surgery or radiation. Acoustic neuromas can grow back after treatment, so regular check-ups are important.

Brain tumor – tumors that develop in the brain or spinal cord are very serious conditions that require immediate medical attention. The type of tumor determines the specific symptoms and treatments.

Meningioma – this is the most common type of brain tumor in adults. It grows from the membranes that surround the brain and spinal cord. Meningiomas typically grow very slowly, so they don’t typically cause any immediate symptoms.

Meningiomas are most often diagnosed after the patient experiences mild, constant headaches or problems with memory or concentration.

Sources & references used in this article:

Steroid perfusion of the inner ear for sudden sensorineural hearing loss after failure of conventional therapy: a pilot study by PP Lefebvre, H Staecker – Acta oto-laryngologica, 2002 – Taylor & Francis

Intratympanic steroid perfusion for refractory sudden sensorineural hearing loss by BD Herr, SJ Marzo – Otolaryngology-head and neck surgery, 2005 – Elsevier

Sudden sensorineural hearing loss: long-term follow-up results by AD Psifidis, GK Psillas, JC Daniilidis – Otolaryngology-Head and Neck …, 2006 – Elsevier

Sudden sensorineural hearing loss as a revealing symptom of vestibular schwannoma by E Sauvaget, S Kici, R Kania, P Herman… – Acta oto …, 2005 – Taylor & Francis

Idiopathic sudden sensorineural hearing loss: prognostic factors by J Xenellis, I Karapatsas, N Papadimitriou… – The Journal of …, 2006 – cambridge.org

Low serum folate levels: a risk factor for sudden sensorineural hearing loss? by G Cadoni, S Agostino, S Scipione, J Galli – Acta oto-laryngologica, 2004 – Taylor & Francis