Sudden Hearing Loss: A Medical Emergency

Medical Intel

Every year in the U.S., 20 per 100,000 people experience sudden hearing loss, a medical emergency commonly caused by upper respiratory tract infection. Dr. Selena Briggs discusses how early, specialized treatment can help restore hearing.

TRANSCRIPT

Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.

Host: Thanks for joining us today, we’re talking to Dr. Selena Briggs, a neurotologist skull base surgeon within the Department of Otolaryngology at MedStar Washington Hospital Center. Welcome Dr. Briggs.

Dr. Selena Briggs: Thank you, thanks for having me.

Host: Tell us a little about yourself, why did you go into medicine, and how did you come to practice at MedStar Washington Hospital Center?

Dr. Briggs: I’ve had an interest in going into medicine, I think, from my youth. It actually stemmed from my pediatrician, Dr. Frank Newburger who practiced here in Silver Spring, and he was a great mentor, and a great pediatrician and that spurred my interest, and then later I developed an interest in music and dance, I was a ballerina, and I loved ballet. And while I was younger, there was a miss America who was deaf and a ballerina, and that sparked my interest in understanding more about deaf culture and hearing loss. So, throughout my career it’s just kind of moved in that direction of hearing health and this direction.

Host: Today we’re talking about upper respiratory infections that can lead to hearing loss. Dr. Briggs, how can an upper respiratory infection cause hearing loss?

Dr. Briggs: That is an excellent question. Most people are unaware of the association between upper respiratory tract infections and hearing loss. It’s not uncommon for an individual to wake up in the morning after experiencing an upper respiratory tract infection and state that they can’t hear out of one ear. They’ll commonly call their primary care provider and try to get an appointment to be seen, and nothing gets seen on examination. That is the main concern. That is of pinnacle concern, in fact. Those individuals may be suffering from something called sudden idiopathic sensorineural hearing loss or simply sudden hearing loss. That’s most commonly associated with upper respiratory tract infections or the common cold.

Host: So, I know when I have colds or even allergy problems and anything really affecting my sinuses I get that kind of clogged feeling in your ear—what are some symptoms patients tell you about when they get this hearing loss going on?

Dr. Briggs: The clogged sensation in the ear and the sudden sensory no hearing loss actually are two separate entities. Both cause hearing loss and both have similar symptoms of presentation, but the source of it is very different and the treatment for it is very different as well. So, when you have an ear infection or even pressure in your ear from a sinus infection, that’s usually caused by something called your Eustachian tube. I don’t know if you’ve ever been on a plane and your ears popped and you feel that sensation? It’s your Eustachian tube opening and closing that allows you to equalize your pressure while you’re on a plane. But when you have a sinus infection, oftentimes that Eustachian tube becomes plugged, and doesn’t open and close normally. That causes pressure, muffled sensation, and sometimes can even cause fluid to develop in your ear. That typically is a short-lived, self-limited process. The sudden sensorineural hearing loss or sudden hearing loss is a completely different process, where it doesn’t cause a pressure problem, but it actually causes injury to your nerve. It may cause permanent damage to your ear. It’s not something that you should take lightly. It can be a long term even permanent issue for individuals. So, if one wakes up with sudden hearing loss, from the sudden sensorineural hearing loss, the nerve type of damage, about one out of three people it will resolve on its own, one out of three people it’ll improve but not go back to its normal, and one out of three people it won’t change at all. There are interventions that we can do to make your likelihood of returning back to normal greater, but the key thing is that you have to get in and be seen within three days to three weeks. Outside of that window, the likelihood of it becoming permanent loss is significantly greater.

Host: How many people experience this?

Dr. Briggs: So, on an annual basis, so every year within the United States, it’s speculated that approximately five to twenty out of 100,000 individuals experience sudden sensorineural hearing loss.

Host: So, since this is suspected to be caused by viral problems or a virus, what can the doctor do either that primary care doctor, and then at what point do you need to be transitioned over to a specialist?

Dr. Briggs: The key thing first is being evaluated by your primary care provider or even urgent care and having an ear examination. Making sure your ear drum looks normal, there’s not wax that’s occluding or plugging up the ear canal, and make sure there’s not fluid behind the ear drum, as we talked about before associated with allergies or sinus problems. It sounds strange, but a normal ear exam is an emergency. So, if you have a normal ear exam, and hearing loss, you need to be seen and have a hearing test right away

Host: What about those individuals who do put it off? Is it damaged to the point where they can never get that back then if they wait too long?

Dr. Briggs: There is a time window, and there is a time urgency. A few days, ot so much out of the window of treatment. Typically, we state 21 days is when medical therapy is most effective, and those therapies tend to be steroids either taken orally or via an injection through the eardrum into the middle ear space.

Host: Once the patient has had this hearing test, how quickly do they receive that treatment, and how long does that treatment take?

Dr. Briggs: So once an individual has a hearing test that documents sudden sensorineural hearing loss, they should be seen by an otolaryngologist or a neurotologist within 24-48 hours. The treatment is started rather urgently, because it gives them the best opportunity for the best outcome. So the treatment, depending on the patient’s associated comorbidities such as diabetes or hypertension, may include oral steroids vs injection steroids in the middle ear space vs a combination of the two, and that’s started immediately. There are other therapies that are recommended within the literature or can be used, such as hyperbaric oxygen therapy for restoration therapy as well.

Host: What’s the hyperbaric oxygen therapy?

Dr. Briggs: Essentially it simulates diving, scuba diving. So, it puts you in a chamber where you have increased oxygenation or oxygen levels, to increase the oxygen to your nerve, in a hope that increasing its oxygenation it’ll help it to heal faster.

Host: And what do the steroids do to help mend the hearing loss?

Dr. Briggs: It decreases inflammation on the nerve similarly, helping to increase blood flow and hopefully improving the hearing

Host: So, the more blood that’s flowing through the ear in a healthy way of course the better you’re able to hear.

Dr. Briggs: Right, exactly.

Host: So aside from that sudden sensation of not being able to hear, are there any other symptoms that an individual should be aware of or talk to their doctor about?

Dr. Briggs: Oftentimes individuals who have this sudden hearing loss may experience other symptoms that can prompt them to know it is the sudden nerve type of loss vs the conductive type of hearing loss with the fluid and the sinuses. Some of those symptoms include ringing in the ears, so if you have a high-pitched sound or even a sound of white noise like when you turn the radio between stations, that’s another indicator that you may have a nerve type of damage in your ear. Vertigo or dizziness in association with the hearing loss is another indicator that it may be a nervous type of loss.

Host: Are there other conditions aside from respiratory infections that might cause that sudden hearing loss? I know you think about construction workers and the loud noises and things, is that the same, or is that different?

Dr. Briggs: That’s a different entity, that’s noise induced hearing loss, and that can cause a sudden we call it a sudden threshold shift, so sudden changes in your hearing. For example, if you’re exposed to a loud sound or a blast, that too can cause a sudden hearing loss. It’s similarly treated, interestingly, however. There is a host of disease processes that can cause hearing loss in addition to the viral ideology, and that’s why it’s even more important for you to come in and be seen and evaluated. Individuals with diabetes can have it associated with neuropathy, it can be an early sign of strokes, it can be a sign of tumors of the skull base, thyroid disorders, autoimmune disorders, there’s a whole list.

Host: So really since upper respiratory, obviously, probably one of the more common causes of hearing loss but since there are so many things that could cause it, it’s really about getting to the root of that issue. Could you talk a little bit about how you do that and how your team works together to do that?

Dr. Briggs: Yeah, definitely. So, the patients will come in and be evaluated with a physical examination and a history, and that largely directs which direction we’ll go in terms of diagnosis and treatment. It’s very common for individuals who have a sudden hearing loss to have an MRI of their brain and their inner ear to evaluate for any changes of the hearing and balance nerve, or any lesions that might be compressing the hearing and balance nerve. And then based upon the patient’s other history and family history and comorbidities, they may undergo various laboratory testing to assess for diabetes or other autoimmune disorders that might be contributing as well as Lyme disease and other infectious processes.

Host: Could you talk about a compelling story that you’ve had come in with that upper respiratory problem and how that treatment looked for that patient

Dr. Briggs: There is one individual who is a clinician as well, who presented with bilateral involvement so most often individuals come in and it’s involving one ear. In exceptionally rare cases it involves both ears. This individual needed their hearing in order to perform their work, and so we were able—he got in almost immediately after onset of symptoms, started oral steroids, and inter-tympanic steroids, and hyperbaric oxygen therapy and remarkably had restoration of his hearing. At his initial visit we had to communicate via typing on his computer and him speaking back, because he couldn’t hear at all.

Host: He couldn’t hear at all? It wasn’t just a decrease?

Dr. Briggs: No, and that’s the other thing to understand with a sudden hearing loss, it’s not always just a sudden decline in hearing, some people actually wake up and be deaf in one ear.

Host: What’s the emotional or the mental state of people when they come into the office?

Dr. Briggs: Completely scared, definitely. It’s life changing and life altering. I think we often take for granted our hearing, and then once we lose it, or lose some aspect of it, we realize how important it can be to your life. It can be jarring, and it can be life altering and scary for patients to experience, but as long as an individual’s gotten in early, the opportunity for treatment is significant. Without treatment, yes, one third may have no change, one third will have some change, and one third will improve somewhat. But with treatment that can dramatically improve the odds of improving the hearing back to their baseline.

Host: Is there anything an individual maybe that’s prone to those upper respiratory infections can do to reduce their risk?

Dr. Briggs: Unfortunately, not. There’s no treatment, there’s no preventative therapy that’s been identified in the literature to reduce your risk of developing sudden sensorineural hearing loss from these upper respiratory tract infections.

Host: Could you talk a little about the importance of an individual coming to an otolaryngologist

Dr. Briggs: It’s critical for patients to come in and be seen by otolaryngologists or a neurotologist because of the specialized care and therapy that can be provided. We work as a team with primary care providers, with urgent care providers and with emergency department providers to get the patients in early and provide them with the treatment that’s necessary, but it is important that they are ultimately referred to an otolaryngologist who could provide them with that inter-tympanic steroid therapy injection which is a very specialized procedure, only performed mostly by neuro-otologists, but also by some otolaryngologists. In addition, it’s important that they be evaluated for those other disease processes that might be mimicking the sensorineural hearing loss, the idiopathic type.

Host: Thank you for joining us today Dr. Briggs.

Dr. Briggs: Thank you for having me

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