Sudden hearing loss
engl .: sudden deafness
A sudden hearing loss is an acute and sudden partial loss of hearing with accompanying hearing loss in one, and in rare cases in both ears. The severity of the hearing loss ranges from barely noticeable to complete deafness.
Epidemiology / frequency distribution
In Germany there are approx. 15.000-20.000 People affected by hearing loss each year. Both women and men are affected about equally often. Children and adolescents suffer from this disease less often, while men and women over 40 years of age form the most common disease group.
To describe the causes, a distinction must be made between symptomatic sudden hearing loss and idiopathic sudden hearing loss.
Dem symptomatic sudden hearing loss can be based on etiologies such as tumors or nerve damage. Under the tumors, that is Acoustic neuroma one of the most common benign tumors that can cause sudden hearing loss. It is an overgrowth of the nerve sheath of the vestibulocochlerar nerve. Compression of the nerves can lead to hearing loss, dizziness, unsteadiness, eye tremors and tinnitus. It is atypical for the symptoms that the onset occurs suddenly, as is the case with the majority of sudden hearing loss.
Further differential diagnostic causesto be distinguished from idiopathic sudden hearing loss are:
- Diseases of central nervous system: multiple sclerosis, Meningitis, loss of liquor
- Ear diseases: inner ear infections (Labyrinthitis), Barotrauma (middle or inner ear damage caused by an extreme change in pressure in the environment), Meniere's disease, Perilymph fistula or obstruction of the external ear canal by wax.
- Ingestion Ototoxic drugshow selected antibiotics.
- Hearing impairment in the sense of a Virus infection (e.g. mumps, zoster oticus, adenoviruses)
- Psychogenic hearing loss (usually occurs on both sides)
- Circulatory disorders due to vertebral body wear in the cervical spine or hearing loss after a whiplash with an effect on the cervical spine.
The causes of a sudden hearing loss are therefore diverse. Diagnostically all the more important are possible side effects and the course of the disease.
Even a simple cold with swelling of the tubal tonsils can lead to a ventilation disorder in the middle ear due to the tube being blocked, which in turn can cause otitis media with hearing loss.
Of the idiopathic sudden hearing loss steps against it suddenly on, within a few seconds to minutes there is a painless, one-sided hearing loss. The cause of this has not yet been clarified; one suspects circulatory disorders in the inner ear. Often one poses Relationships with stressful situations firmly.
In stressful situations, more catecholamines (adrenaline, noradrenaline) are released in the body and these have a vasoconstrictive effect. One suspects a hearing loss in stressful situations secondary reduced blood flow to the ear due to the vasoconstriction. This explanatory approach is used, among other things, for hearing loss in the context of burnout syndrome or depression. Both clinical pictures lead to an increased cortisone level.
Cortisone has a circulation-centering effect, i.e. vasoconstriction occurs in the periphery and vasodilation in the center (the vital organs). For the blood flow to the ear, this means a further decrease.
Another guess is that Association between sudden hearing loss and stroke. It is believed that in some cases the sudden hearing loss may be a harbinger of a possible stroke. However, this has not yet been proven with certainty.
Symptoms of sudden hearing loss
The sudden hearing loss is usually one characteristic Ear. Often, shortly before the hearing loss / sudden hearing loss, the patients perceived a long-lasting noise, such as monotonous whistling or humming, which was also called Tinnitus referred to as. Ear pain practically never occurs with a sudden hearing loss, although a feeling of pressure on the ear has been reported in individual cases. Simultaneous Dizziness symptoms can also occur at times (see: Dizziness from diseases of the ear).
The sudden, one-sided Sudden hearing loss can include a so-called Double listening (Diplakusis) as well as lead to a feeling of numbness and a feeling of cotton wool. Patients with a sudden hearing loss are mostly very scared and insecure, as many have never had a sudden hearing loss and the sudden one-ear hearing is completely unfamiliar. In some patients, the sudden loss of one ear also triggers an acute vertigo syndrome with a tendency to fall, as the body closes both ears Balance measurement is used to using.
50% of hearing losses resolve within the first few days. At low expression and exclusion of symptomatic sudden hearing loss is therefore often too bed rest and wait and see.
Other measures are the highly concentrated systemic or intratympanic measures Administration of glucocorticoids over a few days. With intratympanic administration, the glucocorticoid is applied directly into the middle ear through the drum case.
Frequently used as an accompaniment is one rheological therapy with pentofixylline. This promotes the flow rate of the blood.
One is also used hyperbaric oxygen therapywhich aims to increase the likelihood of spontaneous remission by strengthening the immune system. Finally, the additional administration of antiviral drugs should be discussed.
The current guidelines of acute acute hearing loss therapy with glucocorticoids recommends a high-dose administration of prednisolone (250mg) or another synthetic glucocorticoid over a period of 3 days. If necessary, this therapy can be continued.
Whether the administration is systemic or intratympanic is left to the attending physician in consultation with the patient. The systemic, high-dose administration of glucocorticoids does not have to be tapered off after three days of treatment, from an endocrinological point of view.
So are they Side effects the systemic high-dose glucocorticoid therapy over a short period of time according to current studies to neglect. In contrast, intratympanic application often leads to pain, slight dizziness, sometimes even perforations of the eardrum and otitis media.
In the case of the therapy extension, however, the intratympanic therapy shows a complication-free course.
The duration of a Sudden hearing loss is very variable and depends on the severity of the sudden hearing loss. The start of therapy also influences the duration of the sudden hearing loss: the longer you wait between the first symptoms and the start of therapy, the worse the prognosis.
In about half of patients, symptoms improve spontaneously and the sudden hearing loss heals without treatment (Spontaneous remission). Spontaneous remission is particularly likely if the hearing loss was only minor. In order to avoid long-term damage, a doctor should be consulted as soon as possible, with whom further therapy can be planned. If the doctor only detects a minor sudden hearing loss (with minor hearing loss), a spontaneous remission can be waited for a few days with the patient's consent. This is not recommended if the patient has pronounced hearing loss, tinnitus and balance problems, as well as previously damaged ears. In these cases the prognosis is worse and therapy is absolutely necessary.
Two thirds of the patients do not suffer any further damage after the hearing loss has healed. Permanent symptoms of varying severity, such as persistent ringing in the ears or hearing loss, are rare.
The diagnosis of the Sudden hearing loss should be by a specialist for Ear, Nose and Throat Healers be asked. This should first examine the patient with the exact patient survey (anamnese) begin, in particular the type of complaint, time of occurrence and known previous illnesses, such as Cardiovascular disease and neurological diseases should be asked. After that, the doctor will inspect the ear first from the outside, then from the inside through the so-called Otoscopy kick off. Here he can track the ear and that eardrum can see e.g. exclude the above-mentioned pollution from a lard plug or inflammation of the eardrum. If this area is normal, the ENT doctor will be one Hearing test carry out. Two tests are very useful at differentiating between a conductive disorder (the sound may for some reason be from the Outer ear not ins Inner ear are passed on) and a sensorineural disorder (the sound reaches the inner ear, but is not neurologically converted and not ans brain passed).
The so-called Weber test a tuning fork is struck and made to vibrate, then placed on the patient's head. If he hears the sound in the same way in both ears, it is neither a sound conduction disorder nor a sound sensation disorder. If it is a sound conduction disorder, he hears the tone louder in the sick ear. In the case of sensorineural disorders in the healthy ear. The Rinne experiment can also be used to diagnose the two disorders. Here, too, a tuning fork is made to vibrate and the patient is placed on the bone behind the auricle (mastoid) set. The patient must give a signal as soon as he can no longer hear the sound. The doctor then holds the tuning fork in front of the patient's ear. If he does not hear the sound, there is a sound conduction disorder. Nowadays stand that ENT doctor but there is still a large number of diagnostic, electronic instruments available for testing hearing.
The so-called Gellè attempt the mobility of the ossicles can be examined. A balloon is placed airtight on the external auditory canal and a tuning fork is placed on the patient's skull. By pressing the balloon, the ossicles are either set in motion or slowed down. If the patient hears the tones generated by the tuning fork constantly, although the balloon is activated, it is a diseased, attached ossicular chain. If the volume changes, there is no illness. For every patient with a suspected one Sudden hearing loss a pure tone threshold audiometry or a tone audiogram is made. Pure tones of different heights generated by a generator are fed into each ear separately via headphones. These tones are initially offered to the patient softly, then increasingly louder. The patient presses a button as soon as he hears the first tone. The limit is also known as the hearing threshold. This value is entered in a curve and at the end the points are connected to one another (Hearing threshold curve). If the inner ear was damaged, the curve would decrease at a higher frequency. With a healthy ear the curve would be roughly straight.
If the Hearing loss can be detected in one ear and at least 30dB is over three consecutive octaves and has occurred within 24 hours, no dizziness and no other possible causes of hearing loss are recognizable, the diagnosis of sudden hearing loss must be made. In order to rule out the numerous other causes of a sudden hearing loss, you should definitely have one more Blood test With Coagulation parameters, Cholesterol levels and Inflammation values respectively.
The examination for an autoimmune disease and a radiological examination using magnetic resonance imaging (MRI of the head) should only take place in the further course of the diagnostic chain. A EKG or one Ultrasound examination of Heart can be performed on an internal medicine ward to rule out cardiovascular disease as the cause of the hearing impairment.
In infusion therapy, active pharmaceutical ingredients are dissolved in a solution. This solution (infusion) is injected into the vein and thus reaches the relevant point in the body via the blood (e.g. the inner ear in the event of sudden hearing loss)
Different drugs are used via infusion therapy. In the guidelines for the therapy of sudden hearing loss, German ENT doctors recommend infusion therapy with glucocorticoids (Prednisolone, methylprednisolone)that have anti-inflammatory and decongestant effects. Infusion therapy can usually be carried out in outpatient practices and varies between 5 and 10 infusions, which are injected continuously one after the other, even on weekends. The duration of a session is between 30 and 40 minutes. When using glucocorticoids over a long period of time, side effects such as osteoporosis, muscle loss or psychological changes (restlessness, sleep disorders) can occur. Since glucocorticoids increase blood sugar, their use in diabetics should be particularly monitored.
Another form of infusion therapy is rheological (= relating to blood flow) therapy. The aim of this method is to increase the blood flow in the inner ear. The active substance Hydroxyethyl starch (HES) has this effect of increasing blood flow, as well as pentoxifylline or low molecular weight dextrans (Sugar molecules). When using these active ingredients via infusions, the following side effects can occur: allergic reaction with itching, headache, stomach pressure, urge to urinate, sleep disorders.
The effectiveness of vitamin C in infusion therapy is currently being investigated, as it is increasingly assumed that vitamin C has a positive influence on blood circulation and the healing of inflammation, and a first study from Japan has shown a significant improvement in hearing sensitivity after infusion therapy with vitamin C. . Since this theory has to be further investigated, no recommendations for this therapy can be made at the moment.
In conclusion, it must be said that the effectiveness of infusion therapy in comparison to other forms of therapy has not been clearly proven, which is why the statutory health insurance companies do not cover the costs for the therapy and the drugs used.
Read more on the topic: Therapy of sudden hearing loss, Cortisone for sudden hearing loss
An important preventive measure of the Sudden hearing loss consists in the treatment of underlying diseases that cause them. The drug setting of a High blood pressure and a corresponding drug setting of the Diabetes mellitus, an anticoagulant in patients with coagulation disorders as well as setting an increased Cholesterol level and reducing a regular stress level should definitely be aimed for here.
The prognosis of sudden hearing loss is relatively favorable. In 80% of those affected, the signs of sudden hearing loss recede completely without lasting impairment. The younger the patient and the milder the symptoms, the higher the likelihood of complete resolution. In many cases, the symptoms have receded even without treatment of the sudden hearing loss, but they can also persist in mild form. Although there is currently no scientific evidence, it is still assumed that a prognostic criterion is also the time at which therapy is started, and the earlier therapy is started, the cheaper it is.
Around 15,000 to 20,000 people in Germany suffer from hearing loss every year. Mostly there are patients of both sexes from the age of 40. Characteristically, patients with sudden hearing loss complain of a sudden hearing loss in one ear. Dizziness and pressure on the ear are sometimes reported. Pain practically never exists. In addition, there is a puffy feeling on the skin of the ear and a sudden feeling of dizziness at times. A sudden hearing loss can result in tinnitus (Ear ringing) to make noticable. Changes in blood flow habits, increased blood clotting, thickening of the blood with the formation of a thormbosis and embolism in the inner ear are assumed to be the cause of sudden hearing loss, as well as infectious, tumorous, autoimmunological and traumatic causes. A change in the flow velocity of the blood results in a reduced supply of the hair cells of the inner ear with simultaneous hearing loss. In addition to the Rinne and Weber test, the ENT doctor has numerous electronic hearing tests available as diagnostic criteria that provide information about the type of hearing impairment. In order to rule out one of the numerous, rarer causes of sudden hearing loss, the doctor should also carry out a blood test if necessary, including magnetic resonance imaging (MRI) of the head. The diagnosis of sudden hearing loss is considered confirmed if the symptoms arose within 24 hours, there is no pain and no other causes of the hearing impairment can be found and a hearing loss of 30dB over 8 octaves can be demonstrated in one ear.
The therapy of sudden hearing loss is considered controversial, as there is no precise scientific evidence and patients without appropriate therapy recover equally often. A therapy consists of an infusion therapy with blood-thinning drugs, which are supposed to restore the flow rate, as well as a blood pressure-regulating therapy; if necessary, an anti-inflammatory therapy and an inotropic therapy with local anesthetics can be carried out.
As a preventive measure, the main diseases accompanying and causing the disease should be stopped and treated with medication (e.g. high blood pressure, cholesterol control, blood thinning, diabetes mellitus control, stress reduction, exercise).
In most cases, hearing loss heals without any symptoms remaining. It is controversial whether this is also the case without medication. The prognosis is more favorable the younger the patient is and the easier the signs of sudden hearing loss are. 80% of the patients have no further symptoms after the treatment.
If hearing loss was previously considered an absolute emergency, studies have shown that a more restrained approach in therapy seems to be more suitable. According to the guideline, acute hearing loss should still be treated promptly, but the good prognostic prospects, even if left untreated, make a corresponding therapy more critical.