Dear Dr. Please excuse the last two attempts I have made to E-Mail you, but something kept going wrong. I am a 23 year old woman with no medical problems (except for inactive tuberculosis that has been treated), I've had no head injuries, or viruses(even so much as a cold). I suddenly lost my hearing a week ago while moving some furniture around, it was not excessively strenuous lifting though and about a minute later realized I had lost ALL hearing in my left ear and have not gotten any better since. I don't have ANY hearing at all in that ear except for a constant ringing which gets worse with loud noise. I've been to an ENT doctor who has me taking PAVABID PLAT 150MG, DELTASONE 10MG. I have also taken a CAT Scan and it came back negative. The doctor is telling me I will probably not get any hearing back and I am terrified. Please advise me as to what treatment and what the possibilies are in my situation. I am desperate!!!!!
Reply: ---------------------------
The condition you have experienced is known as sudden sensorineural hearing loss. There are approximately 4000 new cases of this condition in the US each year. There are numerous potential causes of this condition including infectious, traumatic, neoplastic, immunologic, toxic, vascular, neurologic, and metabolic causes, in fact too numerous to list in this post. However, the cause of sudden sensorineural hearing loss is identified in roughly only 10% of cases and therefore the remaining 90% are classified as idiopathic. When the cause of the hearing loss cannot be determined, it is not yet clear whether any treatment is effective. In fact the management of idiopathic sudden sensorineural hearing loss is fairly controversial. There are many treatment regimens that have been described in the literature some of which include the medications you are currently prescribed. A recent comprehensive review of sudden sensorineural hearing loss has listed the following as "the most practical" regimen for diagnosis and management:
1) evaluation with basic audiometry and MRI scanning
2) low-salt diet and a diuretic medication (such as Dyazide)
3) prednisone
4) acyclovir, with the latter 2 medications being used for 10 days.
Most ENT physicians who have studied the condition suspect that treatment, if it is to be effective must be started immediately and that treatment started 30 days or more after the onset of hearing loss is probably ineffective.
The other fact to consider is that once an appropriate evaluation to identify a cause has resulted in the diagnosis of idiopathic hearing loss, many physicians will advise observation only, since 2/3 of patients will recover some or all of their hearing regardless of the treatment regimen. Fifteen percent will remain the same, and 15% will worsen with time.
If you are interested, a recent comprehensive review of this condition was recently published in The Otolaryngologic Clinics of North America in June of 1996 entitled "Update on Otology and Neurotology, Part II.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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