Related Subjects:
|Assessing Hearing Loss
|Benign Paroxysmal Positional Vertigo (BPPV)
|Cholesteatoma
|Epistaxis (Nosebleeds)
|Acute Mastoiditis
|Nasal polyps
|Acute Sinusitis
|Sudden Sensorineural Hearing loss (SNHL)
|Causes of Vertigo
🎧 Sensorineural Hearing Loss (SNHL) arises from pathology in the inner ear or the vestibulocochlear nerve.
⚡ Sudden idiopathic SNHL is an ENT emergency → treat promptly with steroids ± ENT referral.
💡 Around two-thirds of idiopathic cases improve spontaneously.
📖 About
- Affects millions worldwide; ~9 million people in the UK are deaf or hard of hearing.
- ~6 million are over 60 → presbyacusis (age-related loss) is the most common cause.
- SNHL can be unilateral or bilateral, sudden or progressive, and often accompanied by tinnitus.
🧬 Aetiology
- Idiopathic – sudden SNHL, ~2/3 improve spontaneously.
- Meniere’s disease – triad of episodic vertigo + tinnitus + fluctuating SNHL.
- Presbyacusis – progressive age-related loss of high frequencies.
- Trauma – temporal bone fracture, barotrauma, or haemorrhage.
- Perilymphatic fistula – after barotrauma/loud noise, causes vertigo + SNHL.
- Cogan’s syndrome – autoimmune, steroid responsive.
- Viral – mumps, measles, CMV.
- Stroke – AICA occlusion → 8th nerve ischaemia.
- Ototoxic drugs – aminoglycosides, loop diuretics, platinum chemo.
- Neurological – Multiple Sclerosis.
- Acoustic neuroma – benign vestibular schwannoma → progressive unilateral SNHL ± tinnitus.
🔎 Investigations
- Pure Tone Audiometry (PTA) – gold standard: shows high-frequency loss in presbyacusis.
- MRI of CP angle – if unilateral/progressive loss or suspicion of acoustic neuroma.
- Tympanometry – to rule out middle ear pathology.
- Bloods if systemic cause suspected (autoimmune, viral).
💊 Management
- Steroids – oral or intratympanic glucocorticoids for sudden idiopathic SNHL.
- Antivirals – occasionally used if viral cause suspected (limited evidence).
- Hyperbaric oxygen – may help acute cases (not routine in UK practice).
- ENT referral – urgent if sudden (<72 hrs), unilateral, or progressive loss.
- Rehabilitation:
- Hearing aids → first-line for persistent or age-related SNHL.
- Cochlear implants → for severe/profound loss unresponsive to aids.
⚠️ Red Flags (Immediate Referral)
- Sudden unilateral SNHL.
- SNHL + facial nerve palsy, vertigo, or headache → ?stroke or acoustic neuroma.
- Progressive asymmetrical hearing loss.
📊 Prognosis & Follow-Up
- Early treatment (<2 weeks) in sudden SNHL improves recovery odds.
- Regular follow-up audiometry essential in chronic cases (esp. Meniere’s, autoimmune).
- Patients benefit from multidisciplinary support (ENT, audiology, hearing therapy).
📚 References
