Therapy
50% of sudden deafness recedes within the first few days. If the severity of a symptomatic sudden deafness is low and it can be excluded, it is therefore often advisable to stay in bed and wait. Other measures include the highly concentrated systemic or intratympanal administration of glucocorticoids over a few days.
In intratympanal administration, the glucocorticoid is applied directly into the middle ear through the eardrum. A rheological therapy with pentofixylline is frequently used as an adjunct. This promotes the flow rate of the blood.
Hyperbaric oxygen therapy is also used to strengthen the immune system and thus increase the probability of spontaneous remission. Finally, the additional administration of antiviral drugs should be discussed. The current guidelines for acute hearing loss therapy with glucocorticoids recommend 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 intratympanal is left to the treating physician in consultation with the patient. The systemic, high-dose administration of glucocorticoids does not have to be discontinued after three days of treatment, from an endocrinological perspective.
Likewise, the side effects of systemic high-dose glucocorticoid therapy over a short period of time are negligible according to current studies. In contrast, intratympanal application often causes pain, slight dizziness, sometimes even perforation of the eardrum and inflammation of the middle ear. In the case of prolonged therapy, however, intratympanic therapy shows a complication-free course.
Duration
The duration of a sudden hearing loss is very variable and depends on the severity of the hearing loss. The start of therapy also influences the duration of the hearing loss: the longer you wait between the first symptoms and the start of therapy, the worse the prognosis. In about half of the patients, the symptoms improve spontaneously and the hearing loss heals without treatment (spontaneous remission).
Spontaneous remission is most likely if the hearing loss was only minor. In order to avoid late damage, a doctor should always be consulted promptly to plan further therapy. If the physician finds only a slight hearing loss (with only 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 a severe hearing loss, tinnitus and also balance problems, as well as already pre-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.
Rarely do permanent symptoms of varying severity, such as persistent ringing in the ears or hearing loss, remain. The diagnosis of sudden deafness should be made by a specialist in ear, nose and throat medicine. He or she should first begin the examination of the patient by taking a detailed medical history, in which the nature of the symptoms, the time of occurrence and known previous illnesses, such as cardiovascular diseases and neurological disorders, should be determined.
Then the doctor will begin the inspection of the ear, first from the outside, then from the inside through the so-called otoscopy. Here he can see the passage of the ear and the eardrum, can exclude e.g. the above-mentioned contamination by a lard plug or an inflammation of the eardrum. If this area is inconspicuous, the ENT specialist will perform a hearing examination.
Two tests are very well suited to differentiate between a sound conduction disorder (for some reason, the sound cannot be passed on from the outer ear to the inner ear) and a sound sensation disorder (the sound reaches the inner ear but is not neurologically transformed and not passed on to the brain). In the so-called Weber test, a tuning fork is struck and made to vibrate, then placed on the patient’s crown.If he hears the same sound 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 sound louder in the sick ear.
If it is a sound sensation disorder in the healthy ear. The gutter test can also be used to diagnose both disorders. Here, too, a tuning fork is made to vibrate and placed on the bone behind the auricle (mastoid).
The patient must give a signal as soon as he no longer hears the sound. Then the doctor holds the tuning fork in front of the patient’s ear. If he does not hear the sound, it is a sound conduction disorder.
Nowadays, however, the ENT physician still has a wide range of diagnostic electronic instruments at his disposal for testing hearing. In the so-called Gellè test, the mobility of the ossicles can be examined. A balloon is placed airtight on the external auditory canal and a tuning fork on the skull bone of the patient.
By pressing the balloon, the auditory ossicles are either set in vibration or slowed down. If the patient constantly hears the sounds produced by the tuning fork, even though the balloon is actuated, it is a pathological, fixed chain of ossicles. No disease is present at varying volumes.
A pure tone threshold audiometry or tone audiogram is made for every patient suspected of having a sudden hearing loss. Using headphones, pure tones of different heights generated by a generator are fed into each ear separately. These tones are first offered to the patient quietly, then louder and louder.
The patient presses a button as soon as he hears the first tone. This limit is also called the hearing threshold. This value is entered into a curve and at the end the points are connected (hearing threshold curve).
In the case of damage to the inner ear, the curve would fall off at a higher frequency. In a healthy ear, the curve would be approximately straight. If the hearing loss in one ear is detectable and is at least 30dB over three consecutive octaves and has been developed within 24 hours, no dizziness or other possible causes of hearing loss can be identified, a diagnosis of sudden deafness must be made.
In order to exclude the numerous other possible causes of sudden deafness, a blood test with coagulation parameters, cholesterol values and inflammation values should be carried out. The examination for an autoimmune disease as well as a radiological examination by means of magnetic resonance imaging (MRI of the head) should only be performed in the further course of the diagnostic chain. An ECG or an ultrasound examination of the heart can be performed at an internal medicine ward to exclude cardiovascular disease as the cause of the hearing disorders.
