Early and Accurate Diagnosis of Sudden Sensorineural Hearing Loss


 

Corridor Consult

Barry Rasgon, MD; Luke James Schloegel, MD

Spring 2009 - Volume 13 Number 2

https://doi.org/10.7812/TPP/08-086

Case 1

An obese man, age 57 years, with a medical history of depression presented to his primary care physician with three days of sudden left-sided hearing loss. He did not report pain, tinnitus, vertigo, or external auditory canal discharge. He said that he had not experienced any recent trauma, upper respiratory infection, or loud noise exposure or taken any ototoxic medications.

His physical examination revealed normal-appearing external auditory canals and tympanic membranes. The membranes exhibited good mobility with insufflation. Findings on the Rinne test with a 512-Hz tuning fork were consistent with air conduction greater than bone conduction on the right side; the left side could not be tested because of profound hearing loss. Findings on the Weber test with a 512-Hz tuning fork were lateralized to the right side. On the basis of the patient’s medical history and physical examination findings, the primary care physician suspected sudden sensorineural hearing loss, prescribed oral prednisone, and referred the patient for urgent audiologic and otolaryngologic examinations. At the four-week follow-up examination, an audiogram showed return of hearing to near baseline on the left side.

Case 2

A woman, age 54 years, with hypertension, presented to the urgent care clinic with two days of right-sided hearing loss and right ear fullness. She reported that she had recently had an upper respiratory infection. Physical examination revealed a normal tympanic membrane appearance and mobility, so a tuning-fork examination was not done. The physician diagnosed eustachian tube dysfunction (ETD) and gave the woman oral decongestants.

She was referred to the Head and Neck Surgery Department when there was no change in her symptoms two weeks after onset. After a thorough medical history was obtained and a physical examination, tuning fork tests were performed showing lateralization to the left ear on Weber test. An audiogram was obtained that showed severe right-sided sensorineural hearing loss, and a diagnosis of sudden sensorineural hearing loss was made. The patient was given oral prednisone and acyclovir. Later, magnetic resonance imaging (MRI) with gadolinium enhancement of the internal auditory canals revealed no retrocochlear lesion. A follow-up audiogram obtained two months after initial presentation showed no improvement in the patient’s hearing.

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