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Sudden Hearing Loss

By

Lawrence R. Lustig

, MD, Columbia University Medical Center and New York Presbyterian Hospital

Last full review/revision Dec 2020| Content last modified Dec 2020
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Sudden hearing loss is moderate to severe hearing loss that develops over a few hours or is noticed on awakening. Such hearing loss typically affects only one ear (unless the cause is a drug). Depending on the cause of sudden hearing loss, people may have other symptoms such as ringing in the ears (tinnitus Ear Ringing or Buzzing Ringing in the ears (tinnitus) is noise originating in the ear rather than in the environment. It is a symptom and not a specific disease. Tinnitus is very common—10 to 15% of people experience... read more ), dizziness, or a false sensation of spinning or moving (vertigo Dizziness and Vertigo Dizziness is an inexact term people often use to describe various related sensations, including Faintness (feeling about to pass out) Light-headedness Dysequilibrium (feeling off balance or... read more ). About 1 in 5,000 to 1 in 10,000 people each year develop sudden hearing loss. For hearing loss that develops gradually, see Hearing Loss Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 10% of people in the United States have some degree of hearing loss that affects their... read more Hearing Loss .

Causes of Sudden Hearing Loss

Causes of sudden hearing loss fall into three general categories:

  • An unknown cause

  • An obvious explanatory event (such as a brain infection or head injury)

  • An underlying disorder

Unknown cause

Obvious event

In many other people, a cause for the sudden hearing loss is obvious. Such causes include

Head injury (such as a fracture of the temporal bone in the skull or sometimes a severe concussion without a fracture) can damage the inner ear and cause sudden hearing loss.

Severe pressure changes (such as those that can occur with diving or less often by bearing down during weightlifting) can cause a hole (fistula) to form between the middle and inner ear. Sometimes, such a fistula is present from birth and can spontaneously cause sudden hearing loss or make the person more susceptible to hearing loss after a head injury or pressure changes.

Ototoxic drugs are drugs that have damaging side effects to the ears. Some drugs can rapidly cause hearing loss, sometimes within a day (especially with an overdose). A few people have a rare genetic disorder that makes them more susceptible to hearing loss from the class of antibiotics called aminoglycosides. All people taking such antibiotics should have blood tests while on the drug to screen for toxic levels that can cause hearing loss. People receiving drugs that are excreted in the urine, such as aminoglycosides, should also have their kidney function checked and monitored to avoid kidney damage.

Underlying disorders

Sudden hearing loss rarely can be the first symptom of some disorders that usually have other initial symptoms. Such disorders include a tumor of the auditory nerve called acoustic neuroma Vestibular Schwannoma A vestibular schwannoma (also known as an acoustic neuroma) is a noncancerous (benign) tumor that originates in the cells that wrap around the vestibular nerve (Schwann cells). These tumors... read more Vestibular Schwannoma , multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause... read more , Meniere disease Meniere Disease Meniere disease is a disorder characterized by recurring attacks of disabling vertigo (a false sensation of moving or spinning), fluctuating hearing loss (in the lower frequencies), and noise... read more , or a small stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction) and symptoms that... read more due to a blockage of a branch of the artery that goes to the balance center of the brain (the cerebellum). Sometimes a syphilis infection Syphilis Syphilis is a sexually transmitted disease caused by the bacteria Treponema pallidum. Syphilis can occur in three stages of symptoms, separated by periods of apparent good health. It begins... read more Syphilis reactivates in people who have HIV infection Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and can cause acquired immunodeficiency syndrome (AIDS). HIV is transmitted... read more Human Immunodeficiency Virus (HIV) Infection . This reactivation can cause sudden hearing loss.

Evaluation of Sudden Hearing Loss

The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

Sudden hearing loss is itself a warning sign.

When to see a doctor

Anyone with sudden hearing loss should see a doctor right away because some causes must be treated quickly. If symptoms of dysfunction of the nervous system other than hearing loss are present, hearing loss may be a symptom of nerve or brain dysfunction.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination may suggest a cause of the sudden hearing loss and the tests that may need to be done.

Doctors note whether hearing loss affects one or both ears and whether a specific event such as head injury Overview of Head Injuries Head injuries that involve the brain are particularly concerning. Common causes of head injuries include falls, motor vehicle crashes, assaults, and mishaps during sports and recreational activities... read more , diving injury Barotrauma Barotrauma is tissue injury caused by a change in pressure, which compresses or expands gas contained in various body structures. The lungs, gastrointestinal tract, part of the face covered... read more , or infectious illness occurred. They ask about accompanying symptoms that involve the ear (such as ringing in the ears or ear discharge), balance center (such as disorientation in the dark or vertigo), and other parts of the brain and nervous system (such as headache, weakness, or an abnormal sense of taste). They try to identify whether people are currently taking (or recently took) any ototoxic drugs Ear Disorders Caused by Drugs Many drugs can damage the ears (ototoxic drugs). Some ototoxic drugs include the antibiotics streptomycin, tobramycin, gentamicin, neomycin, and vancomycin, certain chemotherapy drugs (for example... read more .

The physical examination focuses on the ears and hearing and on examination of the nervous system.

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Testing

Typically, people should have an audiogram (a hearing test Testing Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 10% of people in the United States have some degree of hearing loss that affects their... read more Testing ). Unless doctors think the problem is clearly an acute infection or drug toxicity, they usually also do gadolinium-enhanced magnetic resonance imaging (MRI) or computed tomography (CT), particularly when the hearing loss is greater in one ear. Other tests are done based on the likely cause. For example, people who had a head injury should have MRI. People at risk of sexually transmitted diseases should have blood tests for HIV infection and syphilis.

Treatment of Sudden Hearing Loss

Treatment is directed at any known cause of the sudden hearing loss. When the cause is unknown, most doctors try giving corticosteroids. In addition, doctors may also prescribe antiviral drugs effective against herpes simplex (such as valacyclovir or famciclovir), even though there is no good evidence that antiviral drugs are beneficial.

When the cause is unknown, about half of people regain normal hearing and hearing is partially recovered in others. Improvement, if it can be achieved, usually occurs within 10 to 14 days. Recovery from an ototoxic drug Ear Disorders Caused by Drugs Many drugs can damage the ears (ototoxic drugs). Some ototoxic drugs include the antibiotics streptomycin, tobramycin, gentamicin, neomycin, and vancomycin, certain chemotherapy drugs (for example... read more varies greatly depending on the drug and the dosage. With some drugs (such as aspirin and diuretics), hearing returns within 24 hours. However, antibiotic and chemotherapy drugs often cause permanent hearing loss if safe dosages have been exceeded.

Key Points about Sudden Hearing Loss

  • Why sudden hearing loss occurs is usually unknown.

  • A few people have an obvious cause (such as severe head injury or infection or use of drugs that can damage hearing).

  • In a very few people, sudden hearing loss is the first sign of an underlying disorder.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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