I was chatting with our founder, Dr. Matt Bromwich, over lunch yesterday. He told me about an interesting case that he had seen in the E.R. that week, and I thought it was important to share. I had never heard of Sudden Sensorineural Hearing Loss (SSNHL) before. My guess is that I’m not the only one.
He said that a woman made the trip to the hospital when she suddenly experienced hearing loss in one of her ears. I’d like to think that we would all do the same, but truth be told, I think I might ignore it for a few days assuming it would just go away. Not a good idea.
As it turns out, for most patients we never discover the cause of Sudden Sensorineural Hearing Loss but it is often thought to be related to viral infections that can cause inflammation of the nerves of hearing and balance (housed in the temporal bone). If left untreated, hearing loss could become permanent! And it’s not that uncommon. Roughly 5 of every 100,000 people between 20 – 30 years of age will experience it. Incidence increases with age, rising to almost 16 of every 100,000 between 50 – 60 years old. It doesn’t discriminate by gender.
The typical course of treatment is high-dose systemic steroids. Here’s where the story gets interesting.
This woman just so happened to have recently had a baby and was breastfeeding her newborn. The conventional course of oral steroid treatment wasn’t an option for her. Her choices were to do nothing and risk permanent hearing loss or opt for a much more invasive treatment called intratympanic injection. Exactly as it sounds – a needle to the middle ear! The physician would first anesthetize the eardrum, then make a small incision and inject the steroid directly into the middle ear space.
This process has a very high incidence of efficacy, but because the process is so invasive, you want to be 100% certain of the diagnosis before proceeding. SSNHL is a condition that is defined by specific clinical signs and symptoms. People suffering will present with a minimum of 30dB of hearing loss across at least 3 sequential frequencies, and to be considered sudden it must occur within a period of 3 days.
Here’s the kicker. She went to the E.R. late on a Friday afternoon and the hospital’s Audiology Clinic was closed for the weekend. Waiting until Monday to confirm the diagnosis meant running the risk of losing her hearing for good. Lucky for her, the resident was a student of Dr. Bromwich’s and was familiar with SHOEBOX Audiometry. He brought the iPad audiometer to her in the E.R. and conducted the hearing test at her bedside. Using the system in its automated mode, he could confirm with confidence that she did indeed have at least 30 dB of hearing loss over 3 frequencies. With that, they decided to proceed with the injection treatment.
I’m told that she is recovering well and is seeing an audiologist for follow-up treatment – which is fantastic news. I also think she was very fortunate. Here is what I took away from this story.
Never ignore a change in hearing. Whether your ears are ringing, you feel dizzy, or simply notice that you need to turn up the volume – call your doctor right away. If people start telling you that you are talking too loud, or you need to be facing the person speaking to be able to hear them – call your doctor right away. And if you notice a sudden change in your hearing – make an appointment to see your doctor right away.
In my ideal world, every family physician and hospital E.R. would be using SHOEBOX Audiometry so that in cases like this a clinically valid hearing test could be performed by anyone, almost anywhere. Wouldn’t it be a shame if even one person lost their hearing permanently because the clinic was closed for the weekend?
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