THE CASE PRESENTATION OF SENSORINEURAL HEARING LOSS

1. +
WELCOME TO ALL IN
15TH CLINICAL
CONFERENCE
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2. Presenter:- Suraj Patel
SUDDEN SENSORINEURAL HEARING LOSS
- A case presentation
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3. DEFINITION
Sudden sensorineural hearing loss is defined as subjective sensation of hearing
impairment in one or both ears developing in hearing of more than or equal to
30 dB on 3 consecutive frequency in comparison to normal ear on audiometry
- National institute on deafness and other communication disorder (NIDCD)
Sensorineural hearing loss (SNHL) occurring within a 3-day period or less.
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4. INTRODUCTION
The term sudden sensorineural hearing loss (SSNHL) was introduce in 1944 by
DeKleyn.
Sudden sensorineural hearing loss (SSNHL) is one of the most perplexing and
controversial unsolved mysteries in otology. SSNHL is medical emergency for which
definite diagnosis and treatment is still largely unknown..
Most patients report onset of hearing loss within minutes to several hours. About one-
third of patients will awaken with the loss; others may discover the problem when
they try to use the telephone, or may describe a brief period of fluctuating
hearing.before the loss.
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5. About 50% of patients complain of concomitant unsteadiness or vertigo.
Sudden hearing loss is most likely a symptom rather than a discrete disease,
merely representing the end result of many insults to the inner ear.
The hearing loss often starts as a sudden drop in hearing in one ear most
frequently.
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6. INCIDENCE AND PREVALENCE
~15000 reported
cases/ yr world
wide
1/10000-15000
India
Highest incidence
50-60 yrs
Lowest incidence
20-30yrs
2% are bilateral
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7. Etiology
IDIOPATHIC
INFECTION
VASCULAR
AUTOIMMUNE
NEOPLASTIC
TRAUMA
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8. Infections
• Mumps
• Herpes zoster
• Meningitis
• Encephalitis
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9. Vascular
Sickle cell
disease
Macrogobulinemia
Cardiopulmonary
bypass
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10. Trauma
Temporal bone fracture
Barotrauma
Perilymph fistula
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11. Autoimmune
Autoimmune inner ear disease
Cogan 'syndrome
Lupus
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12. Neoplastic
Acoustic neuroma
Leukemia
Myeloma
Migraine
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13. Vascular occlusion ,
thrombosis, haemorrhage
& vascular spasm
Histopathology
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14. Occlusion of the cochlear artery cause
immediate loss of hearing that become
irreversible within minute.
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15. Viral infection can cause hair cell loss, ganglion cell loss, strial atrophy &
inflammatory viral cochleitis.
Viral insult can cause direct neural injury, direct vascular structure injury & direct
injury to erythrocytes , leading to secondary micro vascular insufficiency.
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16. SIGN AND SYMPTOMS
Tinnitus Vertigo
Fullness
of ear
Unilateral
hearing
loss
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17. 17
ASSESSMENT AND
MANAGEMENT
WITH SUDDEN
SENSORINEURAL
HEARING LOSS

18. AUDIOLOGICAL EVALUATION
• PURE TONE AUDIOMETRY
• IMPEDANCE AUDIOMETRY
• OTO-ACOUSTIC EMMISION
• AUDITORY BRAIN STEM RESPONSE
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19. PURE TONE AUDIOMERTY
 Flat neurosensory hearing loss (40%)
 High frequency neurosensory hearing loss (30%)
 Low frequency neurosensory hearing loss (20%)
 Profound or total neurosensory hearing loss. (10%)
 Speech intelligibility may be consistent with the pure tone thresholds as in
case of cochlear losses or may be abnormally poor as in retrocochlear
losses. (Jerger, 1974)
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20. I Impedance Audiometry
 Tympanometry– Usually ‘A’ type tympanogram .
 Acoustic reflexes – elevated or may be absent .
(Jerger,1974)
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21. OTO ACOUSTIC EMISSION
 If the hair cells or the source of the end cochlear potential affected,
reduced or absent DPOAE.
 If DPOAE are retained and hearing is impaired, the lesion may be retro
cochlear (Moore et al1996)
 The presence of initial DPOAE responses indicated good prognosis, the
absence of initial DPOAE responses did not always indicate poor prognosis
(park, lee park kim na & shin ,2010).
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22. Auditory Brainstem Response
Auditory brainstem response (ABR) testing should be performed if a retro
cochlear site of lesion is suspected.
In the usual case of idiopathic sudden SNHL, ABRs are absent with severe
hearing loss and attenuated with lesser degrees.
(Gstoettner, 1993).
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23. MANAGEMENT
MEDICAL
MANAGEMENT
AUDIOLOGIC
MANAGEMENT
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24.  Corticosteroid drugs such as prednisone is used to reduce swelling,
pain, and other symptoms of inflammation
 Vitamin D is given orally.
 Control the immunologically mediated vasculitis by inhibiting cytocrine
secretion
 Act on hair cells & cochlear vessels
MEDICATION
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25. INTRA -TYMPANIC
 Balance inner ear fluids
 Restore endocochlear potential and stria vascular is morphology
 Greater concentration of drugs in the perilymph
 Minimizes systemic effects and absorption
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26. TRANS- TYMPANIC
 The inner ear is isolated physically and anatomically from the
remaining part of the body by a labyrinth-blood barrier
 The possibility of delivering drugs directly to the inner ear
allows a more target-specific treatment
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27. Diuretic
 Diuretics or diuretics like medications actually can decrease fluid
pressure load in the inner ear.
 Hydrochlorothiazide , acetazolamide .
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28. Hyperbaric Oxygen
• Increases oxygen concentration in all body tissues
• Stimulates the growth of new blood vessels & improving blood flow to areas with
arterial blockage
• Increased blood vessel diameter and in antioxidants
• Aids the treatment of infection
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29. General measures
• Low salt diet
• Avoid caffeine, nicotine and alcohol
• Avoid exposure to noise
• Enjoy a well balanced diet
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30. Surgery
Perilymph fistula,
If any history of recent trauma/ barotrauma
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31. Audiological
management
BTE
CROS
BAHA
Assistive
Listening
Devices
Cochlear
Implants
Speech
Reading
&/or Hearing
Therapy
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32. BTE
Larger amplifier for severe-profound hearing losses
Less feedback (whistling) due to better seal
Easier to handle
All types of hearing losses
All ages
Most amplification
Cosmetically appealing
Larger batteries which are easier to handle
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33. CROS
No surgical procedure required
Provides hearing for sounds coming from deaf ear side
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34. BAHA
Discreet and can easily be hidden in the hair
Does not occlude the other hearing ear
Can evaluate benefits before having the surgery
Hearing for sounds coming from deaf ear side
No need to wear connecting headband, earmold or wire
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35. ALD
Amplified Telephones, Alerting Systems, TV Listening Systems, Personal Amplifiers,
FM Listening Systems, Infrared Systems, Vibrating Alarm Clocks and Watches,
Chatterbox and Tour Guide Systems.
An ALD can be used with or without hearing aids .
Hearing aids + ALDs = Better listening and better communication
Overcome the negative effects of distance, background noise, or poor room
acoustics
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36. COCHLEAR IMPLANT
 Small, complex electronic device
 Severe or profound hearing loss where hearing aids are unable to
provide benefit.
 Sound is picked up and processed by the sound processor -
electrically stimulated, restoring the sensation of hearing
 Compensates for the destruction of the hair cells by routing the
signal directly to the auditory nerve
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37. PROGNOSIS
Age
Time since
onset
Audiogram
type
Vertigo
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38. • 12345 Case Number
• 55 yrs /Male Age / Gender
• Gujarati Language
• Power loom Occupation
• 19-12-2018 Re-evaluations
Case demographic details
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39.  C/o reduced hearing sensitivity.
 Tinnitus in right ear
 Since 3 days
 Progressive and sudden
 Medical history was unknown
Complaint
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40. Hard of hearing
since 3 daysComplaint
SSNHLProvisional
Diagnosis
Audiological
evaluation
Recommen-
dations
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41. Pre- evaluation audiogram 03/12/18
RE:PROFOUND HEARING LOSS
LE:MODERATE SENSORINEURAL HEARING LOSS 41

42. EAR CANAL
VOLUME
STATIC COMPLIANCE MIDDLE EAR PRESSURE
RE 1.78 0.66 - 25
LE 1.6 0.57 - 25
Pre evaluation IA/AR
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IPSILATERAL CONTRALATERAL
RIGHT EAR ABSENT ABSENT
LEFT EAR ABSENT ABSENT
Impression :
•Bilateral (?) indication of normal middle ear function.

43. • Betahistine – 16mg
• Vertin
• B-complex +floric acid
medications
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44. Re- evaluation audiogram 19/12/18
RE:MILD SENSORINEURAL HEARING LOSS
LE:MODERATE SENSORINEURAL HEARING LOSS 44

45. EAR CANAL
VOLUME
STATIC COMPLIANCE MIDDLE EAR PRESSURE
RE 1.60 0.60 - 10
LE 1.97 0.71 - 20
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IPSILATERAL CONTRALATERAL
RIGHT EAR ABSENT ABSENT
LEFT EAR ABSENT ABSENT
Impression :
•Bilateral (?) indication of normal middle ear function.
Post evaluation IA/AR

46. AUDIOLOGICAL MANAGEMENT
Counselling was done.
Importance of Binaural amplification.
Head shadow effect, and binaural squelch effect.
Recommended for binaural BTE
Hearing protection device
Compensation from employer
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48. USE OF COMMUNICATION STRATEGIES
 Talk about your problem
 How to cope up with difficult listening situations:
• Adequate Light enhancing speech reading
• Request for speaking Naturally
• Avoid Noisy Situations
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