rehabilitative outcomes for affected patients.
What is the purpose of the sudden hearing loss guideline? To provide clinicians with
evidence-based recommendations for the diagnosis, management, and follow-up of patients who
present with SHL. The guideline is intended for all clinicians who diagnose or manage adult
patients (18 and over) who present with SHL. The guideline was developed by a multidisciplinary
panel representing the fields of otolaryngology, otology, neurotology, neurology, family medicine,
emergency medicine, audiology, nurse practitioners, and consumer advocacy groups.
What are the newsworthy points made in the guideline?
1. Prompt and accurate diagnosis is important:
a. Sensorineural ('nerve') hearing loss should be distinguished clinically from conductive
('mechanical') hearing loss.
B. Unusual presentations such as bilateral SSNHL, recurrent SSNHL, or focal neurological
findings (problem with nerve, spinal cord, or brain function) may represent definable underlying
disease and should be managed accordingly.
C. The diagnosis of idiopathic sudden sensorineural hearing loss (ISSNHL), is made when
audiometry confirms a 30 decibel hearing loss at three consecutive frequencies and an underlying
condition cannot be identified by history and physical exam.
2. Unnecessary tests and treatments should be avoided: a. Routine head/brain CT scans,
often ordered in the ER setting, are not helpful and expose the patient to ionizing radiation. b.
Routine, non-targeted, laboratory testing is not recommended. c. The following should not be
routinely prescribed: antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants
to patients with ISSNHL.
3. Retrocochlear workup should be performed in all patients with ISSNHL, regardless of
hearing recovery.
4. Initial therapy for ISSNHL may include corticosteroids. a. Corticosteroids may be
delivered systemically or via intratympanic application. b. Hyperbaric oxygen, currently not FDA-
approved for this indication, may be offered.
5. Doctors should offer intratympanic steroid perfusion when patients have incomplete
recovery from ISSNHL after failure of initial management.
6. Follow-up and counseling is important:
a. Doctors should educate patients with ISSNHL about the natural history of the condition, the
benefits and risks of medical interventions, and the limitations of existing evidence regarding
efficacy.
b. Doctors should obtain follow-up audiometry within six months of diagnosis for patients with
ISSNHL.
c. Doctors should counsel patients with incomplete hearing recovery about the possible
benefits of amplification and hearing assistive technology and other supportive measures.
Provided by American Academy of Otolaryngology