Hearing loss is often a gradual process and associated with ageing, though it can also happen suddenly and at any age. Here Carly Sygrove – Hearing Loss Coach – shares a guest blog about her experience.
Sudden sensorineural hearing loss (SSNHL)
Sudden sensorineural hearing loss is defined as a sudden or rapid loss of hearing, which occurs all at once or within 72 hours. It most commonly affects just one ear but can also affect both. Some people wake up with the loss, often with a sensation of ear pressure or fullness. Others notice a “pop” before their hearing drops. People with SSNHL often experience dizziness, vertigo, or tinnitus at the time of the loss.
Experts estimate that every year one person per 5,000 are affected by SSNHL. The actual number of new cases of SSNHL each year could be much higher because the condition often goes undiagnosed, as some people recover quickly and never seek medical help.
SSNHL Causes
The causes of SSNHL are not fully understood and most cases are thought to be due to viral infections, problems with blood circulation, trauma, or a symptom of an autoimmune condition. For most people affected, the cause of SSNHL is often unknown, with the diagnosis being “idiopathic.”
Treatment for SSNHL
The National Institute for Health and Care Excellence (NICE), which provides evidence-based recommendations for health and care in England, advises treating idiopathic sudden sensorineural hearing loss in adults with steroids.
Steroids may be administered in pill form, intravenously, injected directly into the ear, or a combination of these.
Additional to steroid treatment, other supplementary treatments may include antiviral medication, antibiotics, vasodilators, and hyperbaric oxygen therapy (HBOT).
Patients should be offered an MRI scan to check for any abnormalities in the ear, which can help doctors find the underlying cause of SSNHL. Blood tests may also be performed, to rule out certain causes of the hearing loss.
When to see a doctor
SSNHL is a serious medical condition and should be treated as an emergency, requiring prompt medical attention. Steroid treatment within 24-48 hours of onset is believed to be the most effective and acting quickly is crucial.
NICE recommend that adults with sudden onset or rapid worsening of hearing loss in one or both ears are referred immediately (to be seen within 24 hours) to an ear, nose, and throat (ENT) service or an emergency department. Delaying SSNHL diagnosis and treatment could decrease the chance of hearing recovery.
Recovery for SSNHL patients
Following SSNHL, some people will regain all or partial hearing, and others will have no recovery.
It is estimated that about half of people with SSNHL will recover some or all of their hearing spontaneously, usually within 1-2 weeks from onset. 85% of those who receive prompt treatment from an ENT will recover some of their hearing.
Sudden hearing loss BIHIMA audiologist survey
BIHIMA created a survey to understand the current treatment path for SSNHL patients. Approximately 50 audiologists responded in December 2021, and the findings were as follows:
1. What percentage of patients with SSNHL do you feel receive treatment within 48 hours of onset?
More than 40% of audiologists felt that only around 5% of patients with SSNHL are seen within 48 hours of onset.
Only 5% of audiologists felt that the majority of patients with SSNHL are seen within 48 hours of onset.
These statistics are cause for concern due to the 48-hour optimal window for treatment and may suggest that people are unnecessary ending up with a permanent hearing loss which could have been restored with prompt treatment.
2. Do you have a triage system to help identify possible cases of SSNHL?
Almost 70% had a triage system, meaning that most of the audiologists questioned have a system in place to enable them to give urgent attention to patients who have potentially experienced SSNHL.
3. Where do you refer patients with SSNHL for aftercare?
Generally, the focus here was on the initial referral to A&E or an ENT department for steroid treatment. Also mentioned was follow-up treatment involving practical support such as the fitting of hearing aids.
4. How do you help patients manage the associated emotional effects of SSNHL? Is there a need for a separate service for this?
There were mixed responses to this question, with no standardised approach. Some audiologists are already providing support through ongoing counselling in their clinics. Others make referrals to external services including hearing therapy and counselling.
Some felt a separate service available on the NHS would be valuable, providing interventions such as CBT and support from a psychologist (with training on hearing loss) alongside audiologist input.
5. What do you feel patients with SSNHL need more support with?
In addition to supporting patients in accessing prompt treatment, most responses focussed heavily on the emotional aftercare.
Suggestions of areas for support included the following:
- Anxiety around it happening to the “good” ear
- Adaptation and acceptance
- Managing the mental trauma and addressing the rapid changes caused by SSNHL
- Guidance on a pathway forward, including support with work
- Counselling and reassurance
- Accepting the loss
- The grieving period after being told it’s not coming back
One participant went further, expressing the need for specialised training courses for audiologists that would include knowledge of treatments, protocols, and grief counselling.
“Simply being told to get on with it by a consultant is not good enough,” responded another contributor.
Raising awareness and improving the patient journey
There is an apparent need for emotional aftercare support, for people with SSNHL. Someone who understands the emotional impact of SSNHL is Carly Sygrove, a hearing loss blogger and transformational coach who helps people with hearing conditions move forward in their lives and achieve their goals. Carly also manages an online support group for people with hearing loss and hears from people every day, from around the globe, struggling with the emotional after-effects of SSNHL.
In April 2022, Carly launched the Sudden Hearing Loss Support website, a resource which offers information and support to anyone affected by SSNHL.
The Sudden Hearing Loss Support website
This website offers support in the form of information provided by hearing specialists, links to charity organisations, relevant research, and links to an online support group. It also features a contact page for people to get in touch.
It is regularly updated with blogs written by specialists in hearing healthcare and real-life hearing loss stories. There is also a printable resource section including a SSNHL awareness poster for audiologists and healthcare workers to display in their patient waiting areas.
Though the sudden hearing loss support website is a step in the right direction, there is undoubtedly a need to consider further developing patient rehabilitation services to help with the emotional impact of this little-known yet life-changing condition.
