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What is the treatment for SSHL? Will single ear impairment spread to the the other? Go for steroid treatment?

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ENT Specialist
Practicing since : 1991
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This is an urgent query with reference to my father (63), who is a chronic Type II Diabetes patient, with a history of over 12 years of diabetes. He has been undergoing treatment for Diabetes and is on multiple medication (blood sugar, hypertension) since several years.
The current issue of concern is that he has developed an acute and sudden condition as diagnosed by an ENT specialist, called Sudden Sensonueral Hearing Loss (SSHL). Under this condition, he has lost hearing ability completely from one ear almost within a span of 24 hours. The ENT doctor we consulted today, has mentioned that cause of this SSHL syndrome is either a viral infection or a vascular disorder.

As a background, previously about 3-4 months ago, a doppler test had also confirmed that he has a peripheral vascular blockage in his lower limb (leg) which caused symptoms relating to leg pain on prolonged walking. We were advised angioplasty of the leg to relieve blockage; however considering that he is diabetic and also there was proteinurea observed in blood, some doctors mentioned that angiogram and subsequent angioplasty has inherent kidney risk. Concerned by that, we have not yet had him operated for the vascular blockage. I doubt whether this peripheral vascular blockage is also responsible for this subsequent hearing loss complication. Request your views on this subject.
The key for us is now to seek immediate and rapid intervention to resolve the SSHL hearing loss condition, since the ENT doctor has mentioned that the treatment is only effective, if delivered within 2-3 weeks. As per him, if left untreated for more than 2 weeks, the hearing loss would become irreversible. He has advised an aggressive steroids treatment programme for next 15 days (oral and also intravenous). However, he has also warned that steroids adminstration can cause blood sugar levels to increase substantially. Given the fact that, currently my father's proteinurea condition continues to persist, and his creatinine levels have increased to 1.6, I am concerned whether we should go ahead with the treatment plan of steroids.

I want to take a very informed decision in this regard. In case the risk for going ahead with steroids is very high and could be potentially life threatening, then we would refrain from the same; I have the following key questions :
1. What is the normal course of treatment provided for SSHL (especially considering diabetes complications and steriod treatment impact).
2. Are there any alternative treatments available ?
3. Is the condition so severe that beyond 2 weeks, the hearing loss becomes permanent?
4. In case hearing loss cannot be restored, is it possible to use hearing aids under SSHL ?
5. Currently, he is suffering from a single ear hearing impairment - Is it likely that this will spread to the second ear as well ?
6. In case we do have to go for Steroids treatment, how should one manage diabetes in parallel?
7. Also let us know, if you feel that Angiogram at this stage is advisable for checking further cardio - vascular blockages - Are there other potential risks and threats, we should be concerned at this stage?
8. Finally, with steroids, what are the chances of the condition getting resolved?

This is a long list of queries; however to make a swift and informed decision, I would seek expert opinion on these concerns.

Request you to please help me.

Posted Wed, 23 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. SSNHL is a medical emergency. The normal course of treatment provided for SSHL in a non diabetic is:
a. IV Methylprednisolone (steroid): 1 gm/day x 3-5 days, then oral 1 mg/kg/day x 4 weeks, (tapered)
b. Acyclovir 800 mg 5 x / day (anti-viral)
c. IV Lomodex 12 hrly (blood thinning agent)
d. Tab Trental (Pentoxyfyiline) 400 mg OD (rheologic or blood flow improvement)
e. Tab Nootropil (Piracteam) 400 mg OD (neural tonic)
f. Cap Palsinuron (empirical ayurvedic)
g. Tab Kyrab-D (anti acidity & reflux)
h. Carbogen (vasodialtor)
i. Hyperbaric Oxygen Therapy (HBOT), if available.

In the of diabetes the option of high dose steroids becomes a problem if the sugar levels are not under control.

2. The alternative treatment is transtympanic (intratympanic) steroids.

3. Whether it will become permanent:
a. The Therapeutic window is 4 to 6 weeks.
b. It is usually unilateral (one sided) in over 95% cases.
c. Spontaneous recovery occurs in 65% cases within 20dB or greater than 50% of total loss.
d. Prognosis is always guarded
e. It is Idiopathic in 85-90% cases (cause remains unknown)
f. 50% recovery usually occurs in the 1st 2 weeks + (this is a good sign)
g. Early detection is important.
h. Most of the treatment is empirical.
i. Side effects of Rx is an important consideration.
j. No treatment is an option
k. Treatment Cost is high. MRI Scanning is advised.

4. Rehabilitation includes the option of no treatment.
a. Hearing aids are difficult to use in Single Sided Deafness (SSD) as one ear is normal and the other has profound hearing loss if the condition is permanent.
b. Bone anchored hearing aids (BAHA) is an option. Traditional BAHA devices use an external Titanium Abutment. These include Cochlear and Oticon.
c. Sophono (Otomag) alpha 1 M is a new type of BAHA without an abutment.

5. Bilateral SSNHL is rare (less than 2-5% cases). No one can answer the question whether it will happen again or in the other ear. Diabetes and hypertension damage vessels and nerves throughout the body. Hence neural damage and clots from the vascular blockages will always carry a risk of this (or worse) happening again.

6. In you do have to go for Steroids as a treatment the dose will have to be reduced with frequent blood sugar and blood pressure monitoring. I recommend intra tympanic steroids instead.

7. The decision regarding the an angiogram is best left to the treating physician or cardiologidt.

8. Finally, with steroids, the chances of the condition getting resolved is around 50%. Prognostic factors are:
a. Timeline
b. Age
c. PTA (Pure Tone Audiogram)
d. Vertigo
e. Tinnitus
f. Co-morbidity such as diabetes, hypertension and vascular blockages releasing clots or micro-embolic fragments.

9. The blood tests include:
a. Hb, CBC
b. ESR
d. Thyroid Function Tests
e. Coagulogram
f. Homocysteine levels
i. HIV, Hepatitis panel
j. Lipid Profile

10. You may share your investigation and progress reports here for more specific treatment and rehabilitation options.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.

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