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Dr. Andrew Rynne

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Diagnosed with moderate sensorineural hearing loss. Will it be cured?

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Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2565 Questions

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Posted on Tue, 11 Dec 2012 in Ear, Nose and Throat Problems
Question: I am 34 years old Male and I was diagnized with Sensorineural hearing loss with moderate loss on my left ear 3 months back. I also have a slight loss on my right ear. While I initially took the steroid treatment, nothing helped. Later I started the Ayurvedic treatment. I am also having tinittus. A week back suddenly I was able to hear well from that left hear. But that losted only for two days and went back to where it was before. I am currently using hearing aid but does not help in lot of situations. Will this ever come back to normal?
doctor
Answered by Dr. Sumit Bhatti 1 hour later
Hi,

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.

The triglyceride levels should be brought under control. The childhood arthritis should be investigated.

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

3. Whether it will ever come back to normal:
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).

6. I recommend that you take transtympanic steroids, Carbogen and HBOT, if available as a salvage procedure, even though 3 months have passed. This is especially because you did experience a sudden improvement for a couple of days. (though there is no explanation for this occurence).
Transtympanic (intratympanic) steroids may be continued for a total of five to six weeks.

7. What Ayurvedic treatment are you on? Tinnitus may be treated later with (Tinnex) Caroverine Injection and Capsules. This may be discussed later.

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
c. BSL, BUL, SE
d. Thyroid Function Tests
e. Coagulogram
f. Homocysteine levels
g. VDRL
h. XXXXXXX XXXXXXX RF (h/o childhood arthritis)
i. HIV, Hepatitis panel
j. Lipid Profile (high triglycerides)

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.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 4 days later
I have attached all the reports this time. 01 first report.jpg gives the original report with Sensorineural hearing loss on my left ear. Couple of days back this has happend to my right ear now. 02 left.jpg and 03 right.jpg will give the latest report taken two days back. I was of the impressions that SNHL happens only to one year. Now this has happend to my second ear also.

I went to ENT and she 03 and 04.jpg gives the diagnosis with injections for right ear. Yesterday I took one injection and it has been better in that ear. I will be continueing for 3 more injections in the alternate day interval.

I have done all the blood tests what you have mentioned. Except B12 which is around 238 rest all is normal.

I'm confused what has caused this. Do I need to be more worried. Does the injection help to recover for long term?

- Since it's neural, Do I need to consult nerologist to get to know if there is something else going on?
- What are the possibilities that it will further go down?
- Should I go back and ask for the injection to my left also keeping recently it had some improvement?
doctor
Answered by Dr. Sumit Bhatti 26 hours later
Hi,

Thank you for writing back.

1. I have gone through the attached reports.

2. Transtympanic Steroids (Intratympanic Steroids) is a good option. You should complete the course, especially as you are showing improvement.

3. It is good to hear that your blood tests are normal. Idiopathic (ISSNHL) which means that the cause is unknown. In your case the viral fever may have been responsible.

5. You may consult a Neurologist. There is never any harm in a second opinion.

6. It is not possible to predict whether there will be any deterioration in the future. I have mentioned the prognostic guidelines in the above answer.

7. You may take the injections in the left ear after the course of the right ear is complete as there is a slight risk of a dead ear. Mean while you may take Carbogen or HBOT (Hyper Baric Oxygen Therapy) which will benefit both ears.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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