Sudden sensorineural hearing loss – Sudden Deafness

Ross Hauser, MD

There is controversy in regard to the optimal management or treatment of sudden sensorineural hearing loss because frequently spontaneous recovery or remission occurs. It is likely that as you are reading this article you have either had deafness come on suddenly, as the diagnosis implies and you are now learning about this problem, or the deafness comae on suddenly and you are still experiencing lingering problems.

People will contact our center with a medical history that goes something like this:

They tell me it is an ear stroke but I can hear during chiropractic adjustments

I experienced sudden onset hearing loss (SSHL) with complete deafness in my right ear. Over the past few months I have been to many specialists, had many tests including MRIs, MRAs, CTA (Computed Tomography Angiography) scans and more. I have been prescribed oral steroids, I have had steroid injections in my ear drum, I have tried hyperbaric chamber and more. Nothing helps except maybe chiropractor. I have had to major traumatic injuries to my right side. I have a history of migraine, shoulder pain and injury and now a spine doctor is showing bone spurs and straightening of c spine.

ENTs and Neurologist are telling me I had an ear stroke but it just doesn’t make sense when the only time sound enters that ear is during a chiropractic adjustment. I feel strongly that it’s a structural issue and not an ear stroke.

Chronic sudden hearing loss

I am 59 years old in other wise good health. I have the sensation of fullness, pressure, deafness, headaches, and tinnitus high and low pitch. I have had these symptoms before. MRIs revealed nothing, ENT advised me to have no treatments and see if the symptoms would go away by themselves. Symptoms slowly disappeared over several weeks. The symptoms have now returned and they are staying. My doctor is following the same path as before and I am being referred to an ENT and I’m afraid this will amount to nothing. I am exploring the idea that this is a cervical spine issue.

Extensive symptomology following fusion

In many people we see, sudden or worsening deafness is not a symptom of its own. It comes among many other newly developing symptoms. For example this is a type of story we hear:

I had a C3/4 C6/7 discectomy and fusion almost ten years ago. The last year or so I have had new symptoms of vertigo, deafness to the point that I now use hearing aids. Tinnitus, sudden deteriorating vision, anxiety and depression, and heart palpitations.

Treatment

The subject of this article is to present evidence that sudden sensorineural hearing loss may be brought on by cervical spine instability. For the patient this evidence is present once a medical examination cannot find a more obvious cause to your problem such as infections or autoimmune dysfunction.

Many people respond to corticosteroids. These are the people we do not usually see at our center, we usually see the people who have had this treatments and results may have been short-term or not at all and corticosteroid was considered a failed conservative therapy. As mentioned in one patient story above, people can get oral steroids or an injection into the eardrum.

People who have a history of impact injuries to the head and neck or display other neurologic-like symptoms such as other ear problems, vision problems, swallowing difficulties may be considered likely of hearing loss induced cervical spine instability.

Concerns over ear drum injections

A September 2021 paper in the American journal of otolaryngology (1) examined the incidence of complications in sudden sensorineural hearing loss (SSNHL) patients treated with intra-tympanic (ear drum) steroid injection (ITSI) and compared hearing recovery rates.

Results:

More on cortisone

A February 2018 study (2) authored by Stefan K. Plontke of the Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle suggests that “(Research) with respect to the therapy of sudden hearing loss is very unsatisfactory – regarding the quality, not the quantity of trials. There is an existing rational basis for the treatment of acute cochlea-vestibular disorders with corticosteroids. The value of systemically applied corticosteroids in the initial treatment of sudden hearing loss (international standard with low/ medium systemic doses) remains unclear.”

Ginkgo biloba and cortisone

It has been suggested that Ginkgo biloba leaves extract may offer pharmacological effects against sudden sensorineural hearing loss. An August 2021 study in the Journal of ethnopharmacology (3) examined past research comparing Ginkgo biloba leaves extract plus corticosteroids with corticosteroids alone for sudden sensorineural hearing loss treatment.

Concerns surrounding antidepressants

Many people that come to us have a long history of chronic health issues. For many of them this has resulted in the prescription of anti-depressants. In some people we see, not all, the antidepressant medication has lead to a worsen of their situation. A March 2021 study in the International journal of epidemiology (4) suggested that “antidepressants increased sudden sensorineural hearing loss risk, regardless of their class. Furthermore, patients who took a higher number of antidepressant classes showed an increased risk of developing sudden sensorineural hearing loss than those who took a lower number of antidepressant classes. Therefore, physicians should estimate the risks and benefits of antidepressant use and avoid prescribing antidepressants concurrently.”

Is sudden sensorineural hearing loss a problem of cholesterol?

There has been much speculation in the medical community that sudden sensorineural hearing loss is caused by cardiovascular disorders. A July 2021 study in the International archives of otorhinolaryngology (5) did not observe a significant correlation between the concentration of Thiobarbituric acid reactive substances (the presence of oxidized fatty acids) in the peripheral blood or the presence of arterial hypertension and the severity of the initial hearing loss or the prognosis of hearing recovery in patients with sudden sensorineural hearing loss. The study authors conclude: “The concentration of Thiobarbituric acid reactive substances in the peripheral blood may not adequately represent the abnormalities that occur in the intracoclear environment.” Possibly that this is not a cholesterol problem. This is taken on set further below after a brief discussion about oxygen.

Hyperbaric oxygen therapy

A December 2017 paper in the journal Medicine (6) offered a case history of a 44-year-old woman who had “abrupt hearing deterioration in the left ear with the sensation of aural fullness and loud tinnitus presented for 48 hours.” The patient received oral high-dose corticosteroids combined with Hyperbaric oxygen therapy that included 15 daily 1-hour exposures to 100% oxygen at 2.5 atmosphere absolute. (The pressure of the delivered oxygen).

The case history authors describe the rationale for the use of Hyperbaric oxygen therapy to treat sudden sensorineural hearing loss citing “that the cochlea (auditory inner ear) and the structures within it, particularly the stria vascularis and the organ of Corti (that part of the inner ear that produces nerve impulses in response to sound vibrations) require a high oxygen supply. However, the direct vascular supply, particularly to the organ of Corti is minimal. . . It is quite well documented in literature that patients receiving Hyperbaric oxygen therapy had statistically significant hearing gains across all frequencies, with tinnitus patients showing the greatest hearing improvement. . . Some authors consider that Hyperbaric oxygen therapy therapy should be used to treat acute hearing deterioration only if patients do not recover their hearing ability following conventional treatment.”

Some people who contact us have had Hyperbaric oxygen therapy with limited or no results. Every treatment, even those we offer, will not help everyone. Treatments are selected based on each patient’s best chance of success with that treatment.

Oxidative stress, oxygen and microvascular circulation

Let’s briefly return to the above study mentioned in the cholesterol segment. The researchers of this article write: “Oxidative stress induced by ROS (Simply Reactive oxygen species (ROS) is a chemical reaction that leads to oxidant damage) and disruption of the redox status (the balance between oxidants and antioxidants) have been reported to play a pivotal role in the cardiovascular, cerebrovascular and inner-ear systems. Several inner-ear pathologies, including acoustic trauma, sudden sensorineural hearing loss, presbyacusis (age-related hearing loss) and Meniere disease are hypothesized to involve dysfunction of the microvascular circulation (the circulation of blood into the smallest blood vessels).

Is it a problem in the neck? Vertebrobasilar insufficiency?

Over the many years of helping people with cervical instability problems, we have come across people who have a myriad of symptoms that seemingly go beyond the orthopedic, musculoskeletal, and neuropathic pain problems commonly associated with cervical spine disease. While many patients can understand that cervical instability can cause problems with pinched nerves and pain and numbness that can extend down into the hands or even into the feet, they can have a lesser understanding that their cervical spine instability also pinches on arteries and disrupts, impedes and retards blood flow into the brain.

A July 2016 research paper in the Journal of the American Medical Association otolaryngology, head & neck surgery (7) offered these connections between Vertebrobasilar insufficiency and Sudden sensorineural hearing loss.

“The etiology of Sudden sensorineural hearing loss is unclear but is likely multifactorial. Some of the proposed mechanisms include infection, autoimmune conditions, vascular insufficiency, and rupture of the labyrinthine membrane (ear drum). Evidence suggests that there is a significant association between vascular events, such as thromboembolism, weak blood circulation, and vasospasm, and the development of Sudden sensorineural hearing loss.

The vertebrobasilar system, which includes the two vertebral arteries and the basilar artery, perfuses the medulla, cerebellum, pons, midbrain, thalamus, and occipital cortex. Vertebrobasilar insufficiency can lead to a wide variety of symptoms, such as vertigo, visual disturbances (blurring, graying, and diplopia), drop attack, numbness or tingling, slurred or lost speech, confusion, and swallowing disturbance, mainly owing to impaired perfusion of the cerebellum, brainstem, and occipital cortex.

Vertebrobasilar insufficiency is normally caused by insufficient collateral circulation owing to atherosclerotic stenosis of the subclavian, vertebral, or basilar arteries but can also be owing to other causes, such as compression of vertebral arteries by cervical spondylosis or subclavian steal syndrome (a phenomenon of flow reversal in the vertebral artery.)

I have a comprehensive article on the subject of  Treating Vertebrobasilar insufficiency, vertebrobasilar artery insufficiency, rotational vertebral artery occlusion syndrome, or Bow Hunter Syndrome. Highlights of that article are summarized here:





The complexity and challenges of cervical neck instability treatment are fully displayed in the controversies and confusions surrounding the diagnosis of vertebrobasilar insufficiency, also called vertebrobasilar artery insufficiency, rotational vertebral artery occlusion syndrome, or Bow Hunter Syndrome. The fact that this one diagnosis or description of symptoms is known by at least four diagnostic names should be evidence enough that patients and their doctors are sometimes not sure what they are dealing with.

When they went to their primary care physician, the patient tells us, the doctor started to suspect that they, the patient, were having some sort of blockage of blood to the brain.

In this video Ross Hauser, MD discusses general problems of ear pain, ear fullness, sound sensitivity, and hearing problems.

Below is the transcript summary and explanatory notes:

 

References

1 Hu CY, Lien KH, Chen SL, Zhang BY, Chan KC. Complications and prognosis associated with intra-tympanic steroid injection to treat sudden sensorineural hearing impairment. American Journal of Otolaryngology. 2021 Sep 10:103221. [Google Scholar]
2 Plontke SK. Diagnostics and therapy of sudden hearing loss. GMS current topics in otorhinolaryngology, head and neck surgery. 2017;16. [Google Scholar]
3 Si X, Yu Z, Ren X, Huang L, Feng Y. Efficacy and safety of standardized Ginkgo biloba L. leaves extract as an adjuvant therapy for sudden sensorineural hearing loss: A systematic review and meta-analysis. Journal of Ethnopharmacology. 2021 Aug 30:114587. [Google Scholar]
4 Zhong PX, Li I, Shih JH, Yeh CB, Chiang KW, Kao LT. Antidepressants and risk of sudden sensorineural hearing loss: a population-based cohort study. International Journal of Epidemiology. 2021 Mar 20. [Google Scholar]
5 Elias TG, Monsanto RD, do Amaral JB, Oyama LM, Maza PK, Penido ND. Evaluation of oxidative-stress pathway and recovery of sudden sensorineural hearing loss. International archives of otorhinolaryngology. 2021 Sep 13;25:428-32. [Google Scholar]
6 Alex-Zarychta D. Successful treatment of sudden sensorineural hearing loss by means of pharmacotherapy combined with early hyperbaric oxygen therapy: Case report. Medicine. 2017 Dec;96(51). [Google Scholar]
7 Hsu YH, Hu HY, Chiu YC, Lee FP, Huang HM. Association of sudden sensorineural hearing loss with vertebrobasilar insufficiency. JAMA Otolaryngology–Head & Neck Surgery. 2016 Jul 1;142(7):672-5. [Google Scholar]

 

 

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