Brief Answer:
SSNHL is a medical emergency.

Detailed Answer:
Hi,

Thank you for your query.

1. This appears to be a SSNHL ( Sudden Sensorineural Hearing Loss ) following acoustic trauma (exposure to loud noise ). It may be a NIHL ( Noise Induced Hearing Loss ) superimposed on a Presbyacusis (age related hearing loss) as this has happened on both sides. (SSNHL is usually one sided ).

2. Repeat an Audiogram with masking.

3. Any Temporary Threshold Shift in hearing usually recovers in 48 to 72 hours.

4. There is always a possibility of some spontaneous improvement, but treatment should be started immediately.

5. Write back if you need details about the treatment and further options.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

---

Brief Answer:
Details discussed below:

Detailed Answer:
Hi,

Thank you for writing back.

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 Rekool-L (anti acidity & reflux)
h. Carbogen (vasodialtor)
i. Hyperbaric Oxygen Therapy (HBOT), if available.

The blood sugar levels should be brought under control.

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. Bilateral SSNHL is rare (less than 2-5% 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 and CT Scanning is advised.
l. Recurrent or progressive ISSNHL may be due to inner ear defects.

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 or an internal magnetic coupling. These include Cochlear, Medtronic (Sophono / Otomag) and Oticon.

5. Transtympanic steroids, Carbogen and HBOT, if available can be used as a salvage procedure. Transtympanic (intratympanic) steroids may be continued for a total of five to six weeks. Anivirals can be added to the TTS.

6. Tinnitus may be treated later with (Tinnex) Caroverine Injection and Capsules.

7. 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). Repeat a PTA with masking.
d. Vertigo
e. Tinnitus
f. Co-morbidity such as diabetes, hypertension and vascular blockages releasing clots or micro-embolic fragments.

8. 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. RF (h/o childhood arthritis)
i. HIV, Hepatitis panel
j. Lipid Profile (high triglycerides)

9. You may follow up here or directly at bit.ly/Dr-Sumit-Bhatti with the test results and progress reports.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

---