Treatment of sudden sensorineural hearing loss in adults

All patients with SSNHL should have a clinical evaluation for the common causes of sensorineural hearing loss including infections, ototoxic drugs, acoustic schwannoma, malignancy, head trauma, barotrauma, loud noise exposure, autoimmune disease, vasculitis, cerebrovascular disease, inner ear hemorrhage, Meniere disease, otosclerosis, Paget disease, multiple sclerosis, sarcoidosis, hypothyroidism, and idiopathic SSNHL. All patients with SSNHL should undergo imaging (MRI with contrast preferred) within 3 months of symptom onset to evaluate for retrocochlear pathology.

dB: decibel; SSNHL: sudden sensorineural hearing loss; MRI: magnetic resonance imaging.
* Intratympanic dexamethasone dose; approximately 0.5 mL (5 mg) of a 10 mg/mL solution.
¶ Although there is a lack of evidence supporting the routine use of antiviral therapy in idiopathic SSNHL, we will treat with valacyclovir (1 g orally 3 times daily for 7 to 10 days) within 48 hours of symptom onset, as there may be a potential benefit and the risks of treatment are low.
Δ Hyperbaric oxygen therapy may be used as an adjunctive treatment with salvage glucocorticoids for patients with more profound (>70 dB) hearing loss. Hyperbaric oxygen therapy may be limited by availability, insurance coverage, and out-of-pocket costs.

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Treatment of sudden sensorineural hearing loss in adults