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Wednesday, July 27, 2022

Sudden hearing loss

First10 EM - By Justin Morgenstern - July 25, 2022
The Paper: Chandrasekhar SS, Tsai Do BS, Schwartz SR,et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg. 2019 Aug;161(1_suppl):S1-S45. doi: 10.1177/0194599819859885. PMID: 31369359.
Emergency Medicine translation
In a patient with sudden hearing loss, your job is to distinguish between conductive and sensorineural hearing loss. For sensorineural hearing loss, conduct a thorough history and physical, but barring abnormalities, you should not order lab testing or imaging. Our primary job is to counsel patients, with the understanding that almost all cases are idiopathic, and that about half resolve on their own, but that there is a risk of permanent hearing loss and tinnitus. The evidence for treatment is mixed and inconclusive. Steroids might be used, and in certain centers hyperbaric oxygen is considered. Talk with your local ENT group to determine their preference, but based on the low quality evidence discussed, I doubt that either helps.. Urgent follow-up is key, as these patients need urgent audiometry, but also may benefit from procedures such as intratympanic steroids.