How is sudden hearing loss treated?

If hearing loss is mild and hardly causes any problems, doctors usually recommend waiting a few days. That’s because your hearing sometimes returns on its own, especially if the hearing loss is mild and only affects low or mid-range frequencies. If the hearing loss doesn’t get better in that time, treatment is recommended.

But there are situations where experts recommend examining the ear and giving treatment within one to two days – namely if

• the hearing loss is severe and/or distressing,
• you already have another ear problem, or
• you also feel dizzy.

If the dizziness is very bad, it’s a good idea to see a doctor on the same day if possible.

Sudden hearing loss is usually treated with steroid medications known as glucocorticoids. These medications reduce inflammation. Active ingredients such as prednisolone and dexamethasone are often simply referred to as cortisone.

The medication is usually taken in the form of tablets. Alternatively, it can be injected directly into the ear – for instance, if treatment with tablets doesn’t help enough or causes severe side effects. Tablets and injections in the ear can also be combined. In rare cases, the active ingredient is injected straight into a vein, like in the arm.

People who are prescribed tablets take them for several days. If the symptoms don't improve enough in that time, they can take the tablets for longer.

If a steroid medication is injected, the ear is numbed first. This can be done using a small sponge that is soaked in anesthetic. The sponge is inserted into the ear canal and placed on the eardrum. The doctor then uses a fine needle to inject the steroids through the eardrum into the middle ear. That takes a few seconds. The injection leaves a small hole in the eardrum that normally soon closes up on its own. The medication is then close to the middle ear. For the steroids to work properly, it’s important to stay lying down for about 20 minutes on the side that has not been treated. The treatment is repeated about 4 to 6 times, with a few days between each injection.

Hearing tests are done after the treatment to check whether your hearing has improved.

Sudden hearing loss can often be treated on an outpatient basis (without a hospital stay). But experts recommend hospital treatment in certain situations – for example, if

• you have very severe hearing loss or you can no longer hear anything at all,
• outpatient treatment doesn't help,
• your hearing loss gets worse despite outpatient treatment, or
• you have certain other diseases, such as those affecting your nervous system, mental health, metabolism or cardiovascular system (heart and blood vessels).

There is not enough good research on the effectiveness of steroids in the treatment of sudden hearing loss. So it’s not possible to reliably say how many people’s hearing is improved by the medications – and by how much.

But past studies suggest that steroid tablets and injections are similarly effective. Steroid injections into the middle ear can still slightly improve your hearing if treatment with tablets hasn’t helped, though. It is not clear whether combining these two approaches has any advantages. There is a lack of research on whether the medications also relieve accompanying symptoms such as tinnitus or dizziness. Treatment with steroid medications – whether as tablets, infusions or injections into the middle ear – is usually not covered by statutory health insurers in Germany.

Like any treatment with medication, treatment with steroids can have side effects. But based on the research so far, it’s not possible to say for sure how often they occur in people with sudden hearing loss.

The risk of side effects from steroid tablets depends on things like the active ingredient and the dose used. Side effects are quite rare and usually easy to manage when the medication is taken for a short time. The possible side effects include:

• High blood sugar levels
• Sleep problems
• Mood swings
• Changes in appetite and weight
• A dry mouth

Steroid injections into the middle ear are usually tolerated better because they don't affect the whole body. But they can also cause side effects, including:

• Pain in the ear
• Temporary dizziness
• A middle ear infection

In very rare cases, the body isn’t able to close the hole in the eardrum (from the injection) on its own. That can cause pain, make your hearing worse, and increase the risk of infections. But the hole can be closed with surgery.

There are a number of other treatments for sudden hearing loss, but there's not enough good research to say how effective they are here. Because of this, they are only rarely used – for instance, if treatment with steroids doesn’t help enough or isn't well tolerated. They include:

• Hyperbaric oxygen therapy, where you breathe in pure oxygen in a high-pressure chamber. The aim is to supply more oxygen to tissue with poorer circulation.
• Antiviral medication that inhibits the reproduction of viruses or kills them.

There are herbal products for sudden hearing loss too, but there's no proof that they work. Homeopathic products haven't been proven to help, either.

In the past, sudden hearing loss was treated with medications that improve the flow of blood through blood vessels (known as vasodilators). But studies haven't found any proof that this medication helps in sudden hearing loss. And it can also have side effects. Because of this, experts no longer recommend it.

If hearing loss doesn’t get better, even after treatment, a hearing aid can provide valuable help. A cochlear implant may be considered for people who have very bad hearing or can no longer hear at all. It is often difficult to cope with permanent hearing loss. But there are many tips and sources of support that can help in everyday life.

People with long-term tinnitus can also learn to manage better with the help of various treatment approaches and strategies.

Because the causes of sudden hearing loss aren't known, it's not possible to say for sure what can help to prevent it or recover from it.

Some people find it pleasant to warm the affected ear, perhaps using a soft heat pack or a hat. Doctors often recommend that you reduce stress in everyday life and, for instance, do relaxation exercises and get enough sleep. Not smoking (anymore) may also help. But general recommendations like these do not guarantee that you won’t have sudden hearing loss or will recover from it more quickly.