Sudden hearing loss

The main sign of sudden hearing loss is unexpectedly not being able to hear properly. It usually only affects one ear. The hearing loss can be very mild and might even go unnoticed. But it may be more severe or even cause deafness.

Sometimes the hearing loss affects one or more frequency ranges. Then it's harder to hear high, middle and/or low frequencies. It is rare for all ranges to be affected.

Other possible symptoms include:

• Tinnitus on the affected side
• Dizziness
• Hearing double (diplacusis): This happens if the affected ear 'hears' sounds at a higher or lower pitch than the healthy ear.
• Being very sensitive to sound (hyperacusis): Quiet or slightly louder noises are perceived as being unpleasantly loud.
• Pressure on the ear
• Feeling like the ear is clogged (full)
• Fuzzy or numb feeling in the ear

The hearing loss can make it more difficult to follow conversations and talk with other people. If it causes tinnitus too, that can add to the distress. So sudden hearing loss can greatly affect your quality of life, depending on the symptoms.

When sudden hearing loss occurs, the inner ear can no longer process the sound waves properly (inner ear hearing loss). It is not clear why that happens.

It is thought that infections and stress might play a role, but there's no proof for either. Some experts believe that sudden hearing loss is caused by decreased blood supply to the inner ear.

Less commonly, inner ear hearing loss is caused by other diseases such as Menière’s disease, or a benign tumor in the inner ear or on the auditory (hearing) nerve. Loud noises such as a bang can also damage the inner ear. This kind of damage is known as acoustic trauma. Earwax may build up and block the ear canal, too, causing you to hear worse. But doctors can easily remove the earwax.

Every year, an estimated 3 in 1,000 people in Germany see their doctor because of sudden hearing loss. It is most common in adults between the ages of 40 and 60. Children very rarely have sudden hearing loss.

As the name suggests, sudden hearing loss typically develops quite quickly. After that, various things may happen:

• Some people can hear much better again after a few hours or days, and their hearing often returns completely. The chances of that happening are good if the hearing loss is only mild and mainly affects low or mid-range frequencies. Full recovery is also more likely if there is no dizziness. Experts estimate that sudden hearing loss goes away by itself in 32 to 65 out of 100 people.
• Others take medications and can then hear better again after a few days or weeks.
• But sometimes people's hearing doesn't get better, even after treatment, and they are hard of hearing over the long term.
• Or their hearing gets better, but the tinnitus doesn’t go away.

People who have sudden hearing loss in the low or mid-range frequencies are more likely to have sudden hearing loss again.

People who have sudden hearing loss are typically referred to an ear, nose and throat (ENT) doctor. The doctor will first ask you about your symptoms and any possible causes of the hearing loss, such as a loud bang. They will then do various ear examinations to see how severe the hearing loss is and to look for possible causes. These may include:

• Otoscopy (looking into the ear using a special instrument)
• Hearing tests
• Examination of the eardrum and middle ear using a measuring probe
• Examinations of the auditory (hearing) nerve and sensory hair cells in the inner ear

Further examinations are usually done to find out whether another medical problem has caused the sudden hearing loss. These include blood tests and imaging procedures such as magnetic resonance imaging (MRI) scans. It is particularly important to thoroughly look for other causes in children because sudden hearing loss is very rare in children.

If no cause for the hearing loss can be found, the problem is diagnosed as “idiopathic sudden hearing loss.”

Sudden hearing loss doesn't always have to be treated. If the hearing loss is only mild and hardly causes any problems, doctors usually recommend waiting a few days. That’s because some people’s hearing gets better without treatment.

But quick treatment (within 1 to 2 days) is recommended 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 the same day.

Treatment for sudden hearing loss normally involves using steroid medications (cortisone). These medications reduce inflammation and are usually taken as tablets for several days. If treatment with tablets doesn’t help or isn’t possible, the drug can be injected into the middle ear under local anesthetic.

But there aren't enough reliable studies to say how effective these medications are in the treatment of sudden hearing loss. Because of this, people who are given steroids for sudden hearing loss usually have to pay for the treatment themselves.

If treatment with steroids doesn’t help enough, other approaches such as hyperbaric oxygen therapy can be tried. For similar reasons, they are not covered by statutory health insurers either (in Germany).

If hearing loss or even deafness last a long time, a hearing aid or cochlear implant may be considered.

When people are ill or need medical advice, they usually go to see their family doctor first. But you can also go straight to an ear, nose and throat (ENT) specialist if you have sudden hearing loss. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

If the hearing loss doesn't get better, you can join a support group to meet other people with similar symptoms, feelings and practical problems. People living in Germany can look for a suitable group in their area on the German-language website of the National Contact and Information Office for the Encouragement and Support of Self-help Groups (Nationale Kontakt- und Informationsstelle zur Anregung und Unterstützung von Selbsthilfegruppen, NAKOS).