Sudden Sensorineural Hearing Loss (SSNHL) with Dr. Sujana Chandrasekhar
Recently Ashley Agan, MD MBA and I sat down with Dr. Sujana Chandrasekhar , a private practice neurotologist with ENT and Allergy Associates , to discuss the diagnosis and treatment of patients with sudden sensorineural hearing loss (SSNHL).?
First, Sujana explains the formal definition of sudden hearing loss, which is a loss of 30 dB over 3 consecutive frequencies over 72 hours, and notes that it is usually unilateral. She explains that the time from hearing loss presentation to ENT referral is usually delayed, as many patients attribute their hearing loss to a cold, the flu, or allergies. Frequently, they are also told over phone to take nasal sprays or prescribed amoxicillin. However, severe / profound hearing loss with or without tinnitus and vertigo necessitates immediate ENT consultation. Upon initial presentation, she usually gets a thorough health history, review of systems, and medication list from the patient. Common causes of SSNHL include: pregnancy and other thrombotic states, stroke, injected or intravenous drugs, high dose aspirin, PDE-5 inhibitors, and COVID-19 infection. She also describes how she uses the physical exam to distinguish between conductive and sensorineural hearing loss. First, Sujana checks the outer ear and visualizes the tympanic membrane to look for external pathologies. Then, she utilizes the Weber and Rinne tests on every patient.?
Next, she explains her further workup for patients determined to have SSNHL. Sujana emphasizes the need for retrocochlear examination to check for vestibular schwannoma, which is best done through MRI. If patients have MRI contraindications, a CT temporal bone with contrast paired with auditory brainstem response (ABR) testing may be an alternative option. Sujana explains that a single ABR test has a low specificity for vestibular schwannomas, missing up to 15-20% diagnoses. She also notes that patients with audiograms showing low frequency hearing loss have a better prognosis than those with high frequency hearing loss. Additional symptoms to look for are otalgia, erythema, healing vesicles, facial palsy, and blebs on the tympanic membrane. These symptoms may point to an infectious cause, such as syphilis, Lyme disease, and herpes zoster. Additionally, children may have syndromic causes of SNHL.?
Sujana also describes her treatment options for SSNHL of different severities. For patients with mild and moderate hearing loss, she prescribes an oral prednisone taper, which patients can stop taking if hearing comes back. Intratympanic steroid injections with dexamethasone may be implicated if patients with moderate SSNHL do not respond to oral prednisone. She explains her steroid injection technique as well as tips for how to make patients more comfortable during and after the procedure. For patients with severe SSNHL, Sujana emphasizes the importance of self-training to listen in the affected ear, starting to wear hearing aids early, and considering BAHA devices. Then, the three of us discuss the value of additional therapies for SSNHL, such as acupuncture, hyperbaric oxygen, papaverine, and B vitamins. Finally, she speaks about intratympanic stem cell injections to regrow inner hair cells as an exciting future treatment of sudden hearing loss. Listen to the full episode and learn more!
Thank you to our sponsor for this episode: Cook Medical ENT!
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Physician; CEO JARALL Medical Management Consulting; Partner at PARE Coding and Compliance Services
1 年I think Dr. C is the best. After many failed attempts with other surgeons she helped get my sons hearing back.
Ear Surgeon & Biomedical Researcher; Past Pres, American Otological Society; Past Pres, AAO-HNS/F; Consulting Editor, Otolaryngologic Clinics of North America, Co-Host, She’s On Call
1 年I had a lot of fun recording this podcast. Thank you for asking me!