Should We Treat Patients Three Weeks or More After Onset of Sudden Sensory Neural Hearing Loss?

Background: Sudden sensory neural hearing loss (SSNHL) is a debilitating condition traditionally considered a medical emergency. Treatment modalities and protocols are variable and to date steroids (oral or intra-tympanic) are the only treatment proven to be beneficial. The literature reports a general spontaneous recovery rate of 32%-65% without differentiating between duration of symptoms at presentation. Time from onset of symptoms to treatment is considered an important prognostic factor though no clear cut-off exists from which treatment is no longer beneficial.

Objective: Analysis of hearing outcomes in patients with SSNHL treated initially 21 days or more after onset of symptoms.

Methods: Between 2010-2016, 895 patients with SSNHL were seen at Shaare Zedek Medical Center. Of these patients 103 were initially treated 21 days or more after the onset of hearing loss. The patients` files were retrospectively analyzed. Treatment modalities and improvement in hearing measured by audiometry were assessed. Clinical improvement was defined by SRT (≥15DB improvement), discrimination (≥15% improvement) or 15 DB improvement on specific frequencies. Patients were treated with intra-tympanic, +/- oral steroids and carbogen inhalations.

Results: Out of the 103 patients treated three weeks of more after onset of symptoms 23 (22.3%) showed significant clinical improvement within treatment period according to the above definition. The 23 patients consisted of 17 who improved in SRT, 4 in discrimination and 2 in specific frequencies (high/low).

Conclusion: It appears that treatment with intra-tympanic, +/- oral steroids and carbogen inhalations may be beneficial for patients presenting 21 days or more after the hearing loss. It is not clear if improvement is associated with the treatment solely or related to spontaneous recovery. We assume that if the patients showed no improvement earlier than 3 weeks there is a high probability that the treatment had a significant role in their recovery.