A sudden loss of hearing has other causes as chronic hearing loss and must be treated as an emergency (1).
With a sudden loss of hearing is a moderate to severe sensorineural hearing loss, which occurs suddenly within a few hours or is noticed upon awakening. Every year about 1/5000 to 1 / 10,000 people are affected. The initial hearing loss is one-sided in general (unless it is a drug-induced hearing loss) and can reach in severity from mild to profound. Many also have tinnitus, and some show drowsiness and / or dizziness. A sudden loss of hearing has other causes as chronic hearing loss and must be treated as an emergency (1). General note 1. Spikes RJ, Chandrasekhar SS, Archer SM, et al: Clinical practice guideline: Sudden hearing loss. Otolaryngol Head Neck Surg 146 (3 Suppl): S1-35, 2012. doi: 10.1177 / 0,194,599,812,436,449th Etiology Here are some common features of a sudden hearing loss are as follows: Most cases are idiopathic (see Table: Causes of sudden hearing loss), some occur in the course of an obvious event. And a few cases represent the first manifestation of an occult, but identifiable disorder is idiopathic. There are numerous theories for some (although contradictory and incomplete) Evidence exists. The most promising opportunities are viral infection (particularly herpes simplex), autoimmune attacks and acute microvascular occlusion. Event obvious: Some causes of hearing loss are readily apparent. A blunt head trauma with fracture of the temporal bone or severe concussion with the participation of the cochlea can result in a sudden loss of hearing. By larger air pressure fluctuations (like diving) or effort (such as weight lifting) can be induced a perilymph fistula between the middle and inner ear that causes sudden, severe symptoms. A perilymphatic fistula can also be congenital, it can spontaneously lead to sudden hearing loss or occur after trauma or severe pressure changes. Ototoxic drugs can lead to deafness in one day sometimes, especially in overdose (after systemic application or use on large wound surfaces such as after burns). A rare genetic disorder mitochondrialvermittelte enhanced susceptibility to ototoxic side effects of aminoglycosides. A number of infections caused a hearing loss during or immediately after an acute illness. Common causes include bacterial meningitis, Lyme disease and many viral infections that the cochlea (and sometimes the vestibular apparatus) concern. The most common viral causes in the developed world are mumps and herpes. Measles is a very rare cause because most of the population is immunized. Occult diseases: Rare hearing loss can also be the isolated initial manifestation of diseases usually show other initial symptoms. Such a hearing loss, the first manifestation of such in rare cases. B. be an acoustic neuroma, a multiple sclerosis, Ménière’s disease or a small cerebellar stroke. Reactivation of syphilis can often lead to hearing loss in HIV-infected patients. Cogan’s syndrome is a rare autoimmune reaction against an unknown common autoantigen in the cornea and in the inner ear; > 50% of patients have vestibulocochlear symptoms. Approximately 10-30% of patients also have severe systemic vasculitis, which may include a life-threatening Aortitis. Vasculitis diseases can cause hearing loss, which is acute in some cases. Hematological diseases such as Waldenström- macroglobulinemia, sickle cell disease and some forms of leukemia can rarely cause hearing loss. Causes of sudden hearing loss type examples Idiopathic N / A Is responsible for a majority of cases of obvious events Acute infections (eg. As meningitis, mumps, herpes) head or ear trauma (incl. Barotrauma while scuba diving that causes a perilymphatic fistula) ototoxic drugs (e.g. aminoglycosides, vancomycin, cisplatin, furosemide, ethacrynic acid.); these usually cause hearing loss for a long time, but may rarely occur as a sudden loss) * occult diseases acoustic autoimmune diseases (eg. B. Cogan’s syndrome, vasculitis) cerebellar stroke Meniere’s disease multiple sclerosis reactivation of syphilis in HIV-infected patients Anomalies of Rotne blood cells (eg. As sickle cell disease) Vascular Diseases (z. B. vertebrobasilar insufficiency) * hearing loss occurs for 1-2 days. N / A = not available. Clarification The study is for the detection and quantitative detection of hearing loss and to clarify the etiology (especially reversible causes). History The history of the disease process should ensure that there is a sudden loss of hearing and not a chronic event. The history should also determine whether the hearing loss is one or both sides, and whether an acute event is based (eg. As head injuries, barotrauma [particularly a diving accident], infectious disease). Important accompanying symptoms are more otologic symptoms (eg. As tinnitus, ear discharge), vestibular symptoms (eg. As disorientation in the dark, dizziness) and other neurological symptoms (eg. As headaches, weakness or facial asymmetry, abnormal taste). In reviewing the organ systems including temporary, wandering neurological deficits (multiple sclerosis) and eye irritation and redness (Cogan’s syndrome) should for symptoms of possible causes, are researched. The medical history should be known by HIV and syphilis infection and its risk factors (eg. As multiple sexual partners, unprotected sex) will be asked. Family history should determine whether there are close relatives with hearing loss (indicating a congenital fistula). The drug history should ask ototoxic drugs specifically to the current or previous application and whether the patient had a known renal failure or kidney failure vorliegt.Körperliche investigation The investigation focuses on the ears and hearing as well as the neurological examination. The tympanic membrane is examined for perforation, drainage or other lesions. During the neurological examination, the focus should be on the cranial nerves (especially the V, VII., And VIII.) And vestibular and cereballare function are addressed, as changes in these areas are often associated with tumors of the brain stem and cerebellar pontine angle. In Weber and Rinne test using a tuning fork to delineate a sensorineural from a sensorineural hearing loss. In addition, the eyes redness and photophobia (possible Cogan’s syndrome) and the skin on a rash (such as viral infection, syphilis.) Are untersucht.Warnzeichen findings of particular importance: abnormalities of the cranial nerves (except hearing loss) Significant asymmetry in language comprehension between the two ears Other neurological symptoms (eg. as motor weakness, aphasia, Horner’s syndrome, sensory or temperature-sensitive anomalies) interpretation of the findings A trauma, ototoxic side effects or infections are usually obvious from the clinical signs as causes. When there is a perilymph fistula, the patient may hear a popping sound in the affected ear before then adjust sudden dizziness, nystagmus and tinnitus. Focal neurological abnormalities are of particular importance. The V and / or VII. Cranial nerve are often affected by tumors, which include the VIII. Cranial nerve, which is why the loss of facial sensitivity, a weak jaw closure (v), a hemifacial weakness and taste abnormalities (VII.) To a lesion in the affected area point. Fluctuating unilateral hearing loss (aural fullness), tinnitus and vertigo is of aural fullness accompanied lets think of Meniere’s disease. Systemic symptoms are inflammation (eg. As fever, rash, joint pain, mucosal lesions) suspect and justify the suspicion of an occult infection or Autoimmunerkrankung.Tests audiometry MRI and CT in the patients an audiogram should be, in addition, most clinicians cause a gadolinium-enhanced MRI to detect inapparent cause, unless the diagnosis is clearly indicative of an acute infection or a prescription drug out, especially in one-sided losses. In patients with acute traumatic cause an MRI should also be performed. A perilymphatic fistula is usually due to a triggering event suspected (z. B. excessive stress, barotrauma) and the examination can be performed by using positive pneumatic pressure to evoke eye movements (nystagmus). A CT of the temporal bone is usually done in order to show the bony features of the inner ear and can help congenital anomalies (eg. As enlarged vestibular aqueduct), fractures of the temporal bone of trauma or erosive processes (eg. As cholesteatoma) to clarify. In patients with risk factors or symptoms that point to a specific cause, appropriate tests should be based on clinical evaluation made based (eg. As serological tests for a possible HIV infection or syphilis, total blood count and coagulation status in haematological diseases, erythrocytes and antinuclear antibodies in vasculitis). Therapy Treatment of sudden hearing loss focuses on the causal disease when it is known. Fistulas are examined and treated surgically if bed rest is not enough to control the symptoms. Following a viral-induced, or idiopathic sudden loss of hearing, the hearing at approximately 50% of the patients returned to normal, in other cases it recovers at least partially. Until improvement or complete healing, it usually takes 10-14 days. The recovery after ingestion of an ototoxic drug varies greatly depending on the agent and its dosage. Some drugs (eg., Aspirin, diuretics) disappears the hearing loss within 24 hours, while other drugs (eg., Antibiotics, chemotherapeutic agents) often lead to permanent hearing damage if safe doses have been exceeded. Many clinicians give patients with idiopathic hearing loss glucocorticoids (typically prednisone 80 mg / kg p. O. 1 time / day for 7 to 14 days followed by a 5-day “taper”). Glucocorticoids may be administered orally and / or by transtympanic injection. The direct injection transtympanic avoids the systemic side effects of oral glucocorticoids and is as effective, except in deep (> 90 dB) hearing loss. There are data showing that both oral and intratympanic steroids lead to better results than either alone. Although doctors often use antiviral drugs effective against herpes simplex (z. B. valacyclovir, famciclovir), the data indicate that such drugs do not affect the hearing results. There are some limited data that suggest that may be a hyperbaric oxygen therapy in idiopathic sudden hearing loss advantage. Summary Most cases are idiopathic. Some cases have an obvious cause (eg. As severe trauma, acute infection, drugs). Very few cases are unusual manifestations of treatable disorders.