Sudden hearing loss

The hearing loss is caused by a sensory sound disorder that affects the inner ear. The sound waves reaches the eardrum via the auricle and the external auditory canal, causing the eardrum to vibrate. As a result of this movement, the sound is transmitted via the ossicles through the middle ear to the inner ear.

In the inner ear, sensory cells convert acoustic stimuli into electrical signals. They reach the brain via the auditory nerve. In the case of a sound sensation disorder, this transition is disturbed and the hearing ability is restricted.

Sound waves travel through the auricle and the external auditory canal to the eardrum. From here, the sound is conducted through the eardrum and ossicles into the inner ear

Sudden hearing loss occurs more frequently around the age of 50, and men and women are equally affected. Children rarely have hearing loss.

The hearing loss usually occurs suddenly and painlessly . Earache is not a typical sign. Severe pain, on the other hand, tends to indicate another clinical picture, for example an otitis media .

The severity of a sudden hearing loss varies from case to case. The hearing loss can be partial and only affect certain frequencies, but it can also lead to complete hearing loss. Depending on the frequency range concerned, a distinction is made between high-frequency, low-frequency and mid-range hearing loss.

An ear infarction usually has various accompanying symptoms and complaints. Often noises in the ears ( tinnitus ) are a typical side effect of a sudden hearing loss. These noises in the ears are perceived individually by each patient in terms of type and intensity; some report a hissing noise or cracking in the ear. Noises in the ears , also known as ringing or ringing in the ears , are completely normal to a certain extent, but if the noises in the ears persist over a longer period of time, doctors speak of tinnitus.

A sudden hearing loss often leads to a feeling of pressure in the affected ear. This “cotton wool-like” dull feeling can subsequently lead to dizziness or nausea, as the sense of balance is impaired.  

You can recognize a sudden hearing loss by these signs :

• Sudden, mostly one-sided appearance
• Hearing loss for no apparent cause
• No earache
• Feeling dizzy, imbalanced, or nausea
• Sensory disturbance in the outer ear
• Ear pressure
• Tinnitus

Sudden hearing loss: treatment

What to do if you experience signs of an ear attack If you show typical signs of a sudden hearing loss, you should consult your general practitioner or an ear, nose and throat specialist as soon as possible. While sudden hearing loss is not dangerous or an emergency, you should discuss treatment options with your doctor as soon as possible. Mainly to rule out other possibly treatable or dangerous causes.

Not every sudden hearing loss requires treatment. The symptoms often subside by themselves after a few days (spontaneous remission). The spontaneous healing rate is high; according to various studies, it is between 50 and 60 percent. In the case of pronounced hearing loss, previously damaged ears and additional impairment of the sense of balance, immediate acute treatment is recommended.

Most treatment options for acute hearing loss aim to improve blood flow to the inner ear. The various therapy options are highly controversial, however, as there is little scientific evidence for their effectiveness. Meaningful studies on the effectiveness of individual therapies sometimes fail due to the high spontaneous remission of the disease.

However , if there is a significant hearing impairment, the following therapy methods can be considered in consultation with your doctor:

• Cortisone therapy
• Infusion therapy (to improve blood flow to the inner ear)
• Oxygen therapy
• Antiviral therapy

Sudden hearing loss: cortisone therapy

Treatment with cortisone is based on the assumption that hearing loss could be caused by inflammation or an autoimmune disease. Swellings caused by inflammation improve with cortisone preparations. Glucocorticoids, like the endogenous hormone cortisone, have anti-inflammatory (anti-inflammatory) and decongestant effects. The doctor can either prescribe these drugs in the form of tablets or give them as an infusion.

In some cases, local therapy with cortisone is recommended. The drug is applied directly through the eardrum into the middle ear (intratympanic). In order to ensure that the medication is administered almost painlessly, the eardrum is pierced under local anesthesia. The advantage of local therapy over taking a tablet or an infusion lies in the higher concentration of active ingredient at the point of action with a lower dose of cortisone. This means that there are fewer sides effects.

There are no glucocorticoid preparations in Germany that have been specially developed for the therapy of acute hearing loss; they are used for treatment that does not require approval (“off-label use”). The therapy of acute hearing loss with glucocorticoids is recommended as the method of first choice in the current guideline.

Sudden hearing loss: infusion therapy

Infusion therapies, so-called rheological therapies, are treatment methods that influence the flow properties of the blood. Infusion therapies aim to improve the flow mechanics of the blood (hemodynamics) in tissues with poor blood circulation.

This happens mainly through:

• Blood thinning (hemodilution)
• Increase in blood volume
• Improvement of the flow properties of the blood
• Lowering of plasma viscosity (viscosity = toughness) / lowering of fibrinogen

In infusion therapy, plasma expanders (volume replacement solutions) and vasodilators (have a vasodilating effect) are mainly used. Plasma expanders increase the amount of fluid in the blood, thus increasing cardiac output and thus improving blood circulation. Vasodilators cause the blood vessels to widen and thus increase the blood flow to the tissue.

In addition to infusion therapy with plasma expanders and vasodilators, the latest studies have provided good research results on the therapy of acute hearing loss by lowering the fibrinogen level. Fibrinogen is a protein that play an important role in blood clotting. High fibrinogen values ​​have an influence on the plasma viscosity and thus on the flow rate of the blood. By lowering the fibrinogen level, the blood flow increases.

Sudden hearing loss: oxygen therapy

Another option for treating sudden hearing loss is treatment with hyperbaric oxygen (hyperbaric oxygenation, HBO). The patient is in a pressure chambers and is exposed to overpressure there (hyperbar). He breathes in pure oxygen through a mask. The increased oxygen supply sets healing processes in motion in the inner ear.

Sudden hearing loss: antiviral therapy

Current studies do not show any significant effectiveness of antiviral drugs in the treatment of sudden hearing loss.

Sudden hearing loss: treatment with home remedies and homeopathy

In general, experts recommend a lot of rest after a sudden hearing loss. Stress is believed to play a major role in causing sudden hearing loss and can delay healing. Autogenic training, progressive muscle relaxation and yoga help with relaxation and promote the healing process. These exercise can be used in conjunction with other therapies for acute hearing loss. In a relaxed general state, the vascular tension decreases and the blood flow to the inner ear improves.

Melissa, hops, valerian and passion flower preparations can be used to promote relaxation.

Sudden hearing loss: treatment with ginko

Ginko biloba is a Chinese tree and medicinal plant. Ginko extracts lower blood viscosity and thus increase blood circulation. Additional treatment with ginkgo preparations promoted hearing recovery compared to exclusively conventional therapy. In patients without symptoms such as dizziness or impaired balance, an additional administration of ginkgo preparations for the treatment of sudden hearing loss can be considered.