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Nine years ago, Richard Einhorn woke up in a hotel room at 5 a.m., “my head buzzing with a strange loud noise,” the 67-year-old New York City music composer recalled.

Startled, he jumped out of bed, and promptly fell over. “I couldn’t stand up, I was so dizzy,” he says.

He then realized that he had lost all hearing on his right side.

Einhorn took a taxi to the nearest emergency room, where he was told that his symptoms pointed to a condition called sudden sensorineural hearing loss, or SSNHL.

This condition, sometimes also called sudden deafness, is an unexplained or rapid loss of hearing — one that is not caused by a “noise trauma,” such as an exploding firecracker right next to the ear.

Marked by inflammation of the inner ear, SSNHL usually affects only one ear. As it was in Einhorn’s experience, SSNHL may be accompanied by tinnitus (ringing of the ears) and vertigo.

SSNHL strikes about 66,000 people in the United States every year, according to an American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) clinical practice guideline published in August.

Although it can develop at any age, SSNHL is most often seen in adults in their late 40s or early 50s.

“It can be very scary for patients — it’s not only disorienting to not be able to hear, but with these symptoms, people worry they’re experiencing a life-threatening emergency such as a stroke,” explains Seth Schwartz, an otolaryngologist at the Virginia Mason Medical Center in Seattle and a co-author of the guideline.

Here’s what you need to know — and do — if you experience sudden hearing loss.

Prompt diagnosis, treatment

If you’re suddenly having trouble hearing out of one ear, it may be tempting to chalk it up to clogged ears from a respiratory infection or allergies and assume it will get better on its own.

And about half of people with SSNHL regain at least some of the hearing in the affected ear spontaneously, according to the AAO-HNS. This usually occurs within one to two weeks.

But prompt diagnosis and treatment can improve those odds, Schwartz says: “You always want to see your primary care physician within 24 to 48 hours.”.

Your doctor will start by checking to make sure there’s no physical reason for your sudden hearing loss, such as earwax blocking your ear canal, fluid in your ear or a punctured eardrum. The physician will also consider possible causes such as head trauma, exposure to certain chemotherapy drugs or neurological diseases like multiple sclerosis. For about 90 percent of people, however, doctors are not able to pinpoint the trigger.

“We have a lot of theories,” Schwartz says. “But right now, most of the time it’s still a mystery.”

Some research suggests a link with metabolic syndrome — a cluster of conditions that include elevated blood pressure, blood sugar and cholesterol, as well as a larger than normal waist circumference.

Exams, multiple specialists

If a physical exam reveals no obvious reason for your sudden hearing loss, your next step should be to see an audiologist, ideally within a few days.

The audiologist will perform a pure-tone test, where you listen for beeps while wearing earphones and raise your hand whenever you hear one. If it determines that you’ve lost at least 30 decibels of hearing in one ear in three consecutive frequencies, you’ll be diagnosed with SSNHL.

“This drop would make it hard for you to hear conversational speech,” says Deborah Berndtson, associate director of audiology practices at the American Speech-Language-Hearing Association.

And if you’re also experiencing symptoms like dizziness, your audiologist can perform tests such as electronystagmography, in which small electrodes are placed on the skin around your eyes to measure your eye movements. This helps determine how well your vestibular system — which is connected to your inner ear and helps with balance — is working.

Once you’ve been told you have SSNHL, see an ear-nose-throat specialist as soon as possible. He or she may have you undergo imaging tests such as MRI to look further for a physical cause. (In rare instances, vestibular schwannomas, benign growths on the nerve that connects the ear to the brain, may be the cause of SSNHL.)

Some doctors may also order lab tests to look for markers of autoimmune disorders or viruses.

Effective remedies, measures

Although sudden hearing issues may resolve on their own in about half of those who experience one, experts can’t predict who will be among them, according to the AAO-HNS. People with SSNHL who also have vertigo may have a poorer prognosis, however.

So talk to your doctor about the benefits, potential risks and possible effectiveness of treatment.

The gold standard for sudden hearing loss has been corticosteroids, says Erika Woodson, an otolaryngologist at the Cleveland Clinic. These medications work by reducing the inflammation and swelling thought to cause hearing loss and dizziness.

For SSNHL, steroids may be given in pill form or as an injection into the eardrum. Both ways are equally effective, according to a 2011 randomized trial published in the Journal of the American Medical Association. There’s also some research to suggest combining both forms may be slightly more effective than one alone.

But when it comes to steroids overall for SSNHL, the guideline published in August 2019 “points out that they may not be that helpful,” Schwartz says. And like all medications, they have their side effects, including weight gain, mood changes, trouble sleeping and high blood pressure and blood sugar.

If you and your doctor determine that steroids are a good option for you, you’ll need to begin treatment fairly quickly.

You may also want to ask your ENT about hyperbaric oxygen therapy (HBOT). This involves breathing pure oxygen in a special chamber as a way to boost oxygen to your ear and brain.

Studies on HBOT have been mixed, but some research suggests that doing it within two weeks of the onset of symptoms in combination with steroids or within four weeks in people who don’t respond to steroids may help.

Some doctors also prescribe antiviral medications, but the AAO-HNS doesn’t recommend routine use of these drugs because there’s no evidence of their benefit.

Cochlear implants, other aids

If your hearing doesn’t improve within three months, your ENT can refer you back to an audiologist to get fitted for a hearing aid, or if your hearing loss is very severe, discuss the possibility of a cochlear implant, Schwartz says.

A cochlear implant is a small electronic device that is surgically implanted. It bypasses the damaged portions of your ear and stimulates your auditory nerve directly.

For a hearing problem or tinnitus that lingers, your doctor may also recommend audiological rehabilitation, which may include behavioral strategies (such as meditation for relaxation), assistive listening devices and training to help you maintain focus in noisy situations, according to the Hearing Loss Association of America.

Richard Einhorn, whose SSNHL wasn’t resolved by steroid treatment, ultimately turned to hearing aids for help.

For the last nine years, he has worn them full-time.

“They don’t solve all my problems, but now I can listen and compose music again, which is the most important thing to me,” he says.

 Copyright 2020, Consumer Reports Inc.

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