Hearing Loss Management

Diagnosis and Assessment

Distinguish conductive hearing loss from sensorineural hearing loss using tuning fork tests (Weber and Rinne), as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
Obtain audiometry as soon as possible, within 14 days of symptom onset, to assess the degree of hearing loss 3
Assess for concerning features such as bilateral sudden hearing loss, recurrent episodes of sudden hearing loss, focal neurologic findings, and severe vestibular symptoms 3, 2
MRI is recommended to evaluate for retrocochlear pathology (e.g., vestibular schwannoma) 3, 2
If MRI is contraindicated, consider auditory brainstem response testing or audiometric follow-up 3, 2

Irrigation or curettage can result in immediate improvement in hearing once removed, and is potentially curative for conductive hearing loss 1
Medical management with decongestants or antihistamines can be used for allergic causes, and observation for 3 months if asymptomatic, as many cases resolve spontaneously 1
Myringotomy with tympanostomy tube placement can be used for persistent effusions, and appropriate antibiotic therapy for acute bacterial infections 1
Oral corticosteroids are recommended as the first-line treatment for idiopathic sudden sensorineural hearing loss (ISSNHL), which should be started promptly, ideally within the first 2 weeks 3, 2
Intratympanic steroid perfusion may be considered as either primary or salvage therapy, typically offered 2-6 weeks after symptom onset if incomplete recovery 3, 2

Surgical repair (tympanoplasty) can be used for persistent perforations, and paper patch myringoplasty as a temporary measure 1
Surgical reconstruction (ossiculoplasty) and prosthetic replacement of damaged ossicles can be used for certain cases of conductive hearing loss 1
Surgical management with stapedectomy or stapedotomy can be used for certain cases of conductive hearing loss, and hearing aids if surgery is contraindicated or declined 1
Osseointegrated bone conductive implants can transfer sound from the affected side to the better-hearing cochlea, and non-surgical headband options for non-surgical candidates 3

Audiometric evaluation should be performed after treatment completion, and regular follow-up to monitor hearing status and effectiveness of interventions 1, 3, 2
Assess impact on communication, social interaction, and daily activities, and consider standardized tools such as the Hearing Handicap Inventory 1, 2
Provide counseling about realistic expectations from treatment, and consider assistive listening devices for specific situations (telephone amplifiers, FM systems) 1, 2
Consider internet-delivered rehabilitation interventions and refer patients to consumer-based organizations, such as the Hearing Loss Association of America, for support and information 3

Non-surgical bone conduction headbands, osseointegrated bone conduction implants (e.g., BAHA, Ponto), and transcutaneous bone conduction systems can be used for certain cases of conductive hearing loss 1, 3

Treat the conductive component first, and address the sensorineural component with appropriate amplification, which may require combination of surgical intervention and hearing aids 1
Consider cochlear implants as an option for unrecovered severe to profound sensorineural hearing loss, particularly for patients with associated tinnitus, which can improve sound localization and speech discrimination 3

Audiologic rehabilitation including communication strategies, and referral to consumer-based organizations for support and information 1, 3
Counsel patients with incomplete hearing recovery about the benefits of amplification and hearing-assistive technology, and discuss the impact on communication, safety concerns, and quality of life 2, 4, 5

Overlooking treatable causes of conductive hearing loss, delaying intervention, neglecting the psychosocial impact of hearing loss, and limiting options to conventional hearing aids when other solutions may be more appropriate 1, 2, 3
Avoid the routine use of vasoactive substances, vasodilators, and thrombolytics (including blood thinners) for SSNHL treatment, due to lack of consistent evidence supporting vascular etiology and potential serious side effects 3
Blood thinners such as aspirin or heparin should not be routinely prescribed for the treatment of SSNHL, as they have not shown consistent clinical benefit in well-designed studies 3, 2