Audiologic Evaluation and Rehabilitation

Initial Evaluation and Follow-up

The American Academy of Otolaryngology-Head and Neck Surgery recommends obtaining follow-up audiometric evaluation within 6 months of diagnosis, and initiating discussion of hearing rehabilitation options early for patients with residual hearing loss 1

Sudden sensorineural hearing loss (SSNHL) is defined as ≥30 dB hearing loss at 3 consecutive frequencies occurring over a 72-hour period, and audiometric confirmation should be obtained as soon as possible and within 14 days of symptom onset 2, 1
A complete audiological evaluation with pure-tone audiometry, high-frequency audiometry, speech audiometry, and distortion product otoacoustic emissions is recommended to detect early cochlear damage 3
The American Academy of Otolaryngology-Head and Neck Surgery recommends distinguishing sensorineural from conductive hearing loss through history, physical examination, and tuning fork tests, and assessing for red flags, including bilateral hearing loss, recurrent episodes, or focal neurologic findings 2, 4

The American Academy of Otolaryngology-Head and Neck Surgery recommends oral corticosteroids as first-line treatment for SSNHL, to be initiated within 14 days of symptom onset, with a regimen of Prednisone 1 mg/kg/day (maximum 60 mg daily) for 10-14 days, followed by a taper over a similar period 2, 1
Intratympanic steroid therapy is recommended for salvage treatment when initial therapy fails, typically administered 2-3 times per week for 2 weeks 2, 4, 1
Combination therapy with both oral and intratympanic steroids may be considered for patients with severe to profound hearing loss, and hyperbaric oxygen therapy (HBOT) may be offered within 2 weeks of diagnosis or up to 1 month in conjunction with steroids 1, 4
The American Academy of Otolaryngology-Head and Neck Surgery advises against routine prescription of antivirals, thrombolytics, vasodilators, and vasoactive substances 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends MRI to rule out retrocochlear pathology (e.g., vestibular schwannoma), and suggests that if MRI cannot be performed, CT scan or auditory brainstem response evaluation are secondary options 2

Approximately 90% of SSNHL cases are idiopathic at presentation, and without treatment, spontaneous recovery occurs in 32-65% of cases 2, 1
Most recovery occurs within 1 month in 78% of patients and by 3 months in 97% of patients, and early intervention is critical, with treatment initiated within 14 days of symptom onset having significantly better outcomes 1

Audiometric evaluation should be obtained at the conclusion of treatment and within 6 months of completing treatment, and patients should be counseled about the natural history of SSNHL, benefits and risks of interventions, and limitations of existing evidence 2
Provide audiologic rehabilitation for patients with residual hearing loss and/or tinnitus, including options such as hearing aids, cochlear implants, and hearing-assistive technology, and regular audiometric and vestibular testing is essential to monitor recovery and detect complications 2, 3, 5
Early cochlear implantation may be considered if profound hearing loss develops, before ossification occurs 5