Management of Bilateral Sudden Sensorineural Hearing Loss

Clinical Approach and Treatment

The American Academy of Otolaryngology-Head and Neck Surgery recommends initiating oral prednisone 1 mg/kg/day (maximum 60 mg/day) as a single daily dose for 7-14 days, followed by taper, for bilateral sudden sensorineural hearing loss when systemic steroids are not contraindicated 1, 2
Bilateral intratympanic steroid therapy can be offered as initial treatment when systemic steroids are contraindicated, with dexamethasone 24 mg/mL or methylprednisolone 40 mg/mL being used 1, 2
Treatment must begin immediately, ideally within 14 days of symptom onset, though benefit has been reported up to 6 weeks 1, 2, 3

The dosing protocol for bilateral intratympanic steroid injections involves injecting 0.4-0.8 mL into each middle ear space via anterosuperior myringotomy after topical anesthetic, with the patient maintaining head in otologic position for 15-30 minutes per side 1, 2
Up to 4 injections per ear can be administered over a 2-week period, with audiograms performed before each subsequent injection to monitor response 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery suggests offering bilateral intratympanic steroid therapy as salvage treatment if hearing recovery is incomplete at 2-6 weeks after initial systemic steroid treatment 1, 4
Patients should understand that one-third to two-thirds may experience spontaneous recovery within the first 2 weeks, and that treatment aims to maximize recovery potential during this critical window 1, 3

Baseline audiometry should be performed within 14 days of symptom onset to confirm diagnosis, with mid-treatment audiograms and post-treatment audiogram at completion of treatment course 1
Repeat audiometry at 6 months post-treatment is recommended, regardless of perceived recovery 1
Counseling about hearing aids, cochlear implantation, and other rehabilitation options should not be delayed, as delay leads to auditory deprivation and poorer outcomes 1, 4