Investigations for Bilateral Sudden Sensorineural Hearing Loss

Introduction to Bilateral SSNHL

The American Academy of Otolaryngology-Head and Neck Surgery recommends aggressive investigation for life-threatening systemic diseases in patients with bilateral SSNHL, including MRI with dedicated internal auditory canal protocol, comprehensive laboratory workup, and consideration of lumbar puncture when meningitis is suspected 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery suggests ordering MRI of the brain and internal auditory canals with a dedicated IAC protocol, which detects various conditions such as vestibular schwannomas and meningeal enhancement suggesting meningitis 3, 2, 4
The American Academy of Otolaryngology-Head and Neck Surgery recommends against routine CT of the head in the initial evaluation, with a strong recommendation based on systematic reviews 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends syphilis serology, HIV testing, viral serologies, Lyme disease testing, and tuberculosis and fungal studies in the laboratory workup for bilateral SSNHL 2, 3, 1, 4
The American Academy of Otolaryngology-Head and Neck Surgery suggests testing for antinuclear antibodies, erythrocyte sedimentation rate, C-reactive protein, angiotensin-converting enzyme level, and antiphospholipid antibodies in the autoimmune/inflammatory workup 2, 4, 1

The American Academy of Otolaryngology-Head and Neck Surgery recommends complete blood count with differential, serum protein electrophoresis, lactate level, and lead level in the metabolic and hematologic studies 2, 4
The American Academy of Otolaryngology-Head and Neck Surgery suggests thyroid function tests and coagulation studies based on clinical context 1, 2, 4

The American Academy of Otolaryngology-Head and Neck Surgery recommends performing lumbar puncture with CSF analysis if meningitis is suspected clinically or if MRI shows meningeal enhancement 2, 3

The American Academy of Otolaryngology-Head and Neck Surgery recommends complete audiometry with pure-tone air and bone conduction testing as soon as possible and within 14 days of symptom onset 3