PP305 - Sudden Sensorineural Hearing Loss: When the Health-Care System Fails to Intervene

Abstract:
Sudden sensorineural hearing loss is an audiologic emergency. Oral steroids are typically administered to recover thresholds, ideally within two weeks. Intratympanic steroid injections can help with further improvement in thresholds. However, research indicates that general practitioners and emergency medicine specialists lack knowledge regarding the appropriate referrals and treatment options for sudden sensorineural hearing loss. We will describe a case of a Spanish-speaking man who was seen by multiple healthcare providers who did not present steroids as a treatment option. Patient was serendipitously seen at RUSH for same-day audiology and otolaryngology appointments, which led to the appropriate care and follow-up.

Summary:
Sudden sensorineural hearing loss (SSNHL) affects between 5-27 per 100,000 people every year in the United States (Chandrasekhar et al, 2019). While SSNHL intervention can be highly successful when intervention type and timing is ideal, there can be several delays to treatment initiation: 1) patients may be unaware that SSNHL requires immediate care; 2) the clinician treating the patient for the first time, typically an urgent care or emergency room physician, may not be knowledgeable on diagnosis and treatment of SSNHL; and 3) the patient may defer the intervention or treatment due to various reasons including lack of support, socioeconomic, or financial concerns (Klein et al, 2023). Our clinical case discusses the clinician’s role in reducing the delay to treatment initiation for improving patient outcomes.

Despite the availability of multidisciplinary clinical practice guidelines from the American Academy of Otolaryngology, the compliance among non-otolaryngologists to the Key Action Statements for the management of SSNHL is low ( < 45%) (Witsell et al, 2016). This was also true for our patient who visited two different emergency rooms searching for treatment. The only treatment the patient was provided was Meclizine and Diazepam to treat the symptoms of dizziness, but he was never informed of further steps to take regarding the hearing loss such as seeing an otolaryngologist and/or audiologist.

The patient was serendipitously seen at the Rush University SCOPE (Student Community Outreach Program of Excellence) Speech & Hearing Clinic, following a pediatric appointment with the patient’s child who was being evaluated for a different reason. During case history, the child’s mother (patient’s spouse) reported that patient had recently experienced a sudden hearing loss, which has yet to be treated. Patient was brought in for a same-day audiological evaluation to quantify the hearing loss and subsequently received steroid treatment through CURE (Center for the Underserved at Rush ENT) Free ENT Clinic. Through this clinic, the patient was able to receive both oral steroids and intratympanic steroid injections resulting in a 20-25 dB improvement in thresholds across the frequencies.

This case highlights the importance of early intervention for SSNHL and the need for additional training and guidance for general practitioners and emergency care providers in recognizing the signs and risk factors for SSNHL, initiating proper referrals and counseling regarding possible treatment options. More relevant to audiology clinicians, we will discuss the importance of counseling patients who have experienced this delay in treatment initiation and the ongoing need to increase public awareness related to SSNHL.