New Sudden Hearing Loss Guidelines Provoke Mixed Opinions

A new guideline from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) on sudden hearing loss—the first and only U.S. clinical practice guideline on this condition—has garnered mixed reactions from the otolaryngology community.

In keeping with the spirit and letter of these guidelines, the AAO-HNS enlisted the help of a panel of multidisciplinary experts representing otolaryngology, otology, neurology, neurotology, family medicine, emergency medicine and audiology, as well as consumer groups, to review the best evidence currently available on many of the issues pertinent to the clinical management of sudden hearing loss.

The guidelines were presented at the annual AAO-HNS meeting in San Francisco in September 2011 and published last month (Otolaryngol Head Neck Surg. 2012;146:S1-S27).

The guidelines include a detailed explanation of the process by which the panel selected, reviewed and evaluated the current published evidence. Per guideline protocol, each statement is accompanied by an indication of the type of action recommended based on the strength of the evidence. Statements supported by strong evidence are given a “strong recommendation,” and statements supported by evidence with sufficient strength carry a “recommendation,” while statements supported by weaker evidence carry an “optional” directive.

“We don’t want guidelines to be cookbooks; rather, we want them to be resources that people can look to for best practices for treatments based on the best evidence available,” said Robert J. Stachler, MD, division chief of otolaryngology at Henry Ford Hospital, clinical associate professor at Wayne State University in Detroit, Mich. and lead author of the guidelines. Although Dr. Stachler said he believes most of the issues covered in the guidelines will not raise too much debate, he did highlight a few that have generated some discussion. The following issues refer to patients diagnosed with sudden sensorineural hearing loss (SSNHL) as opposed to conductive hearing loss.

Optional Corticosteroid Use and Hyperbaric Oxygen

Statement eight, which states that initial treatment of SSNHL with steroids is optional, may be most surprising to clinicians who see these patients.

According to Sujana Chandrasekhar, MD, director of New York Otology and vice-chair of the guidelines, most of the guidelines panel went into the review process with a bias toward using oral systemic steroids for initial treatment, because it reflects standard current practice by most clinicians who treat SSNHL. The current evidence on the efficacy of initial oral steroids, however, was not strong enough to warrant a recommendation, she said. “We are not saying that we recommend against initial treatment with steroids; we are saying it is optional,” she said.