AAO-HNS14: Treatments Beyond Steroids for Sudden Sensorineural Hearing Loss Examined

by Thomas R. Collins •

Seth Schwartz, MD, MPH, chair of the AAO’s Guidelines Task Force, discussed the guideline that clinicians “may offer hyperbaric oxygen therapy,” in which pure oxygen is delivered at a higher-than-usual pressure. While the treatment is not approved for SSNHL in the United States, international literature shows some possible promise. A Cochrane Review, for example, found improvement in acute idiopathic SSNHL but with the clinical significance unclear and no benefit in chronic idiopathic SSNHL.

SSNHL still continues to be something that’s identified as a gap in knowledge in our membership.—James Saunders, MD

“I’ve had more and more patients come into my clinic since the guidelines came out asking about this therapy,” said Dr. Schwartz, “and I think there’s a lot of uncertainty about who exactly we should recommend it to and how we should handle it. And we’re currently trying to come up with a protocol at our hospital.”

Afterward, Dr. Chandrasekhar emphasized how important it is to talk to patients about the options with this disorder. “This is one entity where you need to spend the time to educate the patient,” she said, “because there’s a reasonable chance they’re going to get better if you do nothing. If you do nothing and they don’t get better, there’s a reasonable chance that injecting with steroids at that point, if you don’t wait too long, will work.”

In her experience, she said, patients almost never opt for no treatment, usually because they’ve already had a “no treatment” period while they waited before seeing a physician.

Take-Home Points

  • Talking to patients about the natural history of SSNHL is vital, because improvement can often be seen with no treatment, and treatment might not necessarily confer a benefit.
  • Good results have been seen using an interleukin-1 receptor antagonist in patients with autoimmune inner ear disease, and researchers hope they translate to those with SSNHL.
  • Steroids are not the gold standard for treatment. They should be considered as an option only, because the literature reports conflicting data with regard to their benefits.
  • Retrocochlear pathology should be investigated, or at least considered, with all patients.