Current concepts in the diagnosis and treatment of sudden sensorineural hearing loss

Sudden hearing loss (SHL) has been a controversial topic in the literature for the past several decades. Although much theoretical work has been done regarding its diagnosis and treatment, no useful practical guidelines exist for application to current patient management. Many authors have discussed the various treatment protocols available to treat this entity, but only a handful of dated, clinical studies supporting these treatments are available. More recent studies applying treatment protocols including vasodilators, plasma expanders, anti-coagulants, and carbogen inhalations have shown no improvement over the rate of spontaneous recovery without therapy. Except in cases of therapy directed toward known predisposing factors, there is insufficient evidence in the literature to support medical treatment for SHL, although steroid therapy appears to be useful in selected patients. Our own review of 14 patients with SHL is presented. A standard diagnostic and therapeutic approach based on a comprehensive review of the literature is described that can be applied to most patients presenting with SHL.