Sudden Hearing Loss Is a Medical Emergency

© February 2003 (revised January 2006) by Neil Bauman, Ph.D.

Question: Recently I woke up and discovered I had lost the hearing in my left ear while I slept. I went to my local doctor, but he didn't seem to think it was a big deal. He told me it was likely my ear plugged up from a cold and to come back in a few days if it didn't get better. I'm scared. Ten days have gone by, and I still can't hear out of my ear. What should I do?—A. P.

Answer: Sudden hearing loss is a big deal. In fact, it is a medical emergency! Like any other medical emergency, you need treatment, and you need it now! You can't afford to waste time if you want your hearing back.

When sudden hearing loss hits them, most people quite logically head for their primary care physician (PCP). Unfortunately, few of these doctors realize the emergency nature of a sudden hearing loss. As a result, they take a "wait and see" attitude. This is wrong!

This attitude would be comparable to your being in an accident and bleeding to death. Someone phones for the ambulance and the dispatcher tells them, "Don't worry about it. If the bleeding doesn't stop in a couple of days, give us another call and we'll come out." Sounds ridiculous, doesn't it? Yet that is exactly how some doctors treat sudden hearing loss.

Here is a real-life horror story to show you what goes on right here in the USA today when you are unfortunate enough to be served by an incompetent doctor. A lady relates:

On Sept. 22, 2005 I noticed that I felt weak, like I was going to die, and I noticed my hearing sense in the left ear was affected. I felt so ill I went to bed early and then awoke two hours later to the feeling that the bed was spinning rapidly through space at 1,000 mph and I was being hurled forward at the same time in summersaults. I tried to make it to the restroom to vomit, and I began falling into the walls and the doors.

It took me nearly an hour to crawl to the phone to call 911.  At the ER, the doctor treated me worse than dirt.  When the blood work looked pretty much OK except for an elevated RBC and blood sugar, the doctor said, "You're not sick.  Go home."

I said, "I've lost my hearing in the left ear."  He retorted, "How long have you been deaf in that ear?"  When I said, "Only since last night when the 'event' began," he said, "Maybe you are just going to have to live with it."

I said, "Do I really look OK?" (At that point my head was rocking and rolling and I was falling over when I'd tried to sit up.  He said "I don't know what you normally look like.  Maybe this is normal for you."  I said, "People don't normally rock and roll all over the bed like this.  And my hearing just disappeared.  This is serious."

He became angry and told me I was going home in a taxi, that nothing was wrong.  I refused, so he got a nurse and she said she was sent by the doctor to convince me nothing was wrong.  I told her my concerns. She went and got a bold-faced administrator to come yell at me and tell me I was going home no matter what in a taxi, barefooted and in a vomit covered gown.

When this lady finally got to a competent ear specialist, 9 days had elapsed. Later, they determined she had suffered a mini-stroke that had cut off the blood supply to her inner ear. If she had been treated immediately with drugs to dissolve the clot, there was a good chance her hearing and balance could have quickly been restored. Instead she has been left with permanent total deafness in one ear. This is not the proper way to treat sudden hearing loss!

The "Golden Hour"

When I was in the "first aid business" we had what we called the "golden hour." This "golden hour" is the time between when an accident occurs and when the person receives effective medical treatment.

If you are in an accident and receive effective treatment within one hour, you have a much better chance of surviving than if you don't receive treatment within those first critical 60 minutes. That is why ambulances come screaming to the victim's side, grab him and dash to the nearest trauma center or hospital. Time is often critical for survival.

In like manner, when sudden hearing loss strikes, the "golden hours" clock begins ticking. The longer you wait before you receive effective treatment, the slimmer your chances are of getting your hearing back.

Fortunately, in most cases, you have more than just one hour to seek treatment for sudden hearing loss. In fact, the "golden hour" for sudden hearing loss is ideally 24 to 48 hours but treatment may still produce some results as long as 14 days later.

You may have an ear stuffed up from a cold—or so you think—so you wait for it to clear and your hearing to return. This is just human nature. When it doesn't get better after a few days, you head for the family doctor. In the meantime, you have let those precious "golden hours" slip away. As a result, you may have just kissed goodbye to your hearing. You could end up wearing a hearing aid or cochlear implant for the rest of your life.

Sudden hearing loss can strike anytime. "Rosalind" wrote, "I was watching TV on Friday night when suddenly I heard nothing." Medical emergency—yes or no? Her husband assured her, "It's probably just sinus." Wrong answer! This was a medical emergency. By the time "Rosalind" finally received appropriate medical treatment, it was too late. Her "golden hours" had slipped away. Most of her hearing never returned. She now wears two hearing aids.

"Lisa" had a different experience. She wrote, "One Friday night I sneezed hard twice. Instantly I lost much of the hearing in my left ear." Medical emergency—yes or no? She relates, "I thought I had somehow just plugged up my ear and that it would clear up on its own." Wrong answer! This too was a medical emergency.

On Wednesday "Lisa" went to a general practitioner (GP) who looked in her ears, cleared out the wax, gave her a prescription for the dizziness she experienced and sent her on her way. Wrong doctor! Wrong diagnosis! Wrong treatment!

Four weeks later "Lisa" went to an Ear, Nose and Throat doctor (ENT). He found that she had a sensorineural hearing loss and put her on steroids. Better doctor. Better treatment, but much too late. The result, as she says, "was a waste of time." Her "golden hours" had also silently slipped away.

Gaurav's experience was different still. He had just returned from a trip to the Colorado Rockies. "The next morning when I woke up," Gaurav wrote, "I felt a slight pressure in my right ear. It felt like it was blocked. I couldn't hear anything out of it. I also felt some dizziness, vertigo, nausea and imbalance." Medical emergency—yes or no? Gaurav thought this ear problem "must have been due to my recent trip and would go away by itself." Wrong answer! This too was a medical emergency.

Two days later Gaurav saw his GP who gave him "a nasal spray and some antibiotics in case it were an infection." Wrong doctor! Wrong diagnosis! Wrong prescription!

When he didn't feel better after a week, Gaurav was referred to an ENT who saw him "for two minutes and said, 'Let's get a hearing test done.'" This hearing test, done 17 days after the sudden hearing loss, showed a profound sensorineural hearing loss. Gaurav was put on steroids and other drugs, but it was too late and little of his hearing ever came back. His "golden hours" had also slipped away.

Gaurav finally got to see a true ear specialist, a neuro-otologist, eight weeks after his hearing loss. There he was told, "If more than two weeks have passed since the sudden hearing loss, there is no point in even looking at a patient because that is the absolute limit of the window of opportunity for saving any hearing." Finally, Gaurav had the right doctor, but much too late to do him any good.

Try This Simple Test

Knowing when a hearing loss is a medical emergency and when it is not is almost impossible for the layperson (and many doctors) to determine. For example, you have a cold. You go to bed. When you wake up the next morning you can't hear in one ear. It feels plugged up. Medical emergency—yes or no? Who knows? The answer may be either one.

You may have an ear plugged up by the cold and the blocked feeling will go away in a few days without any treatment or medical intervention. This would be a conductive loss and would not be a medical emergency.

However, you really might have a viral infection of your inner ear which is a medical emergency. In fact, about 25% of all the cases of sudden hearing loss develop just like this.

The problem is many people assume it is just a cold and wait to see if it will clear up. By the time they realize it isn't clearing up, their "golden hours" have silently slipped away.

Until now, you had no way of knowing whether it was a medical emergency or not. Fortunately for you, Dr. Jeffery Harris, chief of otolaryngology/head and neck surgery at the University of California, San Diego (UCSD) Medical Center has recently come up with a quick test to separate these two conditions.

Here is all you need to do, assuming that only one ear is "blocked." Hum out loud. If you hear your voice louder in the blocked ear, the problem is congestion (fluid in your middle ear) and is probably temporary until your cold goes away and your ear clears.

However, if you hear your voice louder in your good ear, this probably indicates a viral attack causing permanent hearing loss if left untreated. If this is your case, seek treatment immediately. This is a true medical emergency and needs to be treated now if you want a chance of getting your hearing back. According to Dr. Harris, your chances of getting your hearing back with immediate treatment are greater than 50%.

If both ears are blocked equally, this little test isn't going to work (unless you can remember how loud humming sounded before you got the cold). Thus, it is better to err on the side of caution if you have reduced hearing in both ears and seek competent medical help now. Ditto if the results of this test are inconclusive. Get to an otologist now. It's better to be safe than sorry.

Safe? or Sorry?

Don't feel foolish bothering the specialist for something that ultimately turns out to be just a cold in your ear. He understands. He would rather you bothered him for something that turns out to be unnecessary than for you to wait and ultimately suffer permanent hearing loss.

When I was in the fire/rescue service, we used this same principle. We would treat motor vehicle accident victims as if they had broken backs/necks. We carefully immobilized them on spine boards and rushed them to the hospital. There, if the x-rays showed no fractures, we'd let them up. However, if there was a fracture, they (and we) were safe—not sorry. Their chances of recovering without paralysis was good because we treated their injuries as a medical emergency until proven otherwise. Do the same with your ears. If you don't, you could be sorry for the rest of your life.

When sudden hearing loss strikes, get yourself to the right doctor now! Who should you go to? Forget about your primary care physician (PCP), general practitioner (GP) or family doctor. These doctors are not trained in assessing and treating sudden hearing loss. Few, if any will point you in the right direction. Result? Wasted time as your "golden hours" steadily tick away.

A better choice is to go to an otolaryngologist, commonly known as an ENT, short for Ear, Nose and Throat doctor. Unfortunately, it may take you a while to get to see one of these specialists, especially if your health insurance requires a visit to your PCP for a referral first. Furthermore, in the end, an ENT may not give you appropriate treatment either. Why? Isn't he an "ear specialist"? You might be surprised to learn that even though an ENT specializes in conditions of the head and neck, he actually spends very little time on ear problems. One otologist I spoke to estimated that ENTs only spend about 5% of their time on ear problems.

If you experience a sudden hearing loss, you need to see the true ear specialist—an otologist. These doctors go by various names—otologist, neurotologist (sometimes spelled neuro-otologist) or oto-neurologist—but these are basically all the same. They are doctors who only treat ear problems—especially problems in your inner ear. These doctors have the best chance of helping you regain your hearing.

To quickly find an otologist or neurotologist near you click on the article "Finding the Right Doctor for Sudden Hearing Loss and Other Ear Problems" and read or scroll down to the heading "Finding an Otologist (Neurotologist)." Follow the directions given there.

You Need to Take Charge

Just getting to see an otologist within 24 to 48 hours can be next to impossible. Gaurav writes, "We must be kidding ourselves if we say that treatment for sudden hearing loss should be started within 24 to 48 hours. With the referral system that we have here [Canada], it is next to impossible. First you see a GP who refers you to an ENT which could take weeks or months. The ENT then asks for you to take a hearing test that takes a week. By that time, it is much too late and irreversible hearing loss as already occurred."

We need to change the system and drastically shorten the delay before effective treatment if people with sudden hearing loss are to be given a chance to save their hearing. We need immediate access to otologists in such cases. It can be done. Here's what one lady did.

Several months ago I received an email that read, "I suffered sudden hearing loss 10 days ago. It was immediate and profound. My doctor put me on a corticosteroid for one week. I think the time has come to be more proactive about helping myself. Could you suggest the best place to go for diagnostic help and treatment? Thanks. Marcia."

I immediately wrote Marcia back, urging her to get effective help immediately as her "golden hours" were fast running out. In my email I wrote, "If I had your condition and could go anywhere, I'd head for the House Ear Institute (HEI) in Los Angeles." I gave her the link to the HEI. That was Friday morning.

When she received my email, Marcia immediately emailed the House Ear Institute. One of the doctors there received her email Friday evening about 8:30. Now here's the good part. This doctor (bless his heart) recognized how critical the time was—11 days had already passed—and Marcia needed attention immediately if anything was going to help her regain her hearing.

He phoned her—clear across the country—and told her he would see her if she flew to Los Angeles, but warned her that it might be too late by the time she got there. However, he knew a specialist that lived close to her and urged her to call him immediately.

She protested that it was now close to midnight on a Friday. No specialist would do anything until Monday at the earliest. The HEI doctor just said, "Call!"

Marcia phoned this specialist in her area, and to her surprise, this otologist got her on the right medication that very night! No fooling around! No waiting!

Later, this same doctor put a micro-catheter in her ear so the drug could be administered right to the place where it is needed, since high doses of steroids are bad for the body as a whole. In addition, he tried a relatively new procedure called apheresis where certain antibodies and other things are filtered out of the blood in an attempt to restore her hearing.

Fast-forward four months. A couple of days ago I received an email from Marcia. She was all excited. No, her hearing hasn't come back—she still has a profound loss, but her comprehension (discrimination) has dramatically increased to 72% so she will be fitted with a hearing aid next week!

Who knows what might have happened if Marcia had sought out the best treatment immediately instead of letting her doctor fool around for 10 days before she took charge.

Will you get your hearing back if you get to an otologist within those "golden hours"? There are no guarantees. You may, or you may not. Doctors still don't know many of the answers to the causes and treatment of sudden hearing loss. What you will know, however, is that you have given yourself the best chance to restore as much of your hearing as is humanly possible. What more could you do?