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AAO-HNS Releases New Guideline for Management of Patients with Sudden Hearing Loss
March 1, 2012

On March 1, 2012, the American Academy of Otolaryngology-Head and Neck Surgery Foundation published a new Clinical Practice Guideline on Sudden Hearing Loss (SHL). This guideline is published as a supplement to Otolaryngology?Head and Neck Surgery.

A sudden loss of hearing is a frightening symptom that most often prompts urgent medical care. Current diagnosis and treatment plans vary greatly. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of adults who present with SHL. Prompt, accurate recognition and management of sudden sensorineural hearing loss (SSNHL), a subset of SHL, may improve hearing recovery and patient quality of life. SSNHL affects 5 to 20 per 100,000 population, with about 4,000 new cases per year in the United States.

The purpose of the guideline is to provide all clinicians who may encounter patients with SHL with evidence-based recommendations for diagnosis, counseling, treatment, and follow-up. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients.

"We are pleased that this guideline provides doctors with a set of evidence-based recommendations for patients who present with sudden hearing loss. This guideline will help advance the care of afflicted patients and result in improved outcomes," said Robert J. Stachler, MD, Guideline Chair.

The AAO-HNS guideline provided strong recommendations for the following actions [taken from the guideline abstract]:

  1. distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL;
  2. educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and
  3. counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures.

The panel creating the guidelines made recommendations that clinicians should:

  1. assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings;
  2. diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination;
  3. evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up;
  4. offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and
  5. obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL.

The panel also offered options that clinicians may offer:

  1. corticosteroids as initial therapy to patients with ISSNHL and
  2. hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL.

The panel recommended against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL.

Last, the panel recommended strongly against:

  1. ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and
  2. obtaining routine laboratory tests in patients with ISSNHL.

The guideline is accessible the AAO-HNS web site.

    © 2018 Sentient Healthcare, Inc.