Ms. Wu, 60, suddenly felt stuffy in her right ear and hearing loss two days ago. A medical examination found that the hearing in her right ear dropped to 50 decibels. After taking high-dose oral steroids for a week, her hearing still showed no improvement or even continued to deteriorate, leaving only a quarter of her original hearing. At the suggestion of Dr. Guo Liangkuan of the Department of Otorhinolaryngology of Guo General Hospital, he urgently switched to “intra-ear steroid injection” treatment. After four courses of treatment, Ms. Wu’s hearing in her right ear returned to normal 25 decibels.
Dr. Guo Liangkuan pointed out that sudden deafness is medically called “sudden sensorineural hearing loss” and is commonly known as “ear stroke” among the people. The strict definition refers to the occurrence of more than 3 consecutive frequencies within 72 hours, and the sensorineural hearing loss reaches more than 30 decibels. Most of this disease occurs on one side. Patients often find that their hearing on one side is significantly worse when they wake up in the morning or when talking on the phone. In addition to hearing loss, most patients will be accompanied by tinnitus and ear congestion, and 30% of patients will also experience symptoms of vertigo.
Current medical research shows that more than 90% of cases of sudden deafness have no clear cause. The main medical speculation is that it may be related to blood circulation disorders in the inner ear. For example, spasm or thrombosis of very small hearing nerve blood vessels, leading to tissue hypoxia. In addition, viral infections such as influenza and herpes invade the inner ear structure, or the autoimmune system mistakenly attacks inner ear cells. These are also possible causative factors.
For this otological emergency, the current standard first-line treatment is steroids, which aim to suppress the inflammation and immune response of the inner ear nerves. Physicians will provide two administration methods depending on the patient’s condition: systemic steroids (oral or intravenous injection) have the advantage of convenience, but for people with diabetes, high blood pressure, gastric ulcers or poor kidney function, high doses of steroids can easily cause side effects such as increased blood sugar, blood pressure fluctuations or stomach pain.
“Intra-ear steroid injection” can act directly on the affected area with almost no systemic side effects, and is suitable for the above-mentioned patients who are inconvenient to take oral steroids. According to statistics from a large-scale study of local patients in Tainan, if treatment can be started within 3 days of symptom onset, up to 80% of patients can improve their hearing.
Dr. Guo emphasized that the key to hearing recovery lies in “the time when treatment starts.” Drug administration is most effective when the nerves are in a state of severe inflammation and hypoxia within 3 days of the acute phase; once hypoxia continues for more than 14 days, auditory nerve cells will begin to die, and the chance of recovery will be significantly reduced.
If the two-week golden period is missed or the initial treatment effect is not good, clinical opportunities can be obtained through “rescue treatment”, including steroid injection into the rescue ear, or “hyperbaric oxygen therapy” that delivers pure oxygen at more than 2 times atmospheric pressure, and pressurizes oxygen into plasma to supply the inner ear. Or the emerging therapy of “high-concentration platelet plasma (PRP)”, which is centrifuged from one’s own blood, uses the growth factors in it to promote nerve repair.
Dr. Guo urges that if you notice sudden hearing loss, tinnitus or ear congestion, you must seize the golden period within 2 weeks to seek medical treatment promptly and start treatment as soon as possible. The more time you buy, the more chance you have to find your voice.
