Idiopathic Sudden Sensori-neural Hearing Loss (ISSNHL)
Idiopathic Sudden Sensori-neural Hearing Loss (ISSNHL)
Objectives
Diagnosis
Criteria for HBO therapy
Work-up considerations
Treatment
Suggested treatment threshold
ICD 10 codes
Level of evidence
Objectives
Restore oxidative metabolism in the stria vascularis; increase perilymphatic oxygen pressure and protect neurosensory cells. Improve rheology.
Diagnosis
History of sudden or rapidly progressive hearing loss >30dB, almost always unilateral, without identifiable cause. Tinnitus, aural fullness or vertigo may be reported.
Criteria for HBO therapy
Confirmed diagnosis of sudden hearing loss, without identifiable cause. Referral via ENT specialist.
Timing of HBO: As soon as possible alone or in conjunction with other medical therapy but within 14 days of onset of hearing loss. As secondary therapy, if conventional therapy has failed, within 6 weeks up to 3 months.
Work-up considerations
- Patient needs to be referred from or discussed with ENT specialist.
- Administer 100% oxygen via non-rebreather reservoir mask during work up if hyper-acute and where possible.
- Comprehensive medical history: onset & possible provocative factors; medication; history of vascular disease.
- Physical examination including neurological, vestibular; otoscopic and tuning fork.
- Audiometric testing: tonal audiometry, speech discrimination, tympanometry.
- Additional testing as per specialist, if necessary.
- CXR, if indicated. Can discuss with HBO consultant if unsure.
- Initiation of corticosteroids.
- Anti-viral therapy, vasodilator, etc controversial.
- Signed informed consent for HBO.
Treatment
- HBO at 2.0 - 2.4 ATA for 90 minutes.
- Treatment schedule: First treatment ASAP, then once daily treatments.
- Utilization review after 10 session through pure tone audiometry.
Suggested treatment threshold
1 – 10 treatments. Up to 20 treatments can be considered if slow response or delay in treatment, but with >10dB improvement after 1st 10 sessions.
ICD 10 codes
H91.2 - Sudden hearing loss
Level of evidence
Level B