Common Causes

Many cases of SSNHL are “idiopathic,” meaning no clear cause is found even after testing. But some important causes include:

• Acoustic trauma (very loud noise)

• Head trauma

• Viral or inflammatory injury to the inner ear

• Vascular problems that briefly reduce blood flow to the cochlea

• Autoimmune inner ear disease

• Tumors on the hearing nerve (e.g., vestibular schwannoma)

• Pressure-related injuries such as barotrauma or decompression sickness (DCS) in divers or after rapid decompression

Treatment Options

1. Steroid Therapy Immediate Treatment (Start ideally within 24 hours, no later than 7 days)

High-dose corticosteroids (by mouth, by shot, by IV or injected through the eardrum into the middle ear) are a mainstay of treatment for idiopathic SSNHL and are often used for pressure-related inner ear injuries as well.

Oral Prednisone / Prednisolone (most common)

• Dose: 1 mg/kg/day

• Typical adult dose: 60 mg daily

• Duration: 7–14 days

Common example regimen: 60 mg PO daily × 7 days, Then taper: 40 → 30 → 20 → 10 mg (each 1 day)

Steroids aim to: Reduce inflammation and swelling in the inner ear, Stabilize cell membranes, and improve blood flow and oxygen delivery

The 2019 American Academy of Otolaryngology guideline emphasizes starting steroid therapy within 2 weeks of symptom onset for best results, with intratympanic injections used either as primary or “salvage” therapy if oral steroids fail or cannot be taken.

Intratympanic Steroid Injection (IT Steroids)

• Dexamethasone 10 mg/mL or 24 mg/mL

• Use if:

  • Cannot take oral steroids

  • No improvement after 48–72 hours

  • Severe/profound hearing loss at onset

  • Salvage therapy up to 4–6 weeks

2. Hyperbaric Oxygen Therapy (HBO or HBOT)

Hyperbaric oxygen therapy (HBO or HBOT) involves breathing 100% oxygen in a pressurized chamber which brings a higher concentration of Oxygen to the damaged inner ear. For sudden hearing loss, it is used in two main settings:

1. Adjunct therapy for idiopathic SSNHL

   • Updated AAO–HNS guidelines allow HBO as an option in combination with steroids, either as initial therapy within 2 weeks or as salvage within 1 month of onset.

2. Inner ear decompression sickness / DCS

   • Recompression with HBO is the primary treatment for DCS and inner ear DCS.

   • Increased pressure shrinks gas bubbles and returns them to solution.

   • High oxygen levels improve blood flow and oxygen delivery to injured inner ear tissues.

While generally safe, HBO can have side effects such as ear or sinus barotrauma, temporary nearsightedness, lung issues, or oxygen toxicity, so it must be supervised by physicians experienced in hyperbaric medicine. Most commonly used protocols:

• Pressure: 2.0–2.5 ATA (Atmospheres)

• Duration: 60–90 minutes per session

• Frequency: Once daily

• Total sessions: 10–20 treatments (sometimes up to 30 in partial responders)

What Is Sudden Hearing Loss?

“Sudden hearing loss” short for Sudden onset Sensorineural Hearing Loss (SSNHL) – damage to the inner ear or hearing nerve that develops over minutes to up to 72 hours. It is commonly defined as a loss of at least 30 dB affecting three or more frequencies on a hearing test

Most people describe it as:

• “My ear suddenly went dead”

• “It feels like cotton or water in my ear, but nothing comes out”

• Ringing (tinnitus), fullness, or distortion in one ear

What To Do If You Suddenly Lose Hearing

STEP 1 —Recognize the Emergency and Seek urgent medical care.

• Get evaluated by an ENT (ear, nose, and throat) specialist as soon as possible. Tell your doctor about any diving, flying, trauma, or decompression events.

  • This helps differentiate idiopathic SSNHL, barotrauma, and inner ear DCS, which are treated differently.

• Emergency department or urgent care if you cannot get in to see your ENT. It is particularly important if you have severe symptoms like vertigo, trouble walking, neurological signs, recent dive or rapid decompression).

• Unfortunately, not all urgent care centers or emergency rooms know exactly what to do for sudden hearing loss. If that is the case, please refer them to this page. Let them know, RESPECTFULLY, that Steroids are the mainstay of therapy. Unless there is a contraindication (medical reason to not give steroids), a 60 mg Predisone taper over 10-14 days should be requested!

STEP 2 — Rapid Hearing Assessment

1. Get a hearing test (audiogram) ASAP, best done by an Audiologist to Confirm the degree and type of hearing loss (sensorineural vs. conductive) and help guide treatment and track recovery over time.

2. If NO medical provider is available: SELF-ASSESSMENT OPTIONS

   • Tuning Fork Substitute (Self-Weber Test)

     • Hum a steady low-pitch note (e.g., “mmm”).

     • Does the sound feel louder in one ear?

       • Lateralizes (seems louder) to good ear → likely sensorineural loss in the bad ear

       • Lateralizes (seems louder) to bad ear → likely conductive loss (less of an emergency)

   • Use an iPhone Audiogram App

     • Download the EarAware Decibel Meter Audiogram app. and check daily progress. alternatively: Apps like Ear Scale, Mimi Hearing Test, Hearing Test Pro, or apps integrated into Apple Health can give a rough threshold measure.

     • Not diagnostic, but detects asymmetry and guides urgency.

   • Simple Functional Test

     • Rub fingers near each ear.

     • Whisper test from a family member at fixed distances to check asymmetry.

   If findings suggest sensorineural loss → treat immediately; do not wait for audiology.

   • Confirms the degree and type of hearing loss (sensorineural vs. conductive).

   • Helps guide treatment and track recovery over time.

3. Act quickly. Best outcomes are seen when treatment starts within days, not weeks.

STEP 4 — Immediate Treatment (Start ideally within 24 hours, no later than 7 days)

Systemic Steroids (First-line for SSNHL) Prednisone 60 mg/day × 7–14 days. The earlier steroids are begun, the better the prognosis. If diabetic or contraindications exist → intratympanic steroids preferred.

Intratympanic Steroid Injection (IT Steroids)

1. Dexamethasone 10 mg/mL or 24 mg/mL

2. Use if:

   • Cannot take oral steroids

   • No improvement after a week of oral steroids

   • Severe/profound hearing loss at onset

Hyperbaric Oxygen Therapy (HBO) Indications per AAO-HNS:

• Start within 2 weeks of onset

• OR as salvage within 1 month

• Take a Hearing Rest Break. Just as you wouldn’t rev an engine that is already overheated, you do not want to overstimulate your ear. Avoid worsening damage by limiting your sound exposure. Keeping sound levels below 85dB is a good rule of thumb for a NORMAL EAR. Keeping it under 78 dB is much safer for a damaged ear.

STEP 4 — Lifestyle, Risk Reduction, and Ear Recovery “Do’s and Don’ts”

A. Noise Avoidance (“Hearing Rest”) Take a Hearing Rest Break. Just as you wouldn’t rev an engine that is already overheated, you do not want to overstimulate your ear. After SSNHL, inner ear cells are vulnerable. Avoid worsening damage by limiting your sound exposure. Keeping sound levels below 85dB is a good rule of thumb for a NORMAL EAR. Keeping it under 78 dB is much safer for a damaged ear. No headphones, no loud venues, no power tools. Use double protection (earmuffs + plugs) if required to be in noise

B. Avoid Substances That Can Worsen Hearing. Medications & chemicals

• Aspirin (high doses) – reversible ototoxicity

• NSAIDs in high doses (ibuprofen, naproxen)

• Loop diuretics (furosemide, bumetanide) in high doses or rapid IV push

• Nicotine – vasoconstriction reduces cochlear blood flow

• Excess caffeine (may reducs cochlear microcirculation)

C. Nutrition for an Ear-Healthy Diet: See below.