Steven D. Rauch, M.D., an otologist at the Massachusetts Eye and Ear Infirmary, and a professor of otology and laryngology at Harvard Medical School
How do you know when hearing loss is serious?
The first thing to do is determine whether there's truly hearing loss. You can crinkle some hairs on the side where you have hearing loss, right next to your ear, listen to your wristwatch, or rub your fingers together. If you can't hear it on one side then you have hearing loss. You can also hum out loud. If your voice moves away from the blockage to your good ear, it means the nerves aren't working on the blocked side. And that's bad. That's an emergency, and you need to be seen within 24 hours.
Why the rush?
All the literature says the sooner you start, the better the results. The classic story is someone whose ears get blocked up from a head cold, and after the cold goes away one ear remains blocked. They buy some ear cleaning junk, call the doctor's office, get some Sudafed, find it still doesn't work, and the doctor phones in a prescription and then another few weeks go by and their doctor says their ears look fine, and they need to see an ENT (ear, nose and throat specialist) but by now they've missed the opportunity for treatment.
Explain the difference between a stuffy ear and sudden deafness.
Middle ear infections are conductive disorders where something -- perhaps ear wax, fluid or pus -- muffles sound.
Still, are there ideas why it happens?
We don't really know. But the three most popular theories are that it's a loss of circulation, or blood flow, to the ear; that it's viral; or it's something mediated by the immune system. But none of these has been proven. There are circumstances for each, and cases where probably all three happen.
Is it instantaneous? Over days? Is there a sound that marks its onset?
All of the above. The clinical definition of SNHL is that it occurs in less than 72 hours. Some patients who go to bed hearing wake up deaf. Others, all of a sudden they hear a pop, and then their hearing is gone. In some, it's like air going out of a tire. Some have hearing that's doing something funny for a day or two or three.
Is it in one ear or two?
Sudden deafness in both ears is exceedingly rare and usually happens in cases where there's a serious neurological problem.
Ear fullness is a symptom. What are others?
Virtually 100 percent of patients have tinnitus (or ringing in the ears) while about 50 percent who present with SNHL have some complaints with altered balance, mild tipsiness ... If the balance problem is a significant piece and is accompanied by hearing loss, the prognosis is much worse ... and patients tend not to recover.
What about pain?
Still, it must be a scary thing.
Most patients who go through this are really distressed. It's tragic, losing function of a body part. You can't tell where sounds are coming from. But as time passes your brain gets used to it. The 40 percent who don't get recovery, or respond to treatment, usually get along fine. Another four to five percent have other problems downstream where the ears give them other problems. But it's tragic to miss a possible opportunity to treat something if you can.