What are the Causes of Sudden Hearing Loss? 
Sudden Hearing Loss may result from dysfunction of the external or middle ears. In this case this it is known as sudden conductive hearing loss. Alternatively, sudden hearing loss may also result from dysfunction of the inner ear or nerve of hearing. This is known as sudden sensorineural hearing loss. The treatments for these two forms of sudden hearing loss are very different and it is, therefore, very important that the patient obtain an accurate diagnosis when he/she complains of sudden hearing loss. 
 

What are the causes and treatments for sudden conductive hearing loss? 
Any process that affects the external or middle ear can cause a sudden conductive hearing loss. The most common causes include wax impacted in the ear canal, infection of the external or middle ear, or fluid accumulation within the middle ear. Fluid accumulation may result from sudden changes in air pressure, such as those experienced on an air flight. A physical examination will confirm the presence of abnormalities within the external or middle ear and treatments can be administered to address these abnormalities. This may include removal of wax, or treatment with antibiotic or decongestants. Occasionally, fluid accumulation within the middle ear will not respond to medications and has to be drained with a quick office procedure. 
 

What are the causes of sudden sensorineural hearing loss? 
It is now clear, based on a abundance of scientific evidence, that the vast majority of cases of sudden sensorineural hearing loss are caused by a viral infection of either the inner ear or nerve of hearing. While it was once felt that this problem was caused by a decrease in blood flow to the inner ear (analogous to a stroke of the inner ear), it is now felt that only a small number of patients with this form of hearing loss suffer from a loss of blood flow to the inner ear. 
 

How is sudden sensorineural hearing loss best treated? 
The only treatment that has proven to be effective in the treatment of sudden sensorineural hearing loss is the steroid drug prednisone. A short course prednisone will, in the majority of patients, improve the recovery of their hearing. The amount of recovery that can be anticipated is based on a variety of factors, the most important of which is how severe the hearing loss is. It is important that the prednisone be administered as soon as possible after the onset of the hearing loss as we have only a limited amount of time during which the hearing loss remains reversible. 

Many other treatments have been advocated for the treatment of sudden sensorineural hearing loss. These treatments are all designed to increase blood flow to the inner ear and include blood thinners and drugs designed to dilate blood vessels such as niacin, carbogen gas, histamine, bellargal, and many others. Despite numerous studies, none of these drugs have ever been shown to be useful in the treatment of sudden sensorineural hearing loss and, therefore, we do not advocate their use for the treatment of this disorder. In addition, there appears to be no role for diet modification or for the use of diuretics (water pills). 

Prednisone is a very effective immune suppressant, however, it does have side-effects. Prednisone may cause alteration in mood, with some patients feeling either depressed or very euphoric. Prednisone may cause water retention and stomach upset. When we use prednisone for a longer periods of time, we always combine it with a medication to protect the stomach from forming ulcers. Prednisone may cause significant increases in blood sugar in patients with Diabetes and must be used with extreme caution in patients with this disorder. Long-term prednisone therapy may cause bone wasting, however, as noted, we rarely use it for prolonged periods of time. A very rare complication of prednisone therapy is a condition known as avascular necrosis of the hip which can cause serious damage to the hip joint. Fortunately this is an extremely rare condition and should not prevent patients from availing themselves of the potential beneficial effects of prednisone.