Sudden sensorineural hearing loss, an invisible male: State of the art

Sudden sensorineural hearing loss (SSNHL), identified by Dekleyn in 1944, is a important otological disorder. It is characterized by a hearing loss greater than 30 dB over three consecutive frequencies, in less than 72 hours, with no identifiable etiology. It is a real sensorineural emergency that can become a permanent handicap if not adequately treated. SSNHL has a prevalence of 5-20 in 100,000 inhabitants. Because of patients recovering rapidly or seeking no medical attention, the true figure might be higher. Sudden hearing loss occurs typically between 50 and 60 years of age and the lowest among 20-30. The prevalence of SSNHL is not significantly different between men and women. There are many potential causes of SSNHL, but despite extensive evaluations, the majority of cases elude definitive diagnosis and therefore, remain idiopathic. Reports estimate that the etiology of SSNHL is diagnosed in only 10% of cases. Therapy for SSNHL is a subject of controversy and the unknown etiology justifies heterogeneous therapeutic approaches, on one hand therapies’ aim is to correct the primary risk factors (smoke, diabetes, hypertension, previous viral or bacterial infection), on the other the purpose is to act on the main etiopathogenetic hypotheses (viral infection, immunologic, vascular compromise). Among the many treatments proposed, the glucocorticoids are the most adopted, but with different routes of administration: oral steroid, intratympanic steroid therapy and their combinations. Therefore, it is very important to establish a international therapeutic protocol correlated to subject’s performance status, risk factors, type and degree of hearing loss.