Background
- Search for treatable cause
- Seek suggestions of:
- Infection e.g. bacterial (syphilis, meningitis), viral (e.g., mumps, CMV, HSV)
- Inflammation (Sarcoidosis)
- Vascular - Hypercoagulable states, embolism
- Tumour (primary or metastatic)
- Trauma (BOS #, direct ear trauma)
- Toxin e.g. aminoglycosides
Clinical
History
- Onset, assoc. Ⅷ symptoms
- Similar deafness in past?
- ALL meds (incl. OTC), especially Aspirin
- PMHx (emboli/hypercoag risks etc)
Examination
- Differentiate sensorineural from conductive deafness
- If clinical sensorineural, (Mx below), full neuro exam
Investigations
- Early, formal audiometry
- ±MRI (not CT as insensitive)
Labs only if indicated by Hx/exam e.g.:
- Clotting studies if hypercoag. state
- FBC/CRP if Hx suggestive of infection
- ANA, ESR and Rheumatoid factor if suspicious
- Syphilis antibody tests
Management
- Treat any identifiable underlying cause (e.g infection, hypercoagulable state)
- ? sensorineural = emergency:
- High-dose prednisolone x one week
- Audiogram next working day
- Consider hyperbaric O2, diuretics or vasodilator (D/W ENT)
CUH
- Urgent refer ENT
- SIVUH ± intratympanic steroid