Management of sudden sensorineural hearing loss among primary care physicians in Canada: a survey study

Abstract

Background Sudden Sensorineural Hearing Loss (SSNHL) is a medical emergency requiring immediate attention as delayed treatment can lead to permanent and devastating consequences. Primary care physicians are likely the first to be presented with SSNHL and therefore have the crucial role of recognizing it and initiating timely and appropriate management. The aim of this study was to gain insight into the current knowledge and practice trends pertaining to the diagnosis and management of SSNHL among family physicians in Canada. Methods An 18-question survey targeting Canadian family physicians was marketed through two, physician-only discussion groups on the social media platform Facebook. Responses were collected between August 1st and December 22nd 2019 then aggregated and quantified. Results 52 family physicians submitted responses. 94.2% (n = 49) reported that in their practice, unilateral SSNHL warrants urgent referral to otolaryngology and 84.6% (n = 44) reported that unilateral sudden-onset hearing loss warrants urgent referral for audiological testing. 73.1% of participants (n = 38) reported that they would attempt to differentiate between conductive and sensorineural hearing loss if presented with unilateral, acute or sudden-onset hearing loss. 61.5% (n = 32) would rely on tuning fork tests to inform management decisions, as compared to 94.2% (n = 49) relying on case history and 88.5% (n = 46) on otoscopy. 76.9% (n = 40) would prescribe corticosteroids if presented with confirmed, unilateral SSNHL. Conclusion The majority of family physicians in the study would make appropriate referral and treatment decisions in the management of SSNHL, understanding it is a medical emergency. Tuning fork tests are under-utilized for informing management decisions compared to other means of differentiating conductive and sensorineural hearing loss. Further research is needed to understand why some family physicians do not prescribe corticosteroids for treatment of SSNHL, which may then identify any gaps in knowledge or inform improvements in clinical protocol. Graphical abstract

Sudden Sensorineural Hearing Loss and Why It’s an Emergency

“…Tinnitus and dizziness are non-specific and may help to differentiate between CHL and SSNHL [ 1 , 3 ]. In one study evaluating management of SSNHL among primary care physicians, the authors found that nearly all participants would warrant a referral to an otolaryngologist, which is contingent on whether the referring physician can recognize SSNHL [ 4 ]. Other exams discussed later in this article can be performed to confirm SSNHL and may help cut down on the time to proper diagnosis and treatment.…”

“…Tuning fork tests, audiograms, otoscopy, and thorough case history is essential in making a proper diagnosis of SSNHL [ 1 , 4 ]. A crucial first step for physicians is to differentiate between SSNHL and other hearing issues.…”

“…The incidence of SSNHL is approximately 5-27 per 100,000 people annually, with incidences peaking in those 50 to 60-years-old [1,2]. SSNHL is defined as a rapid onset of ≥30 dB hearing loss across three contiguous frequencies in 72 hours or less [2][3][4][5].…”

“…Contrasted from conductive hearing loss, SSNHL involves inner ear or nerve damage with unilateral ear involvement more likely [ 1 , 2 , 4 ]. Conductive hearing loss usually involves some obstruction of the outer or middle ear such as an infection or cerumen impaction [ 1 ].…”

The association of genetic polymorphisms in interleukin-1 receptors type 1 and type 2 with sudden sensorineural hearing loss in a Taiwanese population: A case control study

“…Sudden sensorineural hearing loss (SSNHL) is defined as a loss of at least 30 dB across three contiguous frequencies occurring within 3 days [ 1 , 2 ]. The estimated incidence is between 5 and 20 per 100,000 persons per year in the United States [ 1 ].…”