One morning, he wakes up with the sensation of having a blocked ear. Or maybe you hear a loud clicking sound. You may answer the phone and notice that the caller sounds farther away than usual. You might notice a new ringing in one ear or start to feel dizzy.
Any of these experiences may seem harmless or temporary. And often it is. Common causes of muffled hearing include earwax buildup, ear or sinus infections, congestion from a cold or allergies, pressure changes, and age- or noise-related hearing loss.
But these symptoms could also indicate a medical emergency that many people don’t recognize, known as sudden sensorineural hearing loss.
I experienced it myself at 32 years old. One night, a sudden ringing began to resonate on the right side of my head. When I held the phone to my right ear, the person on the other end of the line sounded like they were underwater. Still, I didn’t realize I had lost my hearing. I sought medical attention for the tinnitus within 48 hours, but the doctor prescribed a nasal spray that didn’t help.
This is what I wish I had known beforehand, so I could have defended my rights and received emergency treatment sooner.
When a clogged ear is something worse
Sudden sensorineural hearing loss is a rapid decrease in hearing that can occur suddenly or develop over the course of a few days. It is a potentially reversible condition, different from hearing loss caused by aging, noise exposure or earwax, but requires immediate treatment for the best chance of recovery.
“It’s an emergency,” said Nicholas Deep, a neuro-otologist at the Mayo Clinic. He explained that it is similar to the treatment of a heart attack or stroke, but “in this case, the affected organ is the cochlea, not the heart or the brain.” The cochlea is a tiny structure in the inner ear that contains sensory hair cells essential for hearing.
Treatment within seven days of symptom onset offers the best chance of recovery. However, the sooner treatment is started, the better the outcome, Deep said.
The most common treatment is a short course of high-dose oral prednisone, a powerful steroid that works by reducing inflammation, to give the inner ear the best chance of recovery, Deep explained. Steroid injections through the eardrum and hyperbaric oxygen therapy may also be recommended if the initial dose of oral steroids does not fully restore hearing.
The signs often go unnoticed. “Hearing loss is a lack of stimulation,” Deep explained. “You don’t realize what you don’t hear.”
According to Deep, many people may downplay symptoms, attribute them to something unimportant, like a cold or allergies, and assume they just have to wait for them to get better.
Navigating the medical system can also be intimidating, leading people to put off visiting the doctor, said Meaghan Reed, an audiologist at Mass Eye and Ear.
Subtle signs
Sudden sensorineural hearing loss does not always manifest itself obviously. It may feel like a sensation of a clogged or pressured ear, or like you need to unclog your ear after a flight or a car trip in the mountains.
It may also manifest as a subtle change in sound quality or distortion at certain frequencies, rather than a decrease in volume. Voices may be heard clearly but may be difficult to understand. Everyday sounds may sound muffled or like you’re underwater. Additionally, it can be more difficult to distinguish where sounds are coming from, since the brain relies on both ears to determine their direction.
According to Deep, because sudden sensorineural hearing loss usually affects only one ear, and the unaffected ear can compensate somewhat, some people don’t notice any changes until they cover the ear with better hearing.
Reed suffered sudden sensorineural hearing loss and recovered on prednisone. Describing his symptoms, he commented that “the sounds became very robotic and unnatural” in his affected ear.
“If I wasn’t an audiologist, I don’t know if I would have gone to a doctor, because my hearing loss was actually relatively mild and low-frequency, and I might have thought that my ear was just clogged and I couldn’t unclog it.”
Between 80 and 90 percent of people with sudden hearing loss also experience tinnitus, which can sound like a ringing, ringing, or other phantom noise in the ear and can be extremely distressing. Tinnitus is considered a brain response to hearing loss, Deep explained. “It’s the brain trying to understand why something isn’t there and trying to replace that sound.” The recent onset of tinnitus could indicate a change in hearing, especially if it occurs in only one ear.
Reed said that in reality, what leads many people to seek medical attention is the tinnitus, not the hearing loss itself. “Sometimes we give them a hearing test and people think they’re not doing well because of the tinnitus.”
Another symptom of sudden sensorineural hearing loss is dizziness or vertigo, which can range from mild unsteadiness to a spinning sensation severe enough to cause vomiting. This could indicate inflammation affecting the auditory and balance systems of the inner ear, Deep explained.
To do?
“You know your body better than anyone,” said Lisa Houston Wenstrup, an audiologist at the University of Cincinnati. If you notice something strange in your hearing, don’t assume it will go away on its own; get yourself checked.
An otolaryngologist or audiologist can perform a diagnostic hearing evaluation, but if you can’t get an urgent appointment, Deep recommends going to the emergency room, explaining your sudden hearing loss, and requesting an evaluation.
“It is essential to emphasize that the hearing loss was sudden,” he said. “Most otolaryngologists and audiologists always have availability for patients with sudden hearing loss, as we all consider it an emergency.”
Primary care doctors can perform a tuning fork test to help distinguish sensorineural hearing loss from conductive hearing loss, which is treated differently. However, “sudden sensorineural hearing loss is invisible,” Reed said, so a doctor may examine the ear and see slight redness, mistake the problem for an ear infection, and prescribe antibiotics, which will not be effective.
If you’re not sure what’s wrong, Deep and Reed suggest a simple at-home humming test. If you hear the sound louder in your asymptomatic ear when humming, this could indicate a sensorineural hearing loss. However, this is just a clue, not a diagnosis.
According to Reed, free online hearing tests, which can be found with a simple Google search, can give you more motivation and evidence to seek treatment right away, but a detailed hearing evaluation is needed to identify the type and extent of hearing loss.
Even with prompt treatment, some people may suffer permanent hearing loss, while others recover spontaneously without treatment.
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In about 90 percent of cases, doctors fail to identify a specific cause for sudden sensorineural hearing loss. Researchers have proposed several theories, including disruption of blood flow to the cochlea, viral injury, inflammation, or an abnormal immune response. “It can happen to anyone,” Deep said. “There was nothing that could have been done to prevent it,” Wenstrup said.
For those who do not recover their hearing, it is normal to feel fear, sadness and anger. “You lose half a sense. It’s scary,” Wenstrup said.
If you miss the opportunity to receive treatment, “don’t beat yourself up,” he added. “We are all doing our best to adapt to this difficult health system.”
Two years after the onset of my symptoms, my hearing has not recovered and the tinnitus persists. I don’t know if earlier treatment would have helped her recover. Still, I wish I had the knowledge and information I have now and I hope others seek treatment early to have a better chance of avoiding the difficulties of permanent hearing loss.