Sudden deafness is a special problem. It can occur in one or both ears. It may be caused by a variety of problems and demands immediate, aggressive and comprehensive evaluation. Treatment is controversial, but there is at least some evidence that suggests that aggressive treatment may improve the chances for hearing recovery even after a sudden profound loss. In any case, even those of us who believe in treating sudden deafness aggressively agree that once the condition has been present for more than 2 to 3 weeks, even the most aggressive treatments do not work. So, prompt attention is essential.
Autoimmune inner ear disease (AIED) is much more common than most physicians believe. In autoimmune disorders, the body makes antibodies against the patient. For example, in rheumatoid arthritis, we make antibodies against our joints. In psoriasis, we make antibodies against our skin; in multiple sclerosis, against our nerve sheaths; in thyroiditis, against our thyroid glands; and there are many other autoimmune disorders, including diabetes mellitus. In autoimmune inner ear disease, antibodies are produced against our own inner ears. AIED can cause hearing loss, tinnitus, dizziness, ear fullness and other symptoms. They may occur in combination or alone. Classically, AIED is thought to be associated with sudden deafness, or rapidly progressive, asymmetric sensorineural hearing loss. However, it can cause hearing loss of any pattern, and it can also cause tinnitus or dizziness in the absence of any measurable hearing loss. AIED can affect adults or children.
Neural problems may also produce hearing loss. Among the more common are acoustic neuroma, multiple sclerosis, autoimmune sensorineural hearing loss (in which the body attacks its own ear) and ototoxicity. Ototoxicity is hearing loss caused by a substance that gets into the body. Most often the substance is a medication, particularly certain antibodies and diuretics. However, other toxins (such as lead) may also cause hearing loss.