Practice Guidelines for Sudden Sensorineural Hearing Loss

Objective To identify and compare patterns of treatment for sudden sensorineural hearing loss among otolaryngologists and primary care physicians. Methods A multiple choice and Likert scale survey was mailed to 1,306 otolaryngologists and primary care physicians throughout our state, regarding treatment and management approaches to SSNHL. Survey answers were analyzed by scope of practice and years of experience. Treatment protocols were compared among family practitioners, internists, general otolaryngologists, and otologists. Results A surprisingly large number of general practitioners treat SSNHL independent of an otolaryngologist. General practitioners as a group, however, are significantly less impressed than otolaryngologists that steroids are an effective treatment (p<0.0001). Over 99% of otolaryngologists start oral steroids at evaluation, as compared to approximately 30% of all general practitioners. Of those general practitioners treating on their own, without otolaryngology consultation, 78% use oral steroids. The vast majority of otolaryngologists start therapy with at least 60 mg of prednisone, while lower doses and Medrol dose packs are more commonly used by general practitioners. Otolaryngologists are more likely to treat with steroids beyond 1 week of hearing loss onset, while general practitioners overwhelmingly will only treat within the first week. Over 50% of otolaryngologists also add anti-viral medications. Conclusions Significant differences exist in the management of SSNHL between otolaryngologists and general practitioners. The lack of strong evidence-based guidelines for the treatment of SSNHL may underlie the variability in management by first-line providers.