Sudden sensorineural hearing loss: An evaluation of treatment and management approaches by referring physicians

Abstract

OBJECTIVE: To assess and compare the current management of sudden sensorineural hearing loss (SSHL) between primary care physicians and general otolaryngologists.

STUDY DESIGN: Written survey of physician practice patterns.

METHODS: A multiple choice and Likert scale survey was mailed to 1306 otolaryngologists and primary care physicians in the upper midwest with respect to management of SSHL.

RESULTS: A significant number of general practitioners treat SSHL independent of an otolaryngologist. General practitioners are significantly less impressed than otolaryngologists that steroids are an effective treatment (P < 0.0001). Over 98 percent of otolaryngologists use oral steroids as compared with 73 percent of general practitioners treating on their own. The vast majority of otolaryngologists start therapy with at least 60 mg of prednisone whereas lower doses and medrol dosepaks are more commonly used by general practitioners. Otolaryngologists are more likely to treat with steroids beyond one week of onset of hearing loss whereas general practitioners overwhelmingly will only treat within the first week. Approximately 50 percent of otolaryngologists add antiviral medications in contrast to 16 percent of generalists.

CONCLUSION: The approach to SSHL differs between otolaryngologists and general practitioners. The lack of strong evidence-based guidelines for the treatment of SSHL may underlie the variability in management by first line providers.