How soon to get hearing aid after sudden loss

#1

Greetings all, new member. About a month ago, I was diagnosed with sudden sensorineural hearing loss in one ear, discovered in connection with tinnitus. Putting aside the tinnitus, my ENT tells me to wait 3-6 months before getting a hearing aid. I’m getting conflicting feedback on this, both from a separate audiologist who tells me there’s no reason to wait, and from two different folks on a tinnitus forum saying 1. Yeah, wait and 2. Nope, get one now.

Is there conventional medical wisdom on this topic or is it normal for competing specialists to give contradictory advice? (Which happens in life). Those who talk about waiting say the brain needs time to make its final adjustments, so you want to operate from a stable baseline before adding an aid. Obviously I want to do this ASAP because everything sounds out of whack now. Oh and my other ear is fine. Thanks all.

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#2

Yes, differing advice from different professionals is common. I’d be inclined to get them now. I’d also be inclined to try Costco for their (assuming you’re in US) 180 day return period.

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#3

Costco doesn’t carry CROS aids. I got mine as soon as i finished prednisone injections. ENT felt it was a safety issue more than anything. My depression lifted feeling more oriented too. Best choice i could make to help with acceptance of new me (5th stage of grief)

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#4

What is the amount of hearing loss?

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#5

Thanks for all the responses gang!

I have moderate hearing loss in one ear. The person (doctor?) who did the test recommended a hearing aid, which my ENT agreed with. To continue the theme of contradictory opinions, and old friend of mine (not ENT but veteran internist) said he wouldn’t ordinarily recommend a hearing aid at all (!) if the other ear was fine, which mine is.

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#6

I work with an otologist. We see cases of SSNHL at least once/week. What we tell patients is that if their hearing is going to improve at all after the sudden hearing loss, it should do so within the first 90 days/3 months. Our office typically tells patients to hold off on purchasing a hearing aid until that 90 days is complete and we know whether the hearing has come back fully, partially, or not at all.
In our office, there are exceptions to this rule based on an individual’s lifestyle. For example, if the person with SSNHL also had low vision, we may offer a hearing aid trial. But in the absence of extenuating circumstances, we tell our patients to hold off until the end of that first 3-month period.
Bear in mind that I am in Canada, and, as I understand it, practices can vary significantly both by country and by jurisdiction within a country.
Did you take prednisone after your hearing loss occurred? Did you get intratympanic membrane steroid injections? Both of these can alter the outcome of SSNHL if given within a timely manner.

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#7

Thank you KerBear. Yeah, I’m in the U.S. fwiw. I received neither prednisone nor the steroid injection you reference. A side issue for the purposes of my question, it took a relatively long time for me to progress through the system to the point where I was told, the window had pretty much closed for those treatments (I’ve been told the steroid injection should be done within 48 hours or so or hearing loss, and as far as I can work out I was past that point before I realized I had a hearing problem.) My ENT spoke last week of an intratympanic shot IIRC but with me at the 5+week stage, he didn’t think it would matter.

If I can somehow get rid of this new (last five days) warbling reaction in my bad ear when exposed to sound, especially high frequencies, I might be able to hang on for three months.

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#8

chriscom, stories like yours frustrate me so much! It’s maddening that so many health professionals have no idea whatsoever that sudden hearing loss is classified as an emergency! Anywhere I’ve ever worked, the medical staff knew that sudden vision loss required a full workup including labs, CT/MRI and an immediate referral to an opthalmologist. But sudden hearing loss does not seem to get afforded the same amount of respect. It shocks me just how often our office receives referrals for SSNHL weeks to months after the hearing loss occurred. I don’t understand how so many GPs, NPs, and, in some cases, hearing instrument specialists, can be so completely clueless that such symptoms are a medical emergency!

Progress through the system can be painfully slow here in Canada, too. Occasionally, our office gets timely referrals for patients who have had appropriate initial treatment (immediate audiogram, oral prednisone, MRI), but that’s pretty rare. Clearly, there is a huge need for more hearing loss education among medical and paramedical health professionals.

I’m sorry this happened to you. I’m in agreement with the one doctor you spoke with who suggested you get a hearing aid, specifically a CROS hearing aid. That system may help, at least somewhat, with your hearing and with your ability to localize sound. It may also help to decrease the perception of the warbling sound (tinnitus) in your ear. Worst case scenario, it doesn’t help you at all. But what if it does? That’s the question I ask my patients. You’ll never know unless you try.

In the meantime, it may help you to take a speech reading course if you have the ability to do so. From what I understand, your local chapter of the Hearing Loss Association of America (HLAA) may offer speechreading courses. Being from Canada, I have no experience with HLAA, but I’ve met a few people online who attend their meetings and find them to be extremely valuable.

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#9

FWIW: That’s a poor standard of primary care. You would have been on a significant steroid course for at least a week if that had happened here - I recently referred a client directly to our ENT dept with a sudden worsening (about 40dB) of hearing and corresponding tinnitus and they moved quickly on it. Subsequent measurement has shown that there was a 35dB recovery.

The lady only attended our office as she thought her aid was faulty about 2 days after the change in her hearing. Kudos to the SHO in Merlin Ward for taking the correct steps too.

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#10

Thanks for the comment. That’s certainly how it looks to me.

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#11

Audiologists and specialists are required to ask you certain “red flag” questions as dictated by the FDA. One of those questions is, “Have you experienced any unilateral hearing loss of sudden or recent onset within the last 90 days?” If the answer is YES, then the audi/spec should not pass GO, should not collect $200, but should immediately refer you to a physician. The audi/spec should also counsel you that fitting you with hearing aids is completely reliant upon clearance from a physician (preferably an ENT.)

When I send out patients on a medical referral, I send a letter that describes the patient’s reason for being referred, and which contains a place for the physician to sign if the patient is cleared for amplification.

Failure to refer to a physician in this situation could subject the audi/spec to possible disciplinary action from their state board, up to and including revocation of the dispensing license.

As a specialist, I would recommend you follow the advice of your physician or attempt to get a second opinion from another physician who will write a note clearing you for amplification.

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#12

Thank you for the feedback. To clarify the sequence, I began experiencing tinnitus (and inflamed lymph nodes), and was sent to an ENT who had an audiologist test my hearing, which uncovered moderate hearing loss in the one ear. Among other things the ENT recommended (I wasn’t sure at the time if he was insisting on) my not getting a hearing aid for either three or six months (there was some confusion at the weakest link in his staff). I went to another audiologist for a second opinion on a bunch of things, with my audiogram in hand. He said there was no reason in the world I couldn’t get a hearing aid immediately. I then had another hearing test back at ENT’s practice because a new thumping sensation in my other ear raised some concern. That audiologist–so I’m on my third, but more engaged than the first one in his office–gave me a Phonak quick-and-dirty tuned to my bad ear and it was such a relief. The feeling of pressure went away, I sounded much more normal to myself, and I could of course just plain hear so much better. She agreed there was no reason I had to wait. This was earlier this week, after my initial post.

That test, however, turned up a further degradation in my left ear, kind of an odd one: a notched loss in a lower frequency. This raises new concerns; My ENT immediately put me on prednisone yesterday and I’m having an ECoG and then another hearing test soon.

But getting back to hearing aids I finally got to understand his reasoning: He wants to give my brain time to adjust, partly to see if/how much my hearing might recover a little, and to be in a better position to decide if I need one at all–as you know the really good high-tech ones are expensive. I’m pretty sure I will, but we’ll see. After all the input I got here and elsewhere, I was finally able to ask the question I hadn’t known was the heart of my issue: Was there any medical reason to wait–would it inhibit whatever little recovery I might have over there. He said no. Just knowing that I can get some relief from all this is a big step forward.

Really appreciate all the responses here. I have this thread on email-alert so will happy respond to any questions and monitor further responses.

Thanks gang.

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#13

While I agree that timely care is important for sudden loss to rule out other things, steroids are a bit of a Hail Mary. Don’t look back with regret about not getting steroids initially–the literature isn’t actually clear that it is effective despite the strong insistence of a lot of practitioners. The theory seems sound but the data is lacking. A cochrane review in the early 2010s found no strong evidence for effect. A quick search suggests that a lot of the recent papers have been comparing injections versus oral steroids and finding no big differences, which would also be true if neither of them did anything. There are papers showing a difference in effect of early versus late treatment, but if untreated recovery were to generally happen quickly or not at all that would also explain the treatment timing effect.

So don’t beat yourself up about things not progressing more quickly in the beginning.

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#14

Thanks Neville. Trying to take a water-under-the-bridge approach. Looking back at the process and checking my calendar, I think it was a combination of genuine tardiness by the office and my own confusion about how long I’d been suffering from it. I think I gave them the impression I was already just after the period when it might have a reasonable shot at helping, when in fact I was still in the middle of the zone. But yeah, a good reminder the research is all over the place.

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