On a cold summer evening in New York, Tom Gerety, then age 53, noticed something was up with his hearing. Over dinner with family, at a hotel in the Hudson Valley, he felt his right ear ringing and found himself straining to hear.
Gerety had spent the weekend swimming in a lake with his kids and at first thought he had some leftover water clogging his ear canal.
But after “several days of desperation” — when jumping up and down, using a vacuum pump, and alcohol and cotton swabs failed to clear his ear — he went to see his doctor.
“The doctor told me, ‘You don’t have water in your ear. You have hearing loss,’” Gerety, an NYU law professor who was then the president of Amherst College, recalls. The diagnosis was a shock and sent Gerety into a “mild panic.” He wondered: “If one ear goes over a weekend or night, why couldn’t both of them go?”
Gerety is one of the 66,000 Americans who are surprised each year by a diagnosis of an underappreciated and sometimes devastating condition: sudden sensorineural hearing loss, or sudden deafness. A new study, published Thursday in the journal JAMA Otolaryngology–Head & Neck Surgery, suggests it isn’t as rare as some think — occurring in up to 20 per 100,000 people.
But too few people know the risks, experts say — even though sudden deafness should be viewed as a health emergency. “Time is of the essence,” Dr. Aaron Remenschneider, a researcher at Massachusetts Eye and Ear, told Vox. “If we see patients early, treat them with [steroids], we can bring back some hearing.”
Like Gerety, most people don’t consider it urgent and go weeks before seeking medical care — if they go to the doctor at all.
“We are all taught early on that if you have chest pain, if you’re slurring your words, go to the emergency room,” said Dr. Elliott Kozin, chief resident in the department of otolaryngology at Harvard Medical School. The message that a sudden drop in hearing or new ringing in your ears is also an emergency needs to get out, he added. “The diagnosis is such a shock because [patients] don’t know such a thing exists.”
Sudden hearing loss can belie a more serious medical problem
One reason a drop in hearing should be treated as a medical emergency is that it might belie a more serious health problem.
The precise cause of sudden deafness is still mysterious, but researchers have two main theories: One is that a virus leads to an inflammatory response in the inner ear, and that inflammation stuns the sensory cells that enable hearing. A second theory is that decreased blood flow to the ear results in hearing loss.
A minority of cases are brought on by viral infections (from Lyme to measles, rubella, even tuberculosis), a head and neck tumor, circulatory problems, autoimmune diseases (like Lupus), or an inner ear disorder (like Ménière’s disease).
But when doctors rule out these potential factors — taking a health history, and doing a physical exam and an MRI — they find the vast majority of patients (85 to 90 percent) have no identifiable cause for their hearing loss.
They either wake up with it or they’re doing a normal daily activity when they notice a pop, click, or crackle in their ear, preceded by static or ringing, Kozin said. Then they can’t hear as well out of that ear, and they may eventually show up at the doctor complaining about a clogged ear.
In reality, the nerves that enable hearing have died off or are on the edge of death, and the plugged feeling is caused by hearing loss, explained Dr. Steven Rauch, a professor of otolaryngology at Harvard Medical School. The mechanism is similar to sudden blindness, sudden paralysis of a vocal cord, or sudden loss of eye movement, he added. “These are all cranial nerves that are known to shut off suddenly for unknown reasons.”
People can adapt to the new hearing normal
The hearing loss that results from sudden deafness can range from mild to severe. And that’s another reason sudden deafness requires urgent care: It can sometimes be reversible.
Decreasing inflammation and restoring blood flow in the ear, through the use of oral or injection steroids, can often restore at least some hearing. Other treatments, like hyperbaric oxygen therapy, are also showing promise when they accompany steroids.
But patients need to seek immediate care to experience these potential benefits. And, unfortunately, people with more profound hearing loss are less likely to benefit from treatment.
That’s what happened in Gerety’s case: When he went to the doctor, he was given a steroid dose. But nearly 20 years on, his hearing has never returned. “If I am listening to NPR and I put my finger in my good ear, I can’t tell what’s being said — not one bit,” he explained.
Still, he’s managed to get used to the new normal in his ears. “Luck favored me with durably good hearing on the other side,” he said, “and so I have adapted by turning and maneuvering in class and in crowds.”
Rauch tries to tell his patients that they’ll eventually adapt too. “I reassure them that the ear fullness that’s so distressing in the first few days and weeks always improves. And six months and a year later, most patients hardly notice it.”
A simple to test to tell if you have sudden hearing loss
If you’re worried about a hearing drop in one ear, there’s a simple test you can do to tell whether it’s caused by a blockage or something more serious: hum aloud.
“If you hear your voice louder in the blocked ear, you have nothing to worry about,” said Rauch. You probably have temporary hearing loss from wax, fluid, or water, and your hearing will return when your cold goes away or the wax clears. But if your voice sounds louder in the good ear, “you have an emergency and need to be seen by an ENT.”