April 2018 Australian Financial Review

If you are healthy and "out of the blue" one ear suddenly feels blocked, regard it as a medical emergency. That's the message in the Medical Journal of Australia Insight.  A blocked or full sensation can be a forerunner of hearing loss or tinnitus in that ear, unless treated swiftly. People with tinnitus experience noises or ringing in the ears or head when no such external physical noise is present. The feeling of an ear being clogged is a common complaint made to GPs or hospital emergency departments, writes Professor Peter Friedland, Head of Clinical Research at the Ear Science Institute Australia and an ENT consultant at the Sir Charles Gairdner Hospital in Perth.

Prof Friedland

Professor Friedland says there is a general ignorance of this condition, which presents 'out of the blue' in 90 percent of cases in completely well and healthy individuals. 

"Unluckily for some of these patients, their symptoms will be brushed off and dismissed without even considering sudden nerve hearing loss," he writes. Unexpected nerve loss, known as sudden sensorineural hearing loss, can present just like this. He says hearing loss is interpreted by the brain in many ways, including a sensation of being blocked or full. "What is so tragic is that if the diagnosis is not considered and not treated immediately, permanent deafness and troublesome tinnitus may be lifelong.”  Friedland, who is also an associate professor at the University of Western Australia and professor at Notre Dame University, says sudden nerve loss is distinctly different from progressive and gradual hearing loss, which usually occurs in both ears.

Pills ineffective

For sudden nerve loss antibiotics, decongestants, antihistamines and ear-drops are totally ineffective. 

"Unfortunately, there is a general ignorance of this condition, which presents 'out of the blue' in 90 percent of cases in completely well and healthy individuals. Simple high-dose steroids for 10 to 14 days or until a diagnosis is confirmed will give most patients a greater chance of a recovery. The potential benefits of restoring hearing far outweigh the risk of side effects from what may be an unnecessary dose of steroids.” If steroids are commenced within 24-72 hours of onset, he says, there is a 30 to 60 percent chance of recovery of the hearing loss.

Peter Friedland"Many Australians continue to miss their golden opportunity of steroids because their doctors think they have fluid in their ears,” Professor Peter Friedland 

For sudden nerve loss, he says, antibiotics, decongestants, antihistamines and ear-drops are totally ineffective. The American Academy of Otolaryngology's Head and Neck Surgery guidelines strongly recommend doctors offer steroids to patients in whom they suspect a sudden nerve hearing loss, even before an audiogram or definitive diagnosis is confirmed. Friedland says the National Institute on Deafness and Other Communication Disorders in the US estimates this nerve loss strikes one in 5000 people. While the number has not been measured in Australia, he believes the US incidence can be roughly extrapolated.

He told the Australian Financial Review that he sees an average of two new patients with this condition every week. "For the past nine years, I have been teaching medical students in Perth about this condition and we are beginning to see some change in awareness, with more GPs either prescribing steroids, calling up for an opinion or ordering an urgent audiogram. But many Australians continue to miss their golden opportunity of steroids because their doctors think they have fluid in their ears."

It is correct, however, that a clogged sensation may also result from a severe upper respiratory tract infection, a plane trip or from diving. Similarly, it could be due to an inflammation of the jaw, grinding or other dental problems.  He says it critical GPs differentiate between a conductive hearing loss and a sudden nerve loss in otherwise healthy patients. A build-up of wax or a painful inflammation can cause conductive loss, as can a perforation of the eardrum or a middle-ear infection.

It is surprising but in sudden nerve deafness, he says, the ear canal and drum are almost always completely normal. This should raise suspicions that the problem is in the inner ear. While the cause of this condition is usually unknown, it is thought to be due to inflammation of the cochlear. This could be the result of a virus, a blood flow problem, head trauma, an explosive noise, a neurological disease such as multiple sclerosis or, in rare cases, a benign acoustic tumour.

But if it occurs suddenly in both ears and is definitely not related to a conductive loss, then it could portend a serious underlying illness.

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