Dear Doctors: I developed sensorineural hearing loss (SNHL) due to lupus in 2019. It affects high-pitched tones, and it makes it harder to hear in a crowd. It’s confusing because sometimes I am able to hear high-pitched tones. I just finished nursing school and will be working with patients soon. Are there any treatments for this?
Dear Reader: Sensorineural hearing loss is the most common of the two major categories of hearing loss. Unlike conductive hearing loss, which involves the outer ear and the middle ear, sensorineural hearing loss arises due to changes that have occurred in the inner ear. Located in a small compartment within the skull, the inner ear is made up of a series of fluid-filled structures that are involved in hearing and our sense of balance.
The part of the inner ear associated with hearing is known as the cochlea. It is a snail-shaped chamber lined with approximately 15,000 tiny hair cells. About 20%, known as inner hair cells, collect vibrations delivered by the outer and middle ear. The remaining 80% are outer hair cells. They amplify vibrations, which allows us to hear quiet sounds. A dense network of nerve endings translates these vibrations into electrical impulses and, via the auditory nerve, carries them the brain to be interpreted as sound.
Although damage to any portion of the inner ear can lead to SNHL, the most common cause is swelling in, or damage to, the hair cells of the cochlea. This can be due to prolonged exposure to loud sounds, physical injury, a pause or stoppage of blood flow to the area, exposure to certain drugs and the natural effects of aging.
Another factor in developing SNHL is the presence of an underlying medical condition, most commonly autoimmune diseases. These are diseases, such as lupus, in which the body’s immune system goes awry and attacks its own tissues. The data show that people living with lupus are at significantly higher risk of developing hearing loss than the general public.
A first-line treatment for SNHL is the use of corticosteroids, which can ease inflammation and swelling. More recently, the Food and Drug Administration has approved hyperbaric oxygen therapy, which involves breathing pure oxygen while in a pressurized chamber. This is done when impaired blood flow to the inner ear is suspected as a factor in SNHL.
Hyperbaric oxygen therapy treatment consists of 10 to 20 daily sessions of 90 minutes each. Each session delivers additional oxygen to tissues throughout the body, including to the cells and structures of the inner ear and the neural networks that serve it. However, each of these treatments are most effective at the onset of the condition.
For many people with SNHL, using a hearing aid can restore access to the missing range of sounds. If you have not yet considered this option, it could fill in the auditory gaps that would make it easier to work with patients. Also, because your degree of hearing loss continues to fluctuate, it would be wise to see an otolaryngologist for additional testing.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
