Singapore General Hospital Guides Primary Care on Managing Sudden Hearing Loss

Singapore General Hospital (SGH) has provided guidance for general practitioners on managing sudden sensorineural hearing loss (SSNHL), a condition that can rapidly develop within three days. The hospital emphasizes that early treatment is essential for potential hearing recovery.

SSNHL affects an estimated five to 20 individuals per 100,000 population annually in Singapore, equating to 300 to 1,200 cases per year. Patients often first present to their general practitioner or an emergency department. The SGH guidelines advise GPs on identifying SSNHL symptoms, which can include rapid hearing decline, tinnitus, or a feeling of ear fullness. Tuning fork tests like the Weber and Rinne can aid in diagnosis, while otoscopy typically shows normal findings.

The guidelines recommend that GPs initiate oral prednisolone treatment immediately upon suspecting SSNHL, provided the duration of hearing loss is less than two weeks. Patients should also be fast-tracked for an Ear, Nose, and Throat (ENT) specialist assessment within two weeks of symptom onset. The hospital highlights that if SSNHL is accompanied by vertigo, it is crucial to rule out a stroke in the anterior inferior cerebellar artery (AICA) territory, particularly if other neurological signs are present.

For unilateral and idiopathic SSNHL, an MRI of the internal auditory meatus is the recommended investigation. In cases of bilateral, fluctuating, or recurrent SSNHL, blood investigations are necessary to rule out underlying causes such as Ménière's disease or autoimmune conditions. However, over 90% of SSNHL cases are idiopathic, with potential contributing factors including viral infections or vascular issues.