Mark Widick, MD, Neural Otolaryngologist Specialist at ENT Associates of South Florida in Boca Raton, Florida, discusses the causes and effects of sudden hearing loss.
Interview conducted by Ivanhoe Broadcast News in May 2017.
Most of your patient visits are related to hearing?
Dr. Widick: Hearing infections of the ear, damage to the ear, trauma to the ear, tumors of the ear, and hearing restoration by a variety of techniques.
People have heard of deafness but not sudden hearing loss, is that prevalent, does it happen a lot?
Dr. Widick: Sudden hearing loss is much more prevalent than we realized until very recently. When we looked at the frequency we were alarmed by what we found. It is common, exactly how common is hard to define but I see it in my office frequently and, the final road, all roads kind of lead to my office so I see most of the cases. When you see them, the problem that we have encountered is it’s often later than we would like it to be. And in those cases, there’s less for me to do. So the message we’re trying to get out is that if you suspect you have lost your hearing rapidly, it’s just as important to rapidly get to the physician that can do something about it. Often physicians that are in primary care or at the neighborhood clinic are not equipped to take care of this problem. Then they will diagnose an infection when the hearing loss is not due to infection. It’s difficult for them to know the difference. If you suspect that the hearing has rapidly dropped and you have no pain, sign, or reason to have an infection, you need to get an audiogram. It’s a test of the hearing that’s very specific and can tell us the difference between hearing loss from infection and hearing loss from sudden loss, which is a loss of the function in the cochlea.
What are the symptoms, because like you said the real concern is if someone suffers from this they might just pass it off as maybe a head cold?
Dr. Widick: I think the lack of those things. No head cold, no reason for this to have happened. It often comes on almost instantaneously. One minute your hearing seems fine, the next minute it’s not there. You put the phone to your ear and you don’t hear it in one ear and you do hear it in the other ear. Sometimes there’s tinnitus or ringing in the ear. Sometimes there’s ear vertigo that can make it very disorienting. All those things can be related to sudden hearing loss, and are less likely related to an infection. And that’s when you really need to get in and insist that you have your hearing tested.
Do we know what causes this?
Dr. Widick: No. We have some ideas, but in any one person it is very difficult to assign a definite diagnosis. We feel that viruses may be involved; we feel that compromise of the blood vessels to the ear. There’s only one blood vessel that feeds the entire hearing system and if it gets kinked and as people get older the vessels elongate like a garden hose they start to become S shaped. If it pinches just a little too much, the blood flow can be compromised or a clump of platelets might accumulate and compromise the flow of blood through that vessel. And once that happens it’s like a stroke to the ear. So we’re hoping that the blood flow gets re-established and then we can resuscitate the ear, especially with this new investigational medication that we are looking at.
How much time is too long to wait? Does a person need to seek help immediately?
Dr. Widick: Yes. You need to treat it just like you would if you woke up and your arm wouldn’t move or you had crushing chest pain, because the results in this situation; time does matter. You want to get it, but in this case you may not want to go to the hospital. You should contact the physician that can test your hearing and recognize this. Unfortunately most hospitals don’t have that ability because that’s not something that they routinely get involved with. And things like MRI scans and CAT scans may be important at some point in the investigation but they are not essential early on. So get to somebody that is expert in treating ears. A physician that treats ears exclusively will much more likely be able to recognize this for what it is and give you treatment that can make a difference.
This can happen to anyone?
Dr. Widick: To anybody. Age doesn’t really seem to play a role here, it can be somebody very young or very old. Sudden hearing loss may be slightly more common in people as they get older but not radically so.
Tell me a little bit about treatment, up until this point what could you do?
Dr. Widick: Treatment at this stage is diverging. Initially, we had steroids as the mainstay of treatment. Steroids as an oral pill like prednisone or more recently, something we have learned is less likely to cause side effects, injected directly in to the middle ear. That sounds kind of dramatic, but it really is very well tolerated. We use a extremely small sharp needle and patients don’t seem to mind very much. We do often see an improvement in the hearing. The study that we were talking about, is a new investigational drug, it’s an FDA trial, a placebo controlled study so it’s possible you won’t receive the treatment. But we have to do these types of things in order to know for sure that we are really making a difference for these patients. That particular agent is very novel in the way it works. It blocks the process by which cells commit suicide basically. It’s called autolysis where the cells explode and die after a trauma. Either a lack of blood or a viral attack, and we want to stop that. They’ve identified a protein, a small protein that interferes with the process of cell death in a stressful situation. And we’re trying to prolong the time that these cells survive and then come back and function again.
Would you be giving this to people who have already experience this sudden deafness?
Dr. Widick: This is geared for people who have experienced sudden deafness and the duration from onset of symptoms is less than seventy-two hours. So it’s a very short window that we have to administer the test drug that we’re working on.
Is the test drug a gel?
Dr. Widick: It is a gelatinous substance that is injected in to the ear.
There are people who could still enroll in this if this is something that happens to them?
Dr. Widick: Right. The challenge that we have is to have this type of outreach so that people understand, both physicians and patients, that this is a common problem. If it strikes you, recognize what’s going on and then get in to the right people so that you can receive some kind of treatment, hopefully making a difference. We do know that a lot of people will get better on their own as well. And that makes it more challenging because we would like to prove that our agent is really making a difference in something that has a certain amount of spontaneous recovery. So there will be some people that we test and they get better and we helped them. There will be other people that we give the drug to they get better but they were going to get better anyway. We have to show that we have increased the number of people that improved significantly compared to the placebo group.
So the sooner you get treatment, if this happens, the better the chance that you can avoid permanent hearing loss?
Dr. Widick: Correct. Yes. The problem is that the cells are dying, they’re drowning, they didn’t get oxygen or they’re being attacked by a virus. The cells often just die when that happens. Then there is a period of just a few days where we can interfere with that process. After that’s happened, at least for this particular study, this drug is a blocker of the processes by which cells eventually disintegrate. If we can block it then hopefully they’ll still be there to help you hear. Therefore, this study is looking at that very early part of the process. There may be some other things involved, swelling and inflammation, and if that’s the case then as a physician up until now I would give steroids. Those steroids reduce swelling. It’s not going to revive dead cells, but if there are some peripheral cells or other cells that are also still alive but they’re being stressed out, we may be able to reduce that stress by getting rid of the inflammation with steroids. Consequently, if it’s been more than seventy two hours, I very may well still offer something. Subsequently, it’s still a good idea to obviously come in and get checked because I will still have something to offer. However, the treatment with the study protocol is very specific and after seventy two hours we can’t offer this agent.
In David’s case did he get to you in time?
Dr. Widick: I saw David well after the seventy two hours and so we went with a different strategy in his case which was the steroids which made a dramatic difference for him. His hearing has been saved and he’s doing well.
Then the bottom line here in the message you want to get out is if you suffer from sudden hearing loss see someone immediately?
Dr. Widick: Right. Do not assume that it’s an infection. In the big picture an infection isn’t that important. I’m not trying to say your cold isn’t a big deal, but it’s not going to rob you of your hearing. Sudden hearing loss can, and so we’re trying to avoid that from happening to people. We have an on-call team. So if people call on the weekend or after hours we will mobilize, because we know those seventy two hours are important, so if I’m not out of state I will be here. There’s more than one physician involved so we can make that happen.
Without hearing you feel lost.
Dr. Widick: Yeah. You know Helen Keller’s famous quote, she was asked if she could get her senses back which would she take. And the answer was hearing. Because vision connects you to things and hearing connects you to people. And that was much more important.
The thought of losing your hearing is scary.
Dr. Widick: Yeah. I mean really it’s so disabling beyond belief. Now the one good thing is cochlear implants. We can now, I mean almost anybody, somebody born deaf who learns sign language who was born to deaf parents they don’t understand language and you can’t really help them.
It’s total deafness.
Dr. Widick: If you had hearing yeah. If you’re born deaf and nobody forced you to lip read and forced you to talk. That’s why there’s been a big turnaround in the approach to deaf people and their education. It used to be there were no cochlear implants teaching sign language. It worked, it’s pretty easy but you isolate them, they are now a subculture and they’re always going to be a subculture. Now with the cochlear implant it’s a threat to those people and it’s been very controversial.
People don’t think about that.
Dr. Widick: They don’t think about it but if you can get a child less than four years of age and they’re born deaf plus you get them in that first four years then their mind will learn language. It would be like you dropping in to China and having everybody speak Mandarin. But it would be worse; you don’t even understand the concepts. But if you’re born deaf and we put a cochlear implant in it just doesn’t work. If you’re like eighteen years old and you’ve been deaf since birth it’s not going to really help.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
AM-111 study for sudden hearing loss
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here.
