Sudden sensorineural deafness, and vibration without a tuning fork

From this month’s BJGP: Sudden sensorineural hearing loss (SSNHL) is an otological emergency. The guidance is that sudden hearing loss that developed within the past 30 days needs to be referred for assessment within 24 hrs. If over 30 days ago, it should still be referred within 2 weeks. The most urgent part of this is steroid treatment, and, while this can be done via intratympanic injection, it can also be done orally. The article gives an example regime of 1 mg/kg (maximum 60 mg) od for 7 days. This should ideally be started within 48 hrs, but can still be started if within 2 weeks of onset of symptoms.

(In a rather awkward bit of timing, the authors stated that the attitude should be ‘Why should I NOT prescribe steroids?’ Excellent advice at almost any other time, but here we are, less than a month later, with a very good reason to be wary of prescribing steroids when we don’t have to. But, of course, they couldn’t really have anticipated this.)

And a useful practical piece of information: I’ve dithered over whether to get a tuning fork, and not, as yet, done so as they were quite expensive when (admittedly some time ago) I last checked on Medisave. Well, seems I don’t have to. The authors of this article experimented with doing Weber’s test with a mobile phone app called Real Razor, on silent vibration mode with a bottom corner of the phone placed on the centre of the patient’s forehead. Although the app vibrates at 163 Hz rather than 256, their results still showed >97% agreement with the results from tuning forks. (Note, however, that the tested group consisted of 74 adults post middle-ear surgery, and, as it’s described as a ‘bedside test’, this implies that it might have been done during the recovery period from surgery. I don’t know how this would affect the results as compared to a population of patients in general practice, so I’m wary. Still, I’ve downloaded the app; better than nothing.)

About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Credits 2020, ENT, Hearing loss. Bookmark the permalink.

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