Does Your Hearing Loss Fluctuate?

Fluctuating sensorineural hearing loss can appear alongside a number of disorders, such as immune-mediated inner ear disease, Ménière's disease, and sudden sensorineural hearing loss (SSHL). It’s a difficult condition to manage because of the different fields of diagnoses and researchers’ understanding of underlying causes are mainly theoretical. As a result, there are very few treatment options. 

Causes and Related Disorders of Fluctuating Sensorineural Hearing Loss   

Autoimmune inner ear disease (AIED) is a rare disease that causes rapid and progressive bilateral sensorineural hearing loss (SNHL) that fluctuates for weeks or months. The progression of this hearing loss occurs too quickly, therefore it is not considered to be caused by aging but it is also too slow to be considered sudden sensorineural hearing loss (SSNHL).  AIED can manifest as part of other autoimmune-mediated syndromes, such as lupus or  rheumatoid arthritis, or as part of Cogan’s syndrome, which includes inflammatory ocular symptoms (conjunctivitis, glaucoma, or uveitis) along with hearing loss and vestibular symptoms.

It’s been recently discovered that autoinflammatory disorders play a factor in fluctuating hearing loss. Theories have been discussed on the underlying process of this disease which cover circulating immune complexes to conditioned immune cell-mediated damage in AIED vs. dysfunction of the body’s existing immune defense system or the innate immunity. The reason why proper diagnostic measurements for these diseases are difficult to grasp is because it needs audiologic proof of fluctuating hearing loss and a positive response to immunosuppression.   

SSNHL is a broad term that is used to describe hearing loss that occurs within a brief period of time - under 72 hours. Most instances are considered unilateral with no defined cause. There are three theories on the underlying cause of SSNHL:

1. Cochlear trauma
2. Vascular compromise
3. Viral infection or reactivation

For people who are smokers, have a history of smoking, or have hearing loss that was the result of vigorous activity and may cause trauma to the cochlea, the first two theories are possible. 

In other people who do not have these risk factors, the viral theory - which suggests that severe infections or reactivation causes inflammation and membrane damage - may be a possibility. This theory was backed up by clinical studies that indicated more levels of specific viral antibodies, in vitro animal research, and temporal bone biopsies that revealed atrophy occurring in the inner ear. The causes can be classified under:
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• Autoimmune
• Infectious
• Neoplastic
• Neurologic
• Metabolic
• Traumatic
• Vascular

Ménière's disease is another class of disorders that are characterized by variables of the following symptoms:

• Fluctuating hearing loss
• Aural symptoms, which include tinnitus and aural fullness.
• Episodic vertigo 

Ménière's disease is defined as a condition with two or more impulsive episodes of vertigo that endures for more than 20 minutes, but less than 12 hours, an audiogram that indicates low - to medium - frequency sensorineural hearing loss in one ear at any point, and fluctuating aural symptoms like aural fullness, hearing loss, tinnitus. It usually occurs in one ear, but it may begin in one ear and then affect the other ear. It rarely starts by being found in both ears at the same time. Before the final diagnosis of Ménière's disease is made, other possible causes, such as benign paroxysmal positional vertigo or vestibular migraine, need to be dismissed.

Contributing Factors

• Allergies
• Autoimmunity
• Genetics

Studies of Epidemiology indicate that some cases of Ménière's disease could be caused by an irregular mutation or an autosomal (any chromosome that is not a sex chromosome) dominant inheritance. Allergy-linked Ménière's disease is induced through environmental or food allergies. The theory is that systemic hypersensitivity to allergens could result in inflammation to the inner ear, which would then cause Ménière's disease.

There are many medical and surgical treatments for vestibular and balance problems, fluctuating hearing loss, but they are often inadequate and do not help prevent inevitable hearing loss. Hearing aids could be the best solution to this problem. If you, or a loved one, are experiencing fluctuating hearing loss, tinnitus or aural fullness, or episodic vertigo please contact us at Pure Sound Hearing Aids for a free hearing test and consultation.

Please be aware that Pure Sound services will only be available by appointment and for essential visits at this time. Essential visits include all appointments that require new hearing aid fittings, repairs and re-fittings. We ask that you please wait in your car, while wearing your mask, and place your hearing aids in a clean zip lock bag.  We will come to your car to get them. If you are having any problems with your hearing aids, or need supplies for your hearing aids, please call us before visiting one of our offices.   

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