9
Table 4. Some Symptoms and Signs Suggestive of Non-
Idiopathic Sudden Sensorineural Hearing Loss
Sudden onset of bilateral hearing loss
Antecedent fluctuating hearing loss on one or both sides
Concurrent severe bilateral vestibular loss with oscillopsia
Gaze evoked or downbeat nystagmus
Concurrent eye pain, redness, lacrimation, and photophobia
Focal neurological symptoms or signs such as headache, confusion, diplopia, dysarthria,
focal weakness, focal numbness, ataxia, facial weakness
Recent head trauma
Recent acoustic trauma
Recent barotrauma
Table 5. Selected Conditions That May Be Associated With
Bilateral SSNHL
Cause Other Features
Infection (viral including herpes simplex
virus [HSV], varicella zoster virus [VZV],
human immunodeficiency virus [HIV]
and others; bacterial; mycoplasma; Lyme;
tuberculosis; syphilis; fungal)
Headache, fever, other cranial nerve
palsies, abnormal cerebrospinal fluid
(CSF) commonly seen in meningitis;
Pinna or ear canal vesicles and facial
weakness are oen seen in VZV. (Ramsay
Hunt Syndrome/Herpes Zoster Oticus)
Autoimmune inner ear disease Hearing fluctuation, vertigo
Ototoxic Medication Vestibular loss, oscillopsia
Trauma Temporal bone fracture with possible
Battle's sign; cochlear concussion without
visible fracture; barotrauma
Lead poisoning Learning disabilities, other stigmata of
lead poisoning
Genetic Disorders May be syndromic or nonsyndromic and
may present later in life
