Sensorineural hearing loss is due to damage to the cochlea, the auditory nerve, or the brain stem. It is the most common cause of permanent hearing loss, although some sensorineural hearing loss is temporary and reversible. Infants may present after failing their newborn hearing screen, while children and adults present with loss of ability to hear high or low pitch sounds or difficulty discriminating between several different voices in a conversation. It differs from conductive hearing loss, which limits the amount of sound waves that reach the inner ear.
Common causes of sensorineural hearing loss include advancing age, Meniere disease, head trauma, noise exposure, ototoxic medications, tumors, or infection. Complications of systemic conditions, such as diabetes, autoimmune disorders, or barotrauma, may also cause sensorineural hearing loss.
Sensorineural hearing loss can present at birth or progress through early childhood and can include genetic causes (ie, Waardenburg syndrome, Usher syndrome, Pendred syndrome), congenital malformations, perilymph fistulas, infection, or prematurity. Causes of congenital hearing loss are almost always sensorineural.
A limited number of cases of sudden sensorineural hearing loss have been documented in relation to COVID-19 as well as with the Pfizer-BioNTech, Moderna, and AstraZeneca vaccinations. These studies suffer from limitations, including recall bias, nocebo effect, and survey methodology. Therefore, more evidence will be needed to determine causality.
Related topics: conductive hearing loss, sudden sensorineural hearing loss
Sensorineural deafness
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Synopsis
Codes
ICD10CM:
H90.5 – Unspecified sensorineural hearing loss
SNOMEDCT:
60700002 – Sensorineural hearing loss
H90.5 – Unspecified sensorineural hearing loss
SNOMEDCT:
60700002 – Sensorineural hearing loss
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Presbycusis (age related) – most common cause; progressive, bilateral, symmetrical, irreversible sensorineural deafness, often at high frequencies
- Meniere disease – episodic vertigo, ear fullness, tinnitus, commonly lower frequency hearing loss
- Noise-induced hearing loss – high-frequency hearing loss that may present gradually with repeated occupational exposure or suddenly with a short blast of loud noise
- Infection – most commonly viral cochleitis in adults and meningitis in children
- Ototoxic drugs – review medication list for aminoglycosides, loop diuretics, and chemotherapy agents
- Tumors – tinnitus and vertigo that is usually unilateral, except in the case of neurofibromatosis type 2
- Trauma
- Cerebrovascular ischemia
- Barotrauma
- Congenital – can be bilateral (infection, hereditary) or unilateral (infection, hereditary, malformations, acquired)
- Idiopathic – unilateral, sudden onset
- Complication of another disease – can occur with diabetes, hypothyroidism, or autoimmune disorders
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:10/24/2022
Last Updated:10/30/2022
Last Updated:10/30/2022