Bilateral Sudden Sensorineural Hearing Loss Research Articles

Sudden sensorineural hearing loss: audiological profile during the COVID-19 pandemic.

Sudden sensorineural hearing loss (SSNHL) is an otological emergency that requires prompt recognition and intervention to prevent devastating impacts on people's lives. During the COVID-19 pandemic, sensory deprivations have been reported in patients positive for SARS-CoV-2 virus, including deleterious effects on the auditory pathway. This study aims to describe the audiological profile of individuals with SSNHL during the COVID-19 pandemic and to correlate hearing recovery in subgroups of individuals with or without COVID-19. Prospective cohort including patients diagnosed with SSNHL evaluated in a tertiary care center between March 2020 and September 2022. Hearing loss was confirmed with pure-tone and speech audiometry, with Speech Recognition Threshold (SRT) and word recognition score (WRS). Audiometric testing was performed at the moment of diagnosis, then 7, 30 and 120 days after diagnosis. The average degree of hearing loss was assessed by calculating the 4-frequency pure tone average (4fPTA). The investigation of COVID-19 included RT-PCR technique for the SARS-CoV-2 virus and collection of information regarding disease severity. A statistical analysis was performed using an analysis of covariance (ANCOVA) model to compare the 4fPTA between the four groups (with and without a history of COVID-19, unilateral and bilateral cases) at the end of the follow-up period. Fifty-two patients with SSNHL were assessed, 40 (76.9%) with unilateral and 12 (23.1%) with bilateral hearing loss, totaling 64 ears included. Of those, 15 (28.8%) patients tested positive for SARS-CoV-2 and were symptomatic for COVID-19. Of all unilateral cases, 22.5% were seropositive and showed symptoms of COVID-19, a number that increased to 50% for bilateral cases. Comparing the COVID-19 positive groups, individuals with unilateral SSNHL went from 40 dB as their average 4fPTA at onset to 20 dB as their average 4fPTA after 120 days, whereas those with bilateral SSNHL went from an initial average of 60 dB to a final average of 66 dB. Although the 4fPTA value of individuals with unilateral SSNHL improved in 7 days, the mean values showed no significant difference between positive and negative groups. There was a higher incidence of bilateral simultaneous SSNHL in patients who had not been vaccinated against COVID-19 and who presented with symptoms of severe COVID-19. Infection with SARS-CoV-2 resulted in more severe SSNHL, in bilateral SSNHL, and in poorer recovery from SSNHL in bilateral cases. Bilateral SSNHL was seen more frequently in patients who had not received vaccination against COVID-19.

Bilateral sudden sensorineural hearing loss: a rare case report

Bilateral sudden sensorineural hearing loss: a rare case report

Clinical characteristics of patients diagnosed with bilateral sudden sensorineural hearing loss.

This study investigated the etiology, clinical features, and prognosis of patients diagnosed with bilateral sudden sensorineural hearing loss (BSSNHL). The clinical data of 100 patients with bilateral sudden hearing loss as a chief complaint treated at Xiangya Second Hospital of Central South University between January 2010 and August 2022, including clinical characteristics, audiometric data, and prognosis, were retrospectively analyzed. These 100 cases accounted for 8.09% (100/1235) of all patients admitted for sudden sensorineural hearing loss (SSNHL) during the same period. Of these, 71 were simultaneous cases and 29 were sequential cases of BSSNHL. Among the 200 ears analyzed in this study, 13, 36, 57, and 94 had mild, moderate, severe, and profound sensorineural hearing loss, respectively. The overall effective rate after comprehensive treatment was 32%, with significant differences in efficacy and prognosis among different degrees of hearing loss (p < 0.05). Comorbidities of hypertension (24 cases), diabetes (14 cases), and coronary heart disease (9 cases) significantly impacted therapeutic efficacy and prognosis in patients with BSSNHL (p < 0.05). Compared to unilateral SSNHL, BSSNHL exhibits distinctive characteristics.

Sudden sensorineural hearing loss related to Streptococcus suis meningitis

Background: Streptococcus suis meningitis is caused by Streptococcus suis, gram positive bacteria which is a pathogen mainly in pigs. It is an emerging zoonosis globally with highest incidence in Southeast Asia. The main risk factors are contact with infected pigs and consumption of raw or moderately cooked pork. Bilateral sudden sensorineural hearing loss is a remarakable symptom in this disease. Early initiation of antibiotic and systemic corticosteroids is recommended to improve clinical outcome and reduce complications. Even so, despite adequate treatment, sensorineural hearing loss related to S. suis meningitis is usually irreversible. We report two male patients consulted to otorhinolaryngology department regarding decreased hearing in both ears. Both patients was previously admitted because of altered mental status, accompanied with fever and headache. History of eating traditional Balinese pork dish before the onset was noted. Pure-tone audiometry revealed bilateral sensorineural hearing loss in both patients. Diagnosis of S. suis meningitis was established and treatment was prompted. Clinically, both patients showed improvement but evaluation audiometry showed no remarkable improvement in hearing threshold. Therefore, transmission avoidance, infection prevention, hygiene practice and educational activities are essential.

Bilateral Sudden Sensorineural Hearing Loss

Bilateral Sudden Sensorineural Hearing Loss

Prognosis of Bilateral Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis.

To comprehensively examine the characteristics and prognosis of bilateral sudden sensorineural hearing loss (BSSHL) and its subtypes compared to unilateral sudden sensorineural hearing loss (USSHL). PubMed, Scopus, and CINAHL. Databases were searched from inception to December 5, 2023, for studies reporting patient characteristics and audiometric outcomes for BSSHL and its simultaneous (Si-BSSHL) and sequential (Se-BSSHL) subtypes. Meta-analysis of continuous measures, proportions (%), mean differences (Δ), and odds ratio (OR) were performed. Eleven studies were included, consisting of 368 patients with BSSHL and 2,705 patients with USSHL. The pooled prevalence among all SSHL cases was 88.1% (95% CI: 81.2%-93.6%) for USSHL and 11.9% (95% CI: 6.4% to 18.8%) for BSSHL. PTA improvement following treatment with steroids was significantly worse in patients with BSSHL (Δ15.3 dB; 95% CI: 14.6 to 15.9; p < 0.0001) compared to patients with USSHL. There was no significant difference in post-treatment PTA improvement between the BSSHL subtypes. Patients with Si-BSSHL were significantly less likely to have an idiopathic etiology (OR: 0.4; 95% CI: 0.2 to 0.8; p = 0.01) and significantly more likely to have an autoimmune disease etiology (OR: 27.4; 95% CI: 2.2 to 336.1; p = 0.01), comorbid cardiovascular disease (OR: 2.3; 95% CI: 1.1 to 5.1; p = 0.03), and comorbid hypertension (OR: 2.5; 95% CI: 1.6 to 3.8; p < 0.0001) compared to patients with USSHL. BSSHL is a considerably rarer form of SSHL with worse prognosis compared to USSHL. BSSHL, and Si-BSSHL in particular, has significantly greater associations with systemic pathologies compared to USSHL. Laryngoscope, 134:3883-3891, 2024.

Progress on clinical features of bilateral sudden sensorineural hearing loss

Progress on clinical features of bilateral sudden sensorineural hearing loss

Catastrophic Bilateral Sudden Sensorineural Hearing Loss Due to Mumps: Report of Two Cases

Catastrophic Bilateral Sudden Sensorineural Hearing Loss Due to Mumps: Report of Two Cases

Idiopathic sequential bilateral profound sudden sensorineural hearing loss occurring 4 years after unilateral presentation

Sudden sensorineural hearing loss is defined as hearing loss of 30db or more at least 3 consecutive audiometric frequencies occurring within 72 hours period or less. Unilateral presentation of sudden sensorineural hearing loss is common, however bilateral sequential presentation of this disease is very rare. Clinically we couldn’t anticipate the occurrence of sequential bilateral sudden sensorineural hearing loss at the first time. This bilateral sudden sensorineural hearing loss will affect the quality of life of patient. So, we report a case of 60 years old female patient with profound bilateral sudden sensorineural hearing loss with time interval of 4 years between involvement of both ears. Even though high dose steroid administered intravenously and intratympanic the patient’s hearing was not restored and eventually require hearing aids. The purpose of presenting this article is that sequential profound bilateral sensorineural hearing loss may present without any warning sign, response to treatment is very poor and the rarity of this condition.

Bilateral sudden sensorineural hearing loss due to subcortical cerebral hemorrhage in a patient with Moyamoya disease: case report

BackgroundMoyamoya disease (MMD) is a chronic cerebrovascular occlusive disease that can results in a variety of neurological deficits. We describe a very rare presentation of MMD in the form of bilateral sudden sensorineural hearing loss after a second attack of subcortical cerebral haemorrhage.Case presentationA 44-year-old female presented with bilateral sudden sensorineural hearing loss (SSNHL) secondary to an acute intracerebral haemorrhage in the left temporoparietal region. She had a previous haemorrhagic event in the right temporoparietal region two years ago. The two haemorrhagic events have apparently led to interruption of the auditory pathways bilaterally, resulting in sudden complete deafness. Digital subtraction angiography was done, and it showed bilateral occlusion of the internal carotid arteries, with the abnormal anastomotic vascular network at the base of the brain characteristic for MMD.ConclusionsSubcortical hemorrhage due to MMD is a potential cause of bilateral SSNHL that can be diagnosed with early proper imaging. Bilateral damage of the auditory pathways is the likely cause of cortical deafness in this clinical scenario.

Teaching NeuroImage: Sudden Bilateral Sensorineural Hearing Loss Due to Vertebrobasilar Ischemia.

Teaching NeuroImage: Sudden Bilateral Sensorineural Hearing Loss Due to Vertebrobasilar Ischemia.

Prognostic changes after sudden deafness in patients with inner ear malformations characterized by LSCC: a retrospective study.

This study aimed to investigate the clinical features and prognosis of sudden sensorineural hearing loss in patients with lateral semicircular canal (LSCC) malformation. This study enrolled patients with LSCC malformation and sudden sensorineural hearing loss (SSNHL) who were admitted to Shandong ENT Hospital between 2020 and 2022. We collected and analyzed data on examinations of audiology, vestibular function, and imaging records of patients and summarized the clinical characteristics and prognosis of these patients. Fourteen patients were enrolled. Patients with LSCC malformation was noted in 0.42% of all SSNHL cases during the same period. One patients had bilateral SSNHL and the rest had unilateral SSNHL. Of them, eight and six patients had unilateral and bilateral LSCC malformations, respectively. Flat hearing loss was noted in 12 ears (80.0%) and severe or profound hearing loss was noted in 10 ears (66.7%). After treatment, the total efficacy rate of SSNHL with LSCC malformation was 40.0%. Vestibular function was abnormal in all patients, but only five patients (35.7%) had dizziness. There were statistically significant differences in the vestibular functions between patients with LSCC malformation and matched patients without the malformation hospitalized during the same period (p < 0.05). Patients with SSNHL and LSCC malformation had flat-type and severe hearing loss and worse disease prognosis compared to those with SSNHL without LSCC malformation. Vestibular function is more likely to be abnormal; however, there was no significant difference in vestibular symptoms between patients with and without LSCC malformation. LSCC is a risk factor for the prognosis of SSNHL.

Characteristics and prognostic analysis of simultaneous bilateral sudden sensorineural hearing loss.

To evaluate the clinical characteristics of simultaneous bilateral sudden sensorineural hearing loss (Si-BSSNHL) as well as its prognostic factors. Patients with Si-BSSNHL who were admitted to the Department of Otology Medicine between December 2018 and December 2021 were enrolled in the case group. Propensity score matching (PSM) for sex and age was used to select the control group, which included people who had unilateral sudden sensorineural hearing loss (USSNHL) during the same time period. Hearing recovery, audiological examinations, vestibular function assessments, laboratory tests, and demographic and clinical manifestations were analyzed for intergroup comparisons. Binary logistic regressions were used for both univariate and multivariate analyses of Si-BSSNHL prognostic factors. Before PSM, the Si-BSSNHL and USSNHL groups differed significantly (p < 0.05) in terms of time from onset to treatment, initial pure-tone average (PTA), final PTA, hearing gain, audiogram curve type, proportion of tinnitus, high-density lipoprotein level, homocysteine level, and effective rate. After PSM, significant differences were also observed in time from onset to treatment, initial PTA, final PTA, hearing gain, total and indirect bilirubin levels, homocysteine level, and effective rate between the two groups (p < 0.05). There was a significant difference in the classification of therapeutic effects between the two groups (p < 0.001). For prognostic analysis, the audiogram curve type was significantly different between the effective group and the ineffective groups of Si-BSSNHL (p = 0.01), in which the sloping type was an independent risk factor for the prognosis of the right ear in Si-SSNHL (95% confidence interval, 0.006-0.549, p = 0.013). Patients with Si-BSSNHL had mild deafness, elevated total and indirect bilirubin and homocysteine levels, and poorer prognosis than those with USSNHL. Audiogram curve type was linked to the therapeutic effect of Si-BSSNHL, and the sloping type was an independent risk factor for a poor prognosis in the right ear of Si-SSNHL.

Sudden Bilateral Sensorineural Hearing Loss due to Basilar Artery Occlusion (P3-5.027)

<h3>Objective:</h3> We describe a case of a patient with occlusion of the basilar artery and bilateral anterior inferior cerebellar arteries (AICAs) who presented with a chief complaint of sudden bilateral sensorineural hearing loss (SNHL). <h3>Background:</h3> Sudden bilateral SNHL, defined as SNHL developing in less than 72 hours, is a rare phenomenon representing less than 5% of all acute SNHL cases. Whereas more frequent unilateral presentation is relatively benign, sudden bilateral SNHL represents a medical emergency and warrants immediate evaluation for life-threatening and/or reversible causes. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 56-year-old right-handed African American woman with personal medical history of hypertension, hyperlipidemia, chronic obstructive pulmonary disease, stroke, tobacco abuse, and obesity presented with sudden onset bilateral hearing loss preceded by one week of persistent vertigo and nausea. On admission she was hypertensive to 240/122 mm Hg, physical examination was significant for saccadic pursuit with spontaneous bilateral horizontal and vertical down-beating nystagmus, truncal ataxia, and bilateral SNHL confirmed by audiogram. CT of head alongside CT angiography showed occlusion of V4 segment of right vertebral artery extending through most of the basilar artery, and near-occlusion of bilateral AICAs. MRI showed late acute/early subacute ischemic infarcts in bilateral anterior cerebellum, cerebellar peduncles, and pons. Patient was out of time window for thrombolysis with rt-PA, mechanical thrombectomy was deferred due to &gt;24h from symptom onset and stable neurological examination throughout hospital admission. Blood pressure was gradually lowered and antiplatelet therapy with aspirin was initiated prior to discharge to rehabilitation facility. <h3>Conclusions:</h3> Sudden bilateral SNHL in isolation or accompanied by vestibular, cerebellar and/or brainstem signs particularly in patients with significant risk factors for cerebrovascular disease should alarm a clinician of a possibility of vertebrobasilar occlusion and prompt appropriate and timely medical management as delay in optimal medical treatment is associated with increased morbidity and mortality in this patient population. <b>Disclosure:</b> Dr. Buciuc has nothing to disclose. Dr. Gonzalez has nothing to disclose. Dr. Ali has nothing to disclose. Dr. Nankee has nothing to disclose. Dr. Holmstedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astrazeneca. The institution of Dr. Holmstedt has received research support from NIH. The institution of Dr. Holmstedt has received research support from Patient-Centered Outcomes Research Institute. The institution of Dr. Holmstedt has received research support from CSPC Pharmaceuticals . Dr. Holmstedt has received personal compensation in the range of $5,000-$9,999 for serving as a Study Adjudicator with Ischemia Care.

A review of bilateral sudden sensorineural hearing loss in pediatric patients.

Bilateral, sudden sensorineural hearing loss (SSNHL) in the pediatric population is a rare phenomenon potentially detrimental to language acquisition and social development. This study comprehensively reviews and analyzes existing literature to determine any correlation or commonality in etiologies, presentations, and management of this condition. PubMed, Cochrane, Scopus, and Web of Science databases were systematically searched for articles related to pediatric SSNHL from 1970 to 2021. Case series, case reports, and cohort studies were included. Data on patient demographics, etiology, diagnostic testing, management, and hearing recovery were collected. Excluding duplicates, 553 unique titles were identified by established search criteria, of which 342 titles were relevant to pediatric sudden hearing loss. Forty-six papers reported cases of bilateral SSNHL, totaling 145 individual cases. Not included in the analysis were 45 cases documented as non-organic hearing loss. The average age of the total 145 included patients was 8.5 years and 51 were male. Reported etiologies included cytomegalovirus (n=3), meningitis (n=13), mumps (n=5), ototoxin exposure (n=13), and enlarged vestibular aqueduct (n=9). Tinnitus (n=30) was the most reported concurrent symptom, followed by vertigo (n=21). Systemic steroid therapy was the most common treatment and, when follow up was reported, most patients (51.2%) had complete or partial recovery of hearing. This is a comprehensive review of pediatric bilateral SSNHL. Though often idiopathic, etiologies also include infectious, structural, and autoimmune. Treatment largely consists of systemic steroid therapy, with variables rates of recovery. Further studies on intratympanic administration of steroids may guide future treatment.

A Case of Bilateral Sudden Sensorineural Hearing Loss Accompanying Unilateral Acute Otitis Media as a First Presentation of Human Immunodeficiency Virus Infection

The etiologies of sudden sensorineural hearing loss (SSNHL) include idiopathic, viral infections, vascular occlusion, abnormal cellular stress responses within the cochlea, and a variety of immune-mediated mechanisms. Although idiopathic cause is most common, many studies have proposed a possible association between SSNHL and viral infections, including herpes simplex virus, human immunodeficiency virus (HIV), rubella, mumps, and so on. Particularly, various mechanisms underlying auditory dysfunction in the HIV/acquired immune deficiency syndrome have been proposed. Herein, we present the case of a 35-year-old male diagnosed with sudden hearing loss on both sides and left acute otitis media, presenting first in the left ear, in which subsequent serological examination revealed HIV infection. It is a case of HIV infection diagnosed after identifying the involvement of the 8th cranial nerve as the first symptom in the absence of any other HIV infection-associated symptoms.

Characteristics and prognosis analysis of bilateral sudden sensorineural hearing loss: A retrospective case-control study.

To evaluate the clinical characteristics and prognostic factors of simultaneous and sequential bilateral sudden sensorineural hearing loss (Si-BSSNHL and Se-BSSNHL, respectively). Retrospective case-control study. A single tertiary referral centre. Patients diagnosed with unilateral sudden sensorineural hearing loss (USSNHL), Si-BSSNHL, or Se-BSSNHL between September 2018 and November 2019. Demographic and clinical characteristics, audiological features, laboratory results and hearing recovery were analysed for intergroup comparisons. Prognostic factors for BSSNHL were analysed using univariate and multivariate logistic analyses between the overall and no-recovery groups. Compared to the USSNHL group, a larger final pure-tone average (PTA) (H=38.0 and 53.8, respectively, both adjusted p-value (p adj) <.05), lower hearing gain (H=-70.8 and - 74.6, respectively, both p adj <.001) and higher homocysteine levels (H=46.8, 58.8, respectively, both p adj <.05) were observed in the Si-BSSNHL and Se-BSSNHL groups, while the rate of positive vestibular tests and proportion of tinnitus were lower in the Se-BSSNHL group (χ2 =8.5 and 38.1, respectively, both p adj <0.05). The USSNHL group showed a significant difference in the degree of deafness and therapeutic outcome in the Se-BSSNHL and Si-BSSNHL groups, respectively (χ2 =12.4, p adj <.05; χ2 =13.6; p adj <.05). Hypertension (95% confidence interval, 1.014-28.623, p < .05) and onset days (95% confidence interval, 0.007-0.626, p < .05) were associated with the therapeutic effects of BSSNHL. Higher homocysteine levels in BSSNHL may implicate microvascular disorders as a causative factor of BSSNHL. Hypertension and onset days were associated with the prognosis of BSSNHL.

Relationship between sudden sensorineural hearing loss and facial auditory nerve and anterior inferior cerebellar artery vascular loop in the internal auditory tract MRI

Objective:To investigate the correlation between the facial auditory nerve and anterior inferior cerebellar artery vascular loop in MRI of the internal auditory meatus and idiopathic sudden sensorineural hearing loss. Methods:This retrospective study enrolled 144 patients with idiopathic sudden sensorineural hearing loss（SSNHL）（experimental group） and 36 healthy subjects with 72 ears（control group）, who attended the Department of Otolaryngology Head and Neck Surgery, the 940th Hospital of the Joint Logistics Support Unit of the Chinese PLA from January, 2019 to January, 2021. The magnetic resonance imaging（MRI） data of the internal auditory meatus and clinical data were collected and compared between the two groups. Results:The distance between the auditory nerve and the peripheral vessels in the unilateral SSNHL-affected ear was significantly different from that in the contralateral ears and that in the healthy ears of the control group （P<0.05）. The distance between the auditory nerve and the peripheral vessels in both ear affected by bilateral SSNHL was significantly different from that in the healthy ears of the control group （P<0.05）. There was no significant difference in radiological grading of vascular loops between the ears affected by unilateral SSNHL and the contralateral ears and the healthy ear of the control group （P>0.05）. No statistically significant differences in radiological grading of vascular loops were found between both ears with bilateral SSNHL and the healthy ears in the control group（P>0.05）. The severity of hearing loss, audiometric configuration, radiological grading of vascular loops and the distance between the facial auditory nerve and peripheral vessels were not significantly different between the affected ears in unilateral SSNHL and both ears in bilateral SSNHL （P>0.05）. Conclusion:SSNHL is associated with the distance between the auditory nerve and the nearest peripheral vessel. SSNHL may occur when the vessel compresses the auditory nerve.

Aberrant Functional Network of Small-World in Sudden Sensorineural Hearing Loss With Tinnitus.

Few researchers investigated the topological properties and relationships with cognitive deficits in sudden sensorineural hearing loss (SNHL) with tinnitus. To explore the topological characteristics of the brain connectome following SNHL from the global level and nodal level, we recruited 36 bilateral SNHL patients with tinnitus and 37 well-matched healthy controls. Every subject underwent pure tone audiometry tests, neuropsychological assessments, and MRI scanning. AAL atlas was employed to divide a brain into 90 cortical and subcortical regions of interest, then investigated the global and nodal properties of “small world” network in SNHL and control groups using a graph-theory analysis. The global characteristics include small worldness, cluster coefficient, characteristic path length, local efficiency, and global efficiency. Node properties include degree centrality, betweenness centrality, nodal efficiency, and nodal clustering coefficient. Interregional connectivity analysis was also computed among 90 nodes. We found that the SNHL group had significantly higher hearing thresholds and cognitive impairments, as well as disrupted internal connections among 90 nodes. SNHL group displayed lower AUC of cluster coefficient and path length lambda, but increased global efficiency. The opercular and triangular parts of the inferior frontal gyrus, rectus gyrus, parahippocampal gyrus, precuneus, and amygdala showed abnormal local features. Some of these connectome alterations were correlated with cognitive ability and the duration of SNHL. This study may prove potential imaging biomarkers and treatment targets for future studies.

Bilateral Sudden Sensorineural Hearing Loss: A Distinct Phenotype Entity.

To investigate the clinical phenotype and hearing prognosis of patients with unilateral and bilateral (simultaneous and nonsimultaneous) sudden sensorineural hearing loss (SSNHL). Retrospective cohort. Otology outpatient clinic of a tertiary university hospital. Three hundred eighty-five medical records from patients with SSNHL. Comparison of demographic, clinical, and audiometric (pretreatment and posttreatment) data of patients with unilateral and bilateral SSNHL. Our final analysis comprised of 239 medical records of patients with SSNHL. Most patients had unilateral SSNHL (186, 77.82%). We identified a potential underlying cause for the SSNHL in 105 (43.9%) of the cases, being more frequent in cases of bilateral simultaneous SSNHL (100%) as compared with unilateral (45.6%) and nonsimultaneous bilateral SSNHL (22.7%). Cases of simultaneous bilateral SSNHL presented more frequently with severe or profound hearing loss (89%; unilateral SSNHL 50.5%; nonsimultaneous bilateral SSNL, 59.1%) and had a significantly worse hearing recovery prognosis as compared with unilateral or nonsimultaneous bilateral SSNHL (p = 0.002). We observed a high heterogeneity of clinical presentations of SSNHL, the most common being unilateral SSNHL. Our results demonstrate that the clinical and audiological prognosis of simultaneous bilateral SSNHL differed significantly from unilateral and nonsimultaneous bilateral SSNHL, suggesting that simultaneous cases of bilateral SSNHL may be a part of a different disease process. The presence of a simultaneous, bilateral SSNHL indicates the need to investigate the presence of an underlying systemic disease.