On a late afternoon last November, Maureen Berger was working in her home office when she suddenly noticed that both of her ears were clogged.
“It felt like the sensation you get on an airplane when the pressure changes” said the 51-year-old Berger, a retired teacher in Deerfield.
Her right ear cleared up right away, but the left remained clogged. Later, when her daughter telephoned, Berger noticed that her daughter’s voice sounded distant. Berger switched the phone to her other ear and there was no problem.
But there was a problem, although Berger didn’t know it at the time–she had suffered sudden sensorineural hearing loss (SSHL). Berger might’ve remained almost deaf in her left ear if she hadn’t been treated by Dr. Sam Marzo, an otolaryngologist at Loyola University Health System, Maywood.
Marzo successfully treated Berger with a new FDA-approved therapy he devised for SSHL that delivers steroids to the cochlea, a spiral-shaped component of the ear located beneath the inner ear, by means of a pump and catheter. He presented a paper on the new procedure at a fall meeting in Orlando of the American Academy of Otolaryngology–Head and Neck Surgery.
Before she went to Marzo, Berger went to an internist and then an otolaryngologist. After various hearing and medical tests, including an MRI to rule out a tumor, oral steroids were prescribed, a traditional treatment for a sudden hearing loss that could not be attributed to an identifiable cause.
“My ENT [a physician specializing in the ear, nose and throat] put me on prednisone and told me to come back in a month,” Berger said. “I noticed a very slight improvement in my hearing, but it plateaued by the end of ten days.”
Then she was referred to Marzo.
“Her inner ear was so far gone she was almost deaf,” says Marzo, describing the condition of Berger’s hearing when he began treating her. “She wouldn’t even have been helped by a hearing aid.”
Neither Berger nor Marzo could pinpoint the cause of her hearing loss. Marzo believes it might have been caused by a virus, though there is no definite test for what causes SSHL. Berger said she was never exposed to loud music or noise, a major cause of hearing loss, nor had she suffered any recent trauma to her ear. Although there is no diagnostic test to confirm it, Marzo therefore believes that a virus was the cause of Berger’s hearing loss.
Marzo first treated her with liquid steroids administered through a small wick, a sponge of polyvinyl acetate about 1 millimeter by 6 millimeters. The wick is inserted into the middle ear under local anesthesia and delivers steroids to the inner ear. With a dropper, the patient administers four drops of the steroid Decadron twice daily for 7 to 10 days.
Berger’s hearing did not improve sufficiently with the initial therapy, so Marzo removed the wick and began his pump procedure. The pump, about 4 inches square and a little thicker than a deck of cards, is a micro-infusion device used by diabetics to dispense insulin and is adapted to this new function. In an outpatient procedure under general anesthesia, a thin catheter was inserted into the round window, an opening between the middle ear and the inner ear. The pump, powered by a 9-volt battery, is programmed to dispense a steroid continually for two weeks across the round window membrane, which diffuses it to the cochlea.
“I could wear the pump on a black rope around my neck under my shirt, or in my shirt pocket,” Berger said. “The wires or catheters were stitched to my [left] ear. The attachments caused no problems at all. I wore it to bed, and I could even take a shower, although I had to put a cotton ball covered with Vaseline into my ear to keep the water out.” The pump may also be worn on a belt.
On the 10th day after insertion, Marzo removed the pump and catheter. No anesthesia was required. Berger was delighted with the results: She could hear again.
“My hearing is now about 50 percent of what it was,” Berger said. “But I don’t have to turn up the volume or the television or radio. I have no air travel restrictions, so I can fly, and swim, too. The only problem I sometimes have is in a noisy environment, a restaurant for example. I have to look directly at a person to hear clearly what they’re saying, although I don’t read lips.”
Marzo urges anyone who has sudden hearing loss to seek medical help immediately. “The longer you wait before treatment, the less likely you’ll recover hearing in the affected ear,” he said. “After about six weeks, it’s too late.”
SSHL incidence in the U.S.
– Strikes about 1 in 10,000 people
– Usually appears in people ages 30 to 60
– Cause: in most cases, unknown. Up to 15% caused by infection, trauma or reaction to ear medicine.
