Vestibular Neuritis hearing recovery?
May 21, 2018 9:27 AM   Subscribe

I had a bacterial ear infection about a month ago, I've been seeing an ENT specialist since then. It seems I have Vestibular Neuritis which is affecting my hearing in the inner ear. I can hear at about 75 (?)%. I've tried Antibiotics and Steroids over the past few weeks. I's improved but slowly and, so far, not completely. ...

I'm wondering if anyone has had this problem and if your hearing did eventually return to normal? It doesn't hurt. I do have moments of vertigo when laying down at times. But generally it's just distracting and annoying to not be able to hear fully. Thanks in advance.
posted by Liquidwolf to Health & Fitness (8 answers total) 1 user marked this as a favorite
I have problems with small/scarred eustachian tubes from both asthma and allergies. I've found that using a steroid nasal inhaler and nasal lavage helps greatly, in addition to the traditional oral steroids/antibiotics treatments.
posted by answergrape at 9:45 AM on May 21, 2018

I'm an audiologist but not yours etc.

Vestibular neuritis from a bacterial infection is very rare and hard to diagnose, so unfortunately there is not a ton of outcome research.

Steroids is the right course of action in these cases, though the recovery rate of hearing loss with steroid treatment is only about 30% (though this rate is based on studies of idiopathic sudden losses, so take with a grain of salt). The longer the hearing loss lingers after onset, the less likely it is to return. Complete recovery is rare. I realize this is probably not welcome news. Likelihood of recovery also depends on the shape of your hearing loss (we don't typically think of hearing in percentages - kind of a misnomer, so you may want to actually talk to an audiologist about what your hearing looks like and what you might expect, rather than your ENT).

Vestibular symptoms are more likely to improve because of compensation - the brain figures out how to compensate for a damaged nerve on one side and the vertigo tends to go away with time. The brain cannot compensate, however, for hearing loss as a result of damage to the hearing/balance nerve.

Continue to consult with your ENT, but as far as I am aware steroids and waiting are the only treatment options. Depending on much hearing loss you end up with, there are amplification options if you want to go that route for unilateral hearing losses (i.e. hearing aids), but with one good ear I've found that benefit is pretty mixed. Most people sort of learn to live with it.
posted by Lutoslawski at 10:12 AM on May 21, 2018 [1 favorite]

Response by poster: Lutoslawski , thanks for the info. Do you think the steroid injection is a worthwhile treatment? I was offered that but so far Ive been only on oral. The idea of piercing the eardrum sounds bad to me, but I'd go for it if I thought it may really help.
posted by Liquidwolf at 10:18 AM on May 21, 2018

That is a difficult question. For the most part, both delivery methods yield similar outcomes. Transtympanic injections don't really do better, though some doctors will still recommend them if oral steroids don't work. However, improvement in hearing with transtympanic injections after a month is really unlikely, unfortunately.

The actual injection is uncomfortable but quick and not particularly terrible, from what I have heard. The hole in the ear drum is small and heals quickly.

One thing to consider is that if it is truly neuritis, then the damage is to the nerve, which is actually deeper than the inner ear, per se. I think the general idea of the transtympanic injection is that you get the steroids into the middle ear and then they can diffuse through the round window into the cochlea (inner ear), and catalyze an immune response there. The nerve is actually just beyond the cochlea, so I think the exact theory of the mechanism of benefit in this case of the injection is unclear.

That said - I am not an otolaryngologist, so I would definitely consult with yours to make a decision that is best for you.
posted by Lutoslawski at 10:43 AM on May 21, 2018

Sorry, one more thing. This good review does have articles which show benefit from a transtympanic injection after systemic steroid treatment, or at least greater concentrations of the drug in the inner ear than with oral steroids, but it also goes through a bunch of factors that may be the reason behind so much mixed benefit.

If you were my patient, which you are not, and I am not giving you medical advice, nor am I an otolaryngologist, I would probably tell you this: there is a huge variance in how effective steroid treatments are, either oral or injection, and we don't really know why. It's probably not likely at this point that an injection would offer much benefit - however, if you are going to spend the rest of your left wondering "what if I had done the injection", than we should do it.
posted by Lutoslawski at 10:53 AM on May 21, 2018

Response by poster: Lutoslawski, thanks again for all this. And I know you're not advising me on anything, I'll talk with my doctor about it. I'm not certain it's Vestibular Neuritis, it just seems to fit what Im experiencing.
posted by Liquidwolf at 11:08 AM on May 21, 2018

There are SLPs who certify in vestibular rehabilitation. They may be hard to find outside areas with large academic-ish medical populations.
posted by cobaltnine at 11:18 AM on May 21, 2018

Response by poster: cobaltnine, thanks that's good to know. I'm in NYC so it's an option.
posted by Liquidwolf at 11:22 AM on May 21, 2018

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