Diagnosis of sudden deafness There is no specific manifestation of sudden deafness in the outer and middle ear, so the diagnosis is mainly based on the experience of onset combined with clinical audiological examination. 30 dB or more in at least three adjacent audiometric frequencies is considered diagnostic. This can also be supplemented with acoustic impedance, cochlear electrograms or auditory brainstem evoked potentials, but early routine ear CT or MRI is generally not necessary unless the history or clinical presentation is truly suspicious. The relationship between treatment and prognosis of sudden deafness Since it has been clinically observed that some of the patients with sudden deafness have different degrees of tendency to heal themselves, and conversely some of them end up not healing despite all-out treatment, some scholars abroad believe that patients with sudden deafness can be left untreated. However, this is incompatible with the current medical ethics and clinical reality in China. More evidence-based medical data from home and abroad confirm that timely, aggressive, and relatively reasonable medical interventions can help most patients with sudden deafness recover more or even all of their hearing. Even then it is necessary for both the doctor and the patient to have an individualized analysis of the condition and an objective prediction of the prognosis. The usual factors for a poor prognosis are: severe or total deafness, previous underlying deafness or recurrent type of deafness, bilateral sudden deafness, with vertigo, and anxiety states. In terms of hearing curve, total deafness type and significant high frequency decline have the worst prognosis; low frequency and medium frequency decline are better; and average decline is fair. In addition, according to clinical observation relatively correct treatment start time late on the treatment effect will also be greatly reduced, the same treatment program generally within 1-3 days for the best efficacy, within a week to start fair, within two weeks for the limit, two months for the limit, two months or more basically ineffective. Therefore, it is extremely important to solemnly warn patients with sudden deafness that timely treatment is very important, and it is even the most important factor affecting prognosis and most likely to be interfered by human factors! Some patients often say that they are busy with work or study, and that they can only be treated in a few days, but this is due to a lack of awareness of the seriousness of delayed treatment. The most important thing is to prevent deafness and disability, and there is nothing more important than this! Knowing this, it is important to know the following: the status of hormones in the treatment of sudden deafness The first thing to say to patients with sudden deafness is that glucocorticoids are preferred in the treatment of sudden deafness. Although there are various concerns and misconceptions about the use of hormones, the rational and correct use of hormones can maximize the positive effects of hormones and avoid the side effects of hormones. This is directly related to the powerful and stable anti-inflammatory and metabolic effects of glucocorticoids on viral infections, autoimmune diseases and other causes. If your doctor has not communicated with you about your treatment plan regarding the use of hormones, then you can initially determine that he is inexperienced in the treatment of sudden deafness or has other problems. Of course, the use of hormones requires prior knowledge of whether the patient also has absolute or relative contraindications such as diabetes, hypertension, acute infection, etc., and requires the patient’s understanding and cooperation and consent. The following methods are generally recommended: 1. Glucocorticoids: Oral prednisone tablets are commonly used as shock therapy, once a day in the morning at a dose of 50-60mg or 1mg/kg, and then gradually reduced and stopped after 5-10 days. After 5-10 days, the dose is gradually reduced and stopped. In China, the general dose tends to be conservative, but the overall daily dose should not be less than 30 mg. Of course, it can also be given intravenously. 2.Improve vascular microcirculation: It is recommended to use fibrin-lowering or thrombolytic drugs with reliable monitoring indicators, such as bactrim. Note that indicators such as blood rheology and coagulation function should be monitored before and during use, and are prohibited in patients with bleeding tendency, abnormal liver and kidney function or hypertension. Low-molecular dextran plus adenosine triphosphate (ATP) and other vasodilators commonly used in the past have been said to have no significant improvement on microcirculation, and only vasodilatation can lead to blood theft instead and is not beneficial to the treatment of sudden deafness. 3. Hyperbaric oxygen or mixed oxygen: It may improve the oxygen supply to the inner ear and be beneficial to the treatment. Care should be taken to exclude hypertension, eustachian tube dysfunction, sinusitis and other unsuitable conditions. 4. Antivirals: For patients with suspected viral infection as the causative agent, antivirals such as oseltamivir may be used early. A week later the administration of drugs is generally ineffective. 5.Other: Ginkgo biloba extract as a mild therapeutic drug to improve microcirculation can be used in outpatient or late treatment; blood activation and blood stasis class of Chinese herbal injections are widely used in the treatment of sudden deafness but evidence of efficacy in evidence-based medicine is limited; Prostil has anti-platelet agglutination and vasodilating effects but preservation requires full refrigeration which is inconvenient. Various types of laser irradiation, blood therapy and acupuncture have been clinically proven to be ineffective. Expectations of efficacy with generic Chinese medicines and advertising fakes are only wishful thinking, and individual “efficacy” may stem from the self-healing nature of sudden deafness, which is not statistically significant. The use of anti-anxiety medication to control emotions, relieve stress and improve the quality of rest seems to be helpful. Regarding the legacy of tinnitus and vertigo Many patients complain that tinnitus and vertigo are even more disturbing to them than deafness. It is true that tinnitus and vertigo may have a greater psychological impact, but generally speaking, patients are habituated to vertigo, and with the use of betahistine mesylate and other medications, even if the vertigo symptoms are severe, they will diminish or disappear in 1-2 months due to gradual adaptation, so the concern about vertigo need not be too great. The trouble is tinnitus, which has a lot to do with the patient’s psychological state and may remain for quite a long time. We can treat it with medication such as ergocryptine caffeine, together with psychological relief and masking therapy. The more relaxed the mind is and the less you count its existence, then it can really cease to exist one day sooner.