On a July day last summer, Andy Strunk awoke to an inexplicable condition: the hearing in his left ear was gone.

A rapid onset of any condition can make a person spin with worry, and Strunk was no different. He wondered: “Is there something bigger going on? Is something not good in my brain? Did I do something wrong? Have I had a stroke?’’

Sudden hearing loss is not uncommon with about 1 in 5000 people per year experiencing sudden hearing loss in one or both ears. In many cases, many individuals do not consider this an emergency medical condition, but urgent treatment is critical.

Seek treatment for sudden hearing loss

“It’s common for these patients to miss the treatment window because they may delay care assuming that symptoms will self-resolve,” Dr. Ashley Nassiri, an Ear, Nose and Throat (ENT) doctor who specializes in ear, hearing and skull-base surgery (Otology & Neurotology). She works at UCHealth Ear, Nose and Throat Clinic – Anschutz Medical Campus.

“An important point for these patients is that the sooner you can get treatment, the higher the chance is that treatment will be effective. We consider sudden sensorineural hearing loss urgent and want to test patients within 3 days of the onset of hearing loss.”

Fortunately, Strunk, the father of two young boys, did not wait to seek medical help. He sent a message through My Health Connection, UCHealth’s patient portal, to Dr. Brad Changstrom at the UCHealth Internal Medicine Clinic – Lowry.

“Hey ….’’ Strunk began in his note, explaining that his hearing had vanished in the left ear. “It’s not getting any better. What should I do? Should I come see you? Or what’s next?’’

The same day, Changstrom responded: “This is highly worrisome to me. You need to see audiology for a hearing test and ENT in the next 24-48 hours. There is risk of permanent hearing loss even with the early treatment.”

“I am having a nurse call the ENT clinic to try to help get you scheduled. If you can’t get in there within the next 24 hours, please let me know. In the meantime, I am starting a high dose steroid medication until you see them.’’ Changstrom wrote.

Changstrom, who is the team physician for the Colorado Avalanche, has since moved from Lowry to UCHealth Foot and Ankle Clinic – Boulder, where he is a primary care sports medicine doctor. He said nurses at Lowry helped get Strunk in to see Nassiri, who is also an Assistant Professor of Otolaryngology at the CU School of Medicine.

Strunk was grateful for the quick reply. The father of two boys, ages 3 and 6, relishes the conversations he has with his sons when they cook dinner after he gets off work at a technology company that builds software for clinicians to reduce waste using technology in medical settings. Full of life, the boys are eager to learn, no matter if they’re learning to prepare a meal, skiing Colorado’s Rocky Mountains or studying how to speak Mandarin.

Strunk purchased kid-safe chef’s knives for the boys so they can assist in chopping the onions and cucumbers. As they prepare the meal, Strunk introduces a bit of a chemistry lesson, pointing out temperature and the size of the vegetables, why an onion that is diced instead of minced will cook differently under different temperatures.

“Daddy, is this the right size? When do we put this in? Is the temperature right,’’ Zach asks.

Hearing their voices clearly is something Strunk never doubted until he woke up that morning last summer.

“Basically, the hearing was just gone,’’ Strunk said.

Idiopathic sudden sensorineural hearing loss

The day after his note to Changstrom via My Health Connection, Strunk was in Nassiri’s office.

“She is just the person that I needed,’’ Strunk said.

Nassiri put a name to Strunk’s condition: Idiopathic sudden sensorineural hearing loss. That means that doctors don’t know what caused the hearing loss, though the leading theory is that it could have been caused by a viral infection or loss of blood flow to the inner ear.

“The leading theory is that either inflammation or lack of adequate blood flow to the cochlea, the hearing instrument of the inner ear, causes a sudden onset hearing loss,” Nassiri said. “Generally, our main treatment option is steroids, which broadly reduce inflammation.’’

Strunk remembered Nassiri’s candor when she told him that Changstrom did the right thing prescribing steroids and that he would know in about 3-6 months how much hearing he would recover.

“It was scary news, but I was glad she was so blunt,’’ Strunk said.

There are two ways to deliver steroids to the inner ear. One route is oral steroids, and Strunk was already taking steroids with the hope that the drug would eventually reach the bloodstream and circulate through the cochlea to have its effect.

Nassiri also offered a second route, via an injection of liquid steroid through the ear drum. The idea is that this liquid steroid sits in the middle ear and diffuses into the cochlea though a small membrane called the round window. In this in-clinic procedure, the ear drum is anesthetized with numbing medicine and a small needle is used to inject the steroid into the middle ear. In addition, she ordered an MRI for Strunk, to rule out any tumors or other inner ear abnormalities that could explain a sudden hearing loss.

“So what happens is, you lie on your side for about 30 minutes and you marinate your cochlea – I’m not sure what the medical term is for it, other than that. But what she did is she placed a liquid steroid and said, ‘this is just going to bathe your cochlea for the next few days and we hope it will help with reduction of inflammation.’’

By the time Strunk returned for a follow-up visit with audiology, his hearing had been restored. Nassiri said that she does not know for certain what caused the sudden hearing loss. And while data suggests that steroids improve rates of hearing recovery, some people recover on their own.

“I was kind of excited with the outcome,’’ Strunk said. “The fact that she was like, ‘you’re going to know in 3-6 months what you’re going to have for the rest of your life, I was expecting it not to return. So with all the steroids and the quick interventions, and the coordination between primary care and specialty care, and given that speed and access to specialty care, all of the right protocols resulted in a really good outcome.”

“I haven’t had any problems since. I’m able to fly, I’m able to swim and I’m able to do everything like I used to,’’ he said.

Urgent treatment for sudden hearing loss is critical

For anyone experiencing sudden hearing loss, Nassiri said, time is of the essence.

“The sooner you get a formal hearing test and treatment if indicated, the better,’’ she said. “Really, if you are beyond eight weeks from the onset of sudden hearing loss, there is no evidence to support efficacy of steroid treatment at that point. Beyond two months, I generally do not recommend steroid treatment because the risks outweigh the potential benefits,’’ she said.

Getting a formal hearing test (audiogram) completed within 72 hours of the onset of sudden hearing loss is ideal.

“It is important for primary care doctors to pick up on this and for patients to advocate for their care. We have a protocol in our office that if a patient, primary care doctor, or other physician calls with concerns for a sudden hearing loss, we get them in for a hearing test within 72 hours. We consider it an ‘ear emergency.’”

“If a person demonstrates sensorineural hearing loss on the hearing test, then they see us almost immediately. That is the internal protocol that we have standardized,’’ Nassiri said. “The level of urgency is not something that is well-known in the general population, and we are trying to get the word out about it.’’

Another detrimental factor is that tinnitus – ringing sound heard in the ears – often accompanies sudden hearing loss, “and that can have a major impact on quality of life. Tinnitus is another diagnosis that we co-manage with the hearing loss,’’ Nassiri said.

When people don’t recover their hearing, they can consider a hearing aid or a cochlear implant, depending on the level of hearing loss.

Fortunately, Strunk’s hearing has been restored. He is more than grateful for the coordination of care between Changstrom and Nassiri.

“I’m really glad that his hearing issues resolved,’’ Changstrom said.

For Strunk, there’s nothing better than hearing the sound of his sons’ voices as they banter back and forth while cooking a nice meal.

No matter what they are making, the question Strunk knows he’ll always hear: “Dad, when is going to be time to eat?’’