SSHL when they wake up in the morning. Others first notice it when they try to use the deafened ear, such as when they use a phone. Still others notice a loud, alarming "pop" just before their hearing disappears. People with sudden deafness often become dizzy, have ringing in their ears (tinnitus), or both. Diagnosis SSHL is diagnosed via pure tone audiometry. If the test shows a loss of at least 30 dB in three adjacent frequencies, the hearing loss is diagnosed as SSHL. For example, a hearing loss of 30 dB would make conversational speech sound more like a whisper. Causes Only 10 to 15 percent of the cases diagnosed as SSHL have an identifiable cause. Most cases are classified as idiopathic, also called sudden idiopathic hearing loss (SIHL) and idiopathic sudden sensorineural hearing loss (ISSHL or ISSNHL) The majority of evidence points to some type of inflammation in the inner ear as the most common cause of SSNHL. Viral – The swelling may be due to a virus. A herpes type virus is believed to be the most common cause of sudden sensorineural hearing loss. The herpes virus lies dormant in our bodies and reactivates for an unknown reason. Vascular ischemia of the inner ear or cranial nerve VIII (CN8) Perilymph fistula, usually due to a rupture of the round or oval windows and the leakage of perilymph. The patient will usually also experience vertigo or imbalance. A history of trauma is usually present and changes to hearing or vertigo occur with alteration in intracranial pressure such as with straining; lifting, blowing etc. Autoimmune – can be due to an autoimmune illness such as systemic lupus erythematosus, granulomatosis with polyangiitis Treatment Hearing loss completely recovers in around 35-39% of patients with SSNHL, usually within one to two weeks from onset. Eighty-five percent of those who receive treatment from an otolaryngologist (sometimes called an ENT surgeon) will recover some of their hearing. vitamins and antioxidants vasodilators betahistine (Betaserc), an anti-vertigo drug hyperbaric oxygen rheologic agents that reduce blood viscosity (such as hydroxyethyl starch, dextran and pentoxifylline) anti-inflammatory agents, primarily oral corticosteroids (such as prednisone and dexamethasone) Intratympanic administration – Gel formulations are under investigation to provide more consistent drug delivery to the inner ear. Local drug delivery can be accomplished through intratympanic administration, a minimally invasive procedure where the ear drum is anesthetized and a drug is administered into