Can Sleep Apnea Cause Nerve Deafness?

More than a handful of times, whenever someone comes to me with sudden hearing loss on one ear, there’s usually a precipitating event, such as an infection, stressful event, or trauma. Here’s a sequence of events where an underlying sleep-breathing problem clearly caused hearing loss.

A middle aged man with known severe hearing loss in both ears came to see me with sudden worsened hearing loss in his left ear 4 weeks ago. He normally uses hearing aids, but now he can’t understands people as well, even with his hearing aid. It turns out that exactly 4 weeks ago, while lifting something from his driveway, he pulled his back, with resulting severe back pain. He went to see his doctor, who prescribed a strong narcotic, which didn’t help that much. He’s usually a stomach sleeper, but due to his back pain, he had to sleep on his back. The night after he took his pain medication, he woke up and noticed his hearing loss on his left ear. His recent hearing test showed significantly diminished hearing in his left ear.

When I examined him, he had the classic anatomy of someone who has obstructive sleep apnea: small jaws, high arched hard palate, and very narrow posterior airway space (space behind the tongue), especially when on his back. All throughout his life, he naturally preferred to sleep on his stomach, but when suddenly forced to sleep on his back, wasn’t able to sleep efficiently (due to gravity’s effect on his tongue). But when he took his pain medication, his muscles relaxed even further, and he probably stopped breathing much more often. This caused a major and sudden stress response which probably caused either major inflammation or a mini-stroke in his inner ear blood vessels. Studies have shown that the area in the brainstem that controls the ear, as well as blood vessels that supply the inner ear are much more susceptible to damage. In particular, the area that’s responsible for the high frequencies is more prone to injury.

His exam only reinforced my observation that people who suffer from sudden nerve deafness all have very similar upper airway breathing passageways.

The traditional thing to do in this situation is to give oral steroids, but since it’s been about 4 weeks, the evidence for improving his condition is poor. Instead, I ordered a formal sleep study.

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