Rapidly progressive hearing loss occurring over weeks: review of differential diagnoses

Background Sudden hearing loss, or progressive hearing loss occurring over months to years, are well-established presentations. However, little is described in the medical literature on how to approach patients presenting with a rapidly progressive hearing loss occurring over weeks. This study aimed to evaluate the clinical significance of patients presenting with rapidly progressive hearing loss. Methods A case of rapidly progressive hearing loss occurring over 12 weeks is presented. A PubMed literature review was performed to determine the evidence-based differential diagnoses for rapidly progressive hearing loss. Results Fifteen causes were identified for rapidly progressive hearing loss: intracranial aetiologies (meningioma, lymphoma, metastatic deposit, cavernous angioma, meningitis, superficial siderosis); paraneoplastic syndrome (small cell lung carcinoma, thymoma); inflammatory or autoimmune disorders (autoimmune inner-ear disease, sarcoidosis, vasculitis, Sjogren's syndrome); infective disorders (syphilis, human immunodeficiency virus); and medication-induced causes. Conclusion Rapidly progressive hearing loss should be considered a 'red flag' symptom that warrants urgent action. Most causes are systemic or sinister in nature, and the patient's hearing loss can potentially be reversed.