Q: I am 36 years old and recently lost my sense of hearing in my right ear. I had an MRI, which was negative. I also underwent blood tests. The only abnormality was an elevated white blood count and an elevated sedimentation rate. My ENT says its idiopathic hearing loss. He says that I have nerve damage and my hearing may or may not come back. I do have chronic idiopathic thrombocytopaenia purpura. Could this have caused hearing loss?

A:The ear is divided anatomically into three sections (external, middle, and inner), and hearing loss may be due to a disease affecting one or more sections. Hearing loss can be categorized as conductive, sensorineural, or both. Conductive hearing loss is when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear. Conductive hearing loss usually involves a reduction in sound level, or the ability to hear faint sounds. This type of hearing loss can often be medically or surgically corrected. Leading causes of conductive hearing loss due to problems in external ear include cerumen (wax) or foreign body impaction, otitis externa (infection of the skin of the external auditory canal) and benign bony growths of the external auditory canal. Middle ear diseases causing conductive deafness are otitis media and trauma, otosclerosis (abnormal bone deposition at the footplate) and rare tumours. Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain. This type of hearing loss cannot be medically or surgically corrected and is a permanent loss. The defect not only involves a reduction in sound level, or ability to hear faint sounds, but also affects speech understanding, or ability to hear clearly. Common causes are inherited disorders and noise exposure but diseases, birth injury, viruses, head trauma, drugs that are toxic to the auditory system, tumours and genetic syndromes too can cause it. Sudden sensorineural hearing loss is one of the most perplexing and controversial area in otolaryngology. One useful definition is an idiopathic (no known cause) hearing loss of sensorineural origin, greater than 30 dB in three contiguous frequencies that occurs in less than three days. Most patients report onset of hearing loss within minutes to several hours. Sudden hearing loss is most likely a symptom rather than a discrete disease, merely representing the end result of many insults to the inner ear. Known causes include multiple sclerosis, Cogan's syndrome, Buerger's disease, macroglobulinaemia, leukaemia, sickle cell disease, polycythaemia, syphilis, bacterial infection, mumps, ototoxic drugs, metastatic tumours, trauma, and lupus. The mechanism remains unknown but it is postulated that viral, vascular, membrane rupture, and auto-immune mechanisms may be responsible. Given the lack of understanding of the cause(s), treatment is empirical and the most commonly used treatment is vasodilator therapy while steroids benefit selected patients. Other treatment regimens have included diuretics, anticoagulants, plasma expanders, and diatrizoate meglumine, or Hypaque, an intravenous contrast dye. Controlled studies have not been performed to show a benefit from any of them. Thrombocytopaenia can be a cause for hearing loss as a part of syndromic hearing loss - that is, hearing loss in association with other congenital or genetic abnormalities. You need to discuss with your doctor and perhaps take another opinion.