Near-complete hearing recovery more than 20 months after total-deafness sudden sensorineural hearing loss

Abstract

Recovery after total-deafness or high-frequency sudden sensorineural hearing loss (SSNHL) is generally expected to occur, if at all, during the early postonset period. We report the case of a 21-year-old male patient with unilateral SSNHL presenting as right-sided total deafness (anacusis), followed by early low- and mid-frequency recovery, persistent high-frequency loss, and near-complete hearing recovery more than 20 months after onset. Retrospective history revealed cold-triggered headaches relieved by sleep, sleep disturbance, tinnitus fluctuation, and stress sensitivity. This long-delayed near-complete recovery challenges the assumption that persistent high-frequency loss after total-deafness SSNHL necessarily represents irreversible hair-cell loss. It supports prolonged audiometric follow-up and counseling that selected patients with fluctuating cochlear symptoms may retain a reversible component mediated by migraine-related vascular dysregulation, ion/fluid homeostasis, or stria vascularis dysfunction.