For rheumatologists, perhaps one of his biggest take-home points is this: “It’s not an emergency,” Dr. Rubinstein says. “When we treat sudden hearing loss, the thinking is that if we don’t treat it within a few weeks of onset, we lose our treatment window. That’s not true for autoimmune disease. I’ve seen people months after the onset of their hearing loss who still respond to treatment. So it’s not a ‘drop everything’ emergency where you don’t really have time to think about what you’re doing.”
That advice diverges from most rheumatological models of nerve dysfunction, such as vision loss in giant cell arteritis (GCA) and mononeuritis in vasculitis, in which tissue ischemia leads to rapid and irreversible nerve damage. Dr. Rubinstein can’t say how the underlying inflammatory lesion of autoimmune SNHL might differ from those rheumatological conditions. Nevertheless, he says the expanded treatment window can allow rheumatologists to fully consider their approach.
“You have plenty of time to make a referral. It’s not an emergency, and it’s really easy to hurt people,” Dr. Rubinstein says. “These drugs are not benign.”
Bryn Nelson, PhD, is a medical journalist based in Seattle.
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