"Since sudden hearing loss is probably due to cochlear ischemia"

It was advised to not prescribe routinely intravenous thrombolysis for treatment of sudden hearing loss. Please, you would read this clinical guideline of sudden hearing loss management. 

http://oto.sagepub.com/content/146/3_suppl/S1.full.pdf

Thank you for your answer. Actually, the reference you quoted states that "no data support the use of thrombolytics, ... in the treatment of SSNHL.". Absence of evidence does not mean evidence of absence. The treatment is not demonstrated to be useful, it has not been demonstrated to be ineffecive... I wonder if a randomized, controlled study of rt-PA within a couple of hours from sudden hearing loss may be done... What do you think?

Sudden hearing loss is secondary to different causes and cochlear ischemia due to thrombosis is uncommon. I agree with you ". Absence of evidence does not mean evidence of absence." To prove the efficacy of intravenous thrombolysis, performing a controlled study selecting a good number of  patients with Sudden hearing loss secondary to cochlear ischemia due to thrombosis, is the evidence based answer. IV thrombolytic  would be given to all patients (applying the same protocol regarding onset, dose/kg & duration). Comparison may be done into another same equal group treated by IV corticotherapy. Limitation of this study will be due to rarity of cases & how can be selected (what is the tool of confirming the cause of sudden hearing loss is due to cochlear ischemia secondary to thrombosis? can we consider the diagnosis by exclusion? I do not think so.   

Actually, the cause(s) of sudden hearing loss is (are) very poorly understood. Given that, it seems to me not at all unreasonable to assume that a substantial part of them is caused by vascular accident. In fact, in all organs sudden onset is the hallmark of ischemia. Given that, one could carry out a study of thrombolytic+regular therapy vs. regular therapy alone in all cases of sudden deafness within 3 hours from onset. Even if we don't know the precise diagnosis in all cases, if vascular origin was indeed frequent and if thrombolysis was indeed effective one could expect a better outcome in the treated group. Number of patients should not be a problem if we carried out a multicentric, international study. What do you think?

 Last case of sudden hearing loss, seen recently in my clinic 1 month post-onset due to late referral to ENT clinic was few months ago.  Another case of sudden hearing loss seen in my clinic 1 day post-onset was 2-3 years ago.  Rarity of cases is a limitation. If you would send to me your proposal of an international multicentric study, i can present to otology team in the department i worked in to overcome rarity of cases. If the otology team accepted the proposal, i will arrange cooperation with you to realize our shared topic, sharing all otology team & their cases. Please, you would check your researchegate inbox to find my own e-mail for future corresponding regarding the proposal of international multicentric study. 

Sudden deafness is hypothesized to occur because of occlusion of the internal auditory artery (cf. Neurology. 1999;52(1):40-4; Semin Neurol 2009; 29(5): 534-540). Thus, in at least some of the cases thrombolysis should be useful.

Sudden hearing loss in toto is uncommon & so sudden hearing loss due to internal auditory artery occlusion is rare.

Still, if it happened to me I would greatly appreciate having a cure...

I agree with you Maurizio. It is an interesting topic for future research to realize the optimal management of such cases.