Successful treatment of sudden hearing loss in Cogan's syndrome with corticosteroids

Cogan's syndrome (CS) is the association of acute nonsyphilitic interstitial keratitis and acute episodes of vertigo, tinnitus, and hearing loss. We have prospectively followed 6 patients with CS who were treated within 4 weeks after the acute onset of hearing loss. Within 1 to 2 weeks after the initiation of corticosteroid therapy, all 6 patients demonstrated improved hearing thresholds for pure tones and supra-threshold speech discrimination results. These patients have been followed an average of 2.5 years (range 0.25-9 years); all have only mild to moderate hearing impairment in the mid (1,000 to 2,000 Hz) and low (250 to 500 Hz) frequency sound ranges. Three of the patients have been tapered off steroids completely with no subsequent permanent decrement of hearing. Thus, early oral corticosteroid administration to patients with sudden hearing loss associated with Cogan's syndrome may preserve auditory function.

[Efficacy of mannitol in certain cases of perception deafness (author's transl)]

The efficacy of perfusion with Mannitol in certain cases of perception deafness, even when they are longstanding, encourages the possibility of using this treatment even though we cannot yet predict the results.

[The effect of Urografin on sensorineural deafness. A clinical study (author's transl)]

Prof. Morimitsu (Fukuoka, Japan) reported a case of hearing improvement after the intravenous administration of Urografin in 1976. Because we had a similar case, injected 10 ml of Urografin (76%) intravenously in 130 patients with sensorineural deafness and tinnitus, which had not improved with previous treatment consisting of vasodilators and stellate ganglion blocks. 21 patients had a hearing improvement after Urografin-therapy; the tinnitus disappeared in 8 cases, and 2 patients noticed an improvement of their hearing and tinnitus. No adverse reactions to these injections, except for one case with a mild cutaneous allergy, were observed. The data did not reveal any particular clinical or audiological criteria which indicated a favourable prognosis with Urografin-therapy.

Otosclerosis-past and present

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[Betahistine treatment of Menière's disease (author's transl)]

An evaluation of Betahistine hydrochloride treatment of 92 patients suffering from Menière disease and Menière-like syndrom is presented. Observed for more than one year 54 (89%) patients showed complete relief of vertigo-attack symptoms. 7 (12%) patients showed a distinct improvement in their hearing as reflected in their audiograms, only 7 (12%) patients showed a further loss of hearing. There appeared to be a trend toward further improvement when therapy was maintained over at least a period of 3--4 month. Vertigo seemed to be the symptom most responsive to treatment and tinnitus the most resistant. Minimal side effects were observed in 17 (18%) patients.

Osmotic treatment of cochleopathies other than Menière's disease

The effect of osmotic treatment on cases with fluctuating sensorineural hearing loss other than Menière's disease is described in this paper. Complete normalization of the hearing threshold has been obtained in eight patients suffering from cochlear hydrops (one case), sensorineural concussion deafness (five cases), temporary noise threshold shift (one case), sudden deafness (two cases). Relief of tinnitus has been observed in a case of post-stapedectomy deafness. The audiometric pattern of end organ disease in a case of cohlear otosclerosis showed a change into a classical otosclerosis audiograph after glycerol administration. The action of osmotic drugs on the inner ear is though to be twofold, i.e. reabsorbing hydrops and normalizing rheological alterations. Therefore, an osmotic treatment is indicated for menieric and non-menieric hydrops and for microcirculatory impairment of the labyrinth. On the basis of these statements the glycerol test for the diagnosis of Menière's disease is called into doubt as not being absolutely specific.

[Sudden deafness: the audiometric profile (author's transl)]

34 cases of unilateral idiopathic sudden deafness were subjected to an intensive audiometrical examination programme. The average hearing loss in percent (calculated on the basis of the pure tone audiogram according to D. Röser, 1973) amounted to 71.6% prior to treatment, the average sound audiogram corresponding to a pantonal hearing defect. The percent gain in audition due to the treatment averaged 24.3%. The pretherapy hearing defect is greater in older patients, and therapy is much less successful in older than in younger patients. If treatment is started within 7 days, it is considerably more successful than in those cases where it is started a long time after the beginning of the disease. This, however, is no proof of the effectiveness of early treatment, but might also be due to the high rate of spontaneous remissions. The final stage of healing or partial recovery is reached, on the average, 20 days after the onset of the illness. In nearly all patients a recruitment was proved to exist; this means that most cases were cochlear hearing defects. The results are compared with the statements contained in medical literature, and an attempt is made to interpret diverging results.

Reversible sudden deafness in early acquired syphilis

Although congenital syphilis is a well established cause of hearing loss, early acquired syphilis is frequently overlooked in the differential diagnosis of sensorineural deafness. This is due, in part, to a decrease in the incidence of syphilis and to the advent of penicillin in previous years which reduced this complication to a clinical rarity. However, with the increase in new cases of syphilis in the past decade, early acquired syphilitic deafness is being seen with increasing frequency. Along with it is the syndrome of early syphilitic meningitis with sudden sensorineural deafness. This potentially reversible condition should be considered in sexually active patients in whom sudden deafness develops. Early diagnosis and treatment are essential for maximum recovery of hearing.

Treatment of sudden deafness with sodium salts of triiodobenzoic acid derivatives

Twenty-two patients with a complaint of sudden deafness were treated with one of the other of two radiopaque contrast media, 9 received daily doses of sodium iothalamate, and 13 were treated similarly with methylglucamine and sodium iodamide. Four of the first group and eight of the second demonstrated either an effective partial or a complete recovery of hearing function. Those failing to respond were generally classified completely deaf at admission and report nausea, vomiting, or vertigo at onset of sudden deafness. Treatment with sodium salts of triiodobenzoic acid derivatives, i.e., sodium iothalamate and methylglucamine and sodium iodamide, is judged to be effective in selected cases of sudden deafness.

Effect of penicillamine on the sensori-neural deafness of retinitis pigmentosa

Four confirmed patients with retinitis pigmentosa and varying degrees of sensori-neural deafness were treated with penicillamine. The results indicated that the deafness improves with the therapy.

Effect of calcitonin treatment on deafness due to Paget's disease of bone

Seventeen patients with Paget's disease of the skull and deafness were followed for nine to 18 months. Patients who received calcitonin treatment showed less deterioration in hearing than untreated patients. Calcitonin treatment may retard the progression of deafness in Paget's disease, and further studies are indicated.

The nystagmus and the therapeutic effects on early-diagnosed cases of sudden deafness

We investigated the hearing prognoses of early diagnosed cases of sudden deafness. We tried to find the most reliable factor to determine the prognosis of hearing loss. Of various possibilities that affect the prognosis; the period of onset to first examination, therapeutic manner and vestibular test findings, the findings of caloric test and spontaneous nystagmus showed much better correlation with the hearing prognosis than others. Thus, we presume the vestibular dysfunction in cases of sudden deafness may reflect the extension and severity of inner ear involvement.

[Vascular problems involving the inner ear (author's transl)]

In this work we deal with so called "sudden deafness" of unknown etiology. By careful study of previous work done by different authors the disease seems to be due to vascular disorders. On this basis we tried a polyvalent therapeutic scheme for the treatment of "sudden deafness" the results of which are given in this paper. Emphasis is given to the fact that the earlier the commencement of treatment the better the result.

[Treatment of acute inner ear deafness (sudden deafness and acoustic trauma) (author's transl)]

The principal facts concerning therapeutic measures in cases of sudden deafness and acoustic trauma are outlined. Experiment data concerning the pharmacology of inner ear circulation are presented. There is sufficient evidence for a critical evaluation of a few treatments whose effect seems to be proven (experimental increase of inner ear circulation in normal animals) or at least possible (in normal animals no or dubious increase; effective under pathological conditions only?). Experimental and clinical experiences concerning the dextran treatment of sudden deafness and acoustic trauma are reported.

[Sympathetic trunk treatment or infusion therapy in cases of sudden deafness (author's transl)]

The optimal criterion for registering the result of a sudden-deafness-therapy is a class interval of 25 dB in the audiogram, followed by punctal evaluation of the mean value of the frequencies 0,5/1/2/4/8 kc/sec. Blocking of the sympathetic trunk, as well as infusions using low-molecular dextranes or derivatives of nicotnic acid, furthermore strictly oral treatment as well as combinations of all these, all lead to a statistically proved recovery of hearing. The extent of improvement is ascertainbly smaller with strictly oral treatment than with blocking the sympathetic trunk or with infusions. Hearing is slightly more improved by blocking the sympathetic trunk than by infusional treatment. Statistically however, the difference is not significant. Low-molecular dextran (Rheomakrodex) is not superior to Xantinol-Nicotinate (Complamin). Future investigations in the assessment of therapeutical results should exclusively evaluate unilateral sudden deafness and include the intact second ear into the computation.

[Sudden deafness in connection with mumps (author's transl)]

The authors report three cases of sudden deafness due to mumps. On the first and second case (children) the deafness was severe perceptive and bilateral; in the first case the perceptive deafness occurred on the eight day while in the second case the forteenth day from the onset of mumps. On the third case (male adult) the deafness was unilateral, sudden with degeneration of vestibular, which occurred during virumia of mumps. The characteristic of this case is that the total deafness of right ear is associated with right parotitis and right orchitis. According to bibliography the pathogenesis, the time of deafness, appearance and the degree of hearing loss are discussed.

[The treatment of sudden deafness and Menière's disease with papaverin and low molecular weight dextran (author's transl)]

This study is concerned with the mean hearing gain in 50 cases of sudden deafness and 40 cases of Menière's disease treated with different drugs and treated with Papaverin and low molecular weight dextran. The treatment of sudden deafness with Papaverin and low molecular dextran was more effective than different drugs. In cases of Menière's disease the treatment with different drugs was not effective, but Papaverin and low molecular dextran was significantly successful. Finally, it is concluded that treatment according to Spoendlin (1969) with Papaverin and low molecular dextran is superior to different drugs.

[Clinical and experimental use of ATP in internal ear diseases]

Intra-arterial ATP infusions with glucose and hyaluronidase were successful in 267 patients suffering from various inner ear disturbances but particularly in sudden deafness. Good clinical results were noted not only in early-treated but also in later cases. Recently, we have also used ATP with hyperbaric oxygen, being successful in cases which were previously treated without improvement. Investigations in guinea-pigs, using artificial hypoxia as a model for human sudden deafness failed because the patterns are not the same. So long as an increase of ATP in the cochlear cells cannot be demonstrated after the i.a. infusions, only an unspecific mechanism can be held responsible for the undoubted clinical successes.

[Round window membrane pathology in sudden deafness (author's transl)]

Exploration of the middle ear was performed on 15 patients with sudden deafness that had failed to improve after intravenous infusion of Eupaverin and Rheomacrodex. Three patients had abnormalities of the round window membrane, in 2 there was a perilymphatic fistula and in 1 an abnormal bulging of the membrane with no transmission of perilymphatic fluid movement. These 3 patients presented with a history of exertion or stress prior to the onset of symptoms. Surgical closure ofthe 2 fistulae led to improvement of hearing, and perilymphatic decompression in the third patient improved the tinnitus but not the deafness. The possible causes of round window pathology are discussed.

Deafness in sarcoidosis

A case of sarcoidosis and sensori-neural deafness in which the lesion was thought to be cochlear in position is presented and the audiometric findings are discussed in detail. A review of the reported cases shows that sarcoid lesions may involve the hearing mechanism at any point along its neural axis.

[Sudden deafness and virus infection (author's transl)]

A survey of the literature concerning sudden deafness caused by virus infection is followed by a discussion of 46 patients with the history of acute loss of hearing, who were subjected to virological-serological examination. In 9 patients the titre movement of the complement fixation reaction was regarded to imply a viral cause of the acute loss of hearing. This was corroborated in 5 cases by the history of recent viral infection. Pathogenetically, the significance of the viral endolymphatic labyrinthitis was underlined. The success of traditional therapy did not differ from the results in cases of sudden deafness due to factors other than viral disease. In the absence of specific therapy the importance of prophylactic measures is stressed.

[The management of sudden deafness (author's transl)]

The mean hearing gain (125-8,000 Hz) in 46 cases of sudden deafness treated with low molecular weight dextran was found to be significantly greater (20.9 dB) than that obtained in twelve cases treated differently (9.4 dB). These alternate measures of care included stellate ganglion blockade, vasoactive drugs, sodium bicarbonate infusions, and CO2-insufflation. Early diagnosis and treatment are considered to be crucial for successful therapy: the mean hearing gain in those patients who came for dextran treatment later than one week was less than half of the gain that resulted after treatment beginning within the first week. The results obtained conform with the hypothesis of cochlear microcirculation impairment or "sludging" as the prevalent cause of sudden deafness.

[Jervell and Lange-Nielsen syndrome]

A rare case of the congenital cardiological syndrome of Jervell and Lange-Nielsen in a 6-year old boy is analyzed. A literature survey of the clinical picture, treatment of and prognosis in this and related to it the Romano-Ward syndrome is given.

Sudden sensori-neural hearing impairment: a report of 1,220 cases

We reviewed the findings in 1,220 cases of sudden sensori-neural hearing impairment encountered over a nine-year period at the Otologic Medical Group. A thorough neuro-otologic evaluation is indicated in each case. Ten patients had an acoustic tumor. A vasodilator regimen was prescribed in 380 cases and resulted in hearing improvement in 40%. Favorable prognostic findings were a low tone loss and absence of vertigo.

ATP-atp

It has been known for some years that intra-arterial application of ATP as well as the only treatment with hyperbaric Oxygen is able to influence favorably a sudden hearing loss. In this study the combined application of both agents was used optimally. Up to now only few cases could be treated. The three above mentioned patients have shown remarkable results. A patient with a long lasting sensorineural hearing loss is especially interesting and this is the reason why we now publish the results gathered up to now.

Sudden deafness following cardio-pulmonary bypass surgery

A case is presented of sudden deafness following cardio-pulmonary bypass surgery. Microembolism is believed to be the most likely cause as this is common following the use of pump oxygenator systems. There was no response to anticoagulants.

Sudden hearing loss due to diving and its prevention with heparin

Vascular embolic and thrombotic problems postulated to be the cause of inner ear sudden deafness have been reported with decompression sickness also. Decompression sickness has been found to lead to cochlear potential loss in the guinea pig, and these losses are minimized by the prophylactic administration of heparin. Preliminary results show that inner ear hemorrhage may be associated with diving deafness, but plasma protein leakage into the perilymph of the ear may precede the hemorrhage. Inner ear hemorrhage in diving deafness seems to be restricted to the microcirculation. Until we gain a better understanding of the pathophysiology of diving induced deafness, it would be premature to consider agents such as heparin for the treatment of the problem in man.