International consensus (ICON) on treatment of sudden sensorineural hearing loss

The Role of Nrf2 in Hearing Loss

Hearing loss is a major unresolved problem in the world, which has brought a heavy burden to society, economy, and families. Hair cell damage and loss mediated by oxidative stress are considered to be important causes of hearing loss. The nuclear factor erythroid 2–related factor 2 (Nrf2) is a major regulator of antioxidant capacity and is involved in the occurrence and development of a series of toxic and chronic diseases associated with oxidative stress. In recent years, studies on the correlation between hearing loss and Nrf2 target have continuously broadened our knowledge, and Nrf2 has become a new strategic target for the development and reuse of hearing protection drugs. This review summarized the correlation of Nrf2 in various types of hearing loss, and the role of drugs in hearing protection through Nrf2 from the literature.

Correlation between serum lipid and prognosis of idiopathic sudden sensorineural hearing loss: a prospective cohort study

BACKGROUND

To investigate the correlation between blood lipids and the prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL).

METHODS

We included 232 patients with ISSNHL at the Second Affiliated Hospital of Shanghai University from June 2015 to March 2017 using a prospective cohort study design. We collected information including age, gender, hypertension, diabetes, mellitus, vertigo, as well as the levels of blood total cholesterol (TC), triglycerides (TG), and low-density lipoproteins (LDL-C). We also recorded the ratio between the levels of low-density lipoproteins and the levels of high-density lipoproteins (LDL-C/HDL-C ratio). Correlations between the prognosis of ISSNHL and TC, TG, LDL-C, and LDL-C/HDL-C ratio were analyzed by univariable and multivariable logistic regression analyses.

RESULTS

The clinical effectiveness rate of patients with TC ranging from 5.2 to 6.2 mmol/L was significantly higher than that of patients with TC <5.2 mmol/L (P<0.001). No notable difference was found between patients with TC <5.2 mmol/L and patients with TC ≥6.2 mmol/L. The clinical effectiveness rate of patients in TG ranging from 1.7 mmol/L to 2.3 mmol/L was markedly higher than those in TG <1.7 mmol/L (P<0.001). No significant difference was found between patients with TG ranging from 2.3 to 5.6 mmol/L, TG ≥5.6 mmol/L, and TG <1.7 mmol/L. The clinical effectiveness rate of patients in LDL-C/HDL-C <1.5 was considerably higher than those in LDL-C/HDL-C ranging from 1.5 to 2.5, 2.5 to 3.5, and ≥3.5 (P<0.001).

CONCLUSIONS

Our findings indicated that TC, TG, and the LDL-C/HDL-C ratio are strongly associated with the prognosis of ISSNHL. These three indices could be recommended as independent markers to predict outcomes.

Intratympanic Triamcinolone Acetonide as a Salvage Treatment for Idiopathic Sudden Sensorineural Hearing Loss

INTRODUCTION

Intratympanic steroid (ITS) injections represent an increasingly used salvage treatment option for patients with idiopathic sudden sensorineural hearing loss -(ISSHL) after systemic treatment. The most effective corticosteroid for this treatment modality still remains unclear. Triamcinolone acetonide has been used for ITS treatment in various clinical settings. However, there are limited clinical data of its usage in the therapeutic management of ISSHL. The aim of this study was to determine the efficacy of intratympanic triamcinolone acetonide injections as a salvage treatment for ISSHL.

METHODS

We conducted a retrospective chart review on patients affected by ISSHL with insufficient hearing recovery after primary systemic corticosteroid therapy and who were treated with intratympanic triamcinolone acetonide as a salvage therapy between January 2014 and August 2019. The patients were divided into groups according to their degree of hearing recovery, and we evaluated potential predictors of hearing recovery. Audiometric results were then compared to historic studies using dexamethasone or methylprednisolone.

RESULTS

One-hundred and fifty-two patients received up to 3 intratympanic injections with triamcinolone acetonide at 1-week intervals. The mean hearing improvement due to ITS salvage treatment was 15.9 ± 18.9 dB. Complete hearing recovery was noted in 15 patients (9.9%), while 73 patients (48%) obtained partial recovery, and 64 patients (42.1%) had no recovery. Primary systemic treatment delay, hearing improvement by primary systemic treatment, and severity of initial hearing loss were identified as significant predictors of hearing improvement. The first of the 3 injections resulted in the greatest hearing improvement.

CONCLUSION

The use of triamcinolone acetonide in ITS salvage treatment resulted in similar hearing improvements as the use of the commonly used corticosteroids, namely, dexamethasone and methylprednisolone. Longer treatment delays, lower hearing improvement by primary systemic treatment, and higher initial hearing loss are associated with poorer prognoses of hearing recovery.

Association between Sudden Sensorineural Hearing Loss and Lyme Disease

Objectives: Sudden sensorineural hearing loss (SSNHL) is defined as sensorineural hearing loss of 30 dB or more over at least three adjacent audiometric frequencies occurring within a 72-h period of time. One of the causes of SSNHL could be the progressive inflammatory state caused by an infection. The aim of this study was to assess the prevalence of SSNHL caused by various factors, most importantly those potentially related to Lyme disease. Material and Methods: The study includes a group of 86 patients between the ages of 20 and 70 who were hospitalized due to SSNHL between 2017 and 2018. All of these patients underwent a detailed medical interview and an otolaryngological examination, including audiological and diagnostic tests. Additionally, ELISA and Western blot tests were performed to confirm the diagnosis of Lyme disease. Results: In this group of 86 patients, nine patients presented with positive antibodies toward Borrelia burgdorferi sensu lato. This group was treated with antibiotics and experienced partial or complete regression of their deafness. This may suggest a relationship between SSNHL and Lyme disease. Conclusion: Infections caused by Borrelia burgdorferi may contribute to the development of inflammatory and angiopathic lesions, which are a possible cause of SSNHL. The longer the duration of the infection, the greater the likelihood of permanent and irreversible changes in the vessels of the cochlea or auditory nerve. Therefore, serological tests for Borrelia burgdorferi should be performed during the diagnosis of SSNHL as a possible cause of this illness.

Comparison of two different intratympanic corticosteroid injection protocols as salvage treatments for idiopathic sudden sensorineural hearing loss

PURPOSE

We aimed to investigate the effect of interval length and total count of intratympanic steroid (ITS) injections in salvage treatment of patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

METHODS

This retrospective case-control study included 64 patients with ISSNHL, who were treated with ITS injections as salvage therapy at a tertiary referral centre. From September 2019 to December 2020, 32 patients received up to four injections every 2-4 days (revised-protocol group). These patients were 1:1 matched to patients, who received up to three injections at 1-week intervals between January 2014 and August 2019 (initial-protocol group). Hearing outcomes of the two groups were compared.

RESULTS

Both ITS salvage treatment protocols resulted in a statistically significant hearing improvement (p < 0.05). The initial-protocol declined hearing thresholds by 12 ± 11.7 dB (p < 0.001, d = 1, P = 99%). Mean hearing function was improved by 13.4 ± 19.1 dB in the revised-protocol group [p < 0.001, d = 0.7, P = 98%]. A clinically significant hearing improvement (> 10 dB) was seen in 18 patients (58.1%) in the initial-protocol group and in 14 patients (41.9%) in the revised-protocol group. A comparison of the hearing outcomes between protocol groups revealed no statistically significant differences (p > 0.05).

CONCLUSION

These results indicate that a shorter injection interval does not lead to better hearing outcomes in ITS salvage treatment for ISSNHL. Moreover, fewer ITS injections may reduce costs, physical/mental stress of the patients and lower the risk of persistent tympanic perforations.

Intratympanic vs Systemic Corticosteroids in First-line Treatment of Idiopathic Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis

Importance

To our knowledge, evidence-based recommendations on the intratympanic vs systemic administration of corticosteroids for the treatment of idiopathic sudden sensorineural hearing loss remain unestablished, and contradictory conclusions have been reported in previous meta-analyses.

Objective

To compare recovery from idiopathic sudden sensorineural hearing loss based on systemic, intratympanic, or a combined treatment with corticosteroids as first-line treatment.

Data Sources

We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We searched PubMed, Embase, OvidSP, CINAHL, and Cochrane Library from January 1, 1966, to July 1, 2018. This study was registered in the International Prospective Register of Systematic Reviews (CRD42018109314).

Study Selection

We included randomized studies. Included studies must have excluded identifiable causes. Corticosteroids must have been administered solitarily. We excluded studies that did not define hearing loss as a minimum 30 dB within 72 hours.

Data Extraction and Synthesis

We identified 170 titles, of which 56 (32.9%) were eligible for full-text screening. We independently extracted data. We applied a fixed-effects model to investigate our objectives.

Main Outcomes and Measure

We aimed to (1) estimate the difference in mean pure tone average (PTA) gain in decibels from intratympanic treatment vs systemic treatment and (2) investigate odds ratios for recovery between the different treatment groups.

Results

We included 7 eligible studies. A total of 710 patients were allocated to receive either intratympanic treatment (IT group, 235 [33%]), systemic treatment (ST group; 325 [46%]) or combined intratympanic and systemic treatment (CB group; 150 [21%]). The PTA was measured by taking the mean of 4 frequencies: 4 studies measured at 500, 1000, 2000, and 3000 Hz and 3 studies measured at 500, 1000, 2000, and 4000 Hz. The ST group had a 2.01-dB higher PTA gain (95% CI, -5.61 dB to 1.59 dB; P = .96; I2 = 0%) compared with the IT group and the odds for achieving complete recovery was not significantly different at an odds ratio of 0.94 (95% CI, 0.61 to 1.44; P = .19; I2 = 34.5%). For the CB group vs the ST group, the odds ratio was 1.11 (95% CI, 0.68 to 1.82; P = .75; I2 = 0%). The analysis of the CB group vs IT group comprised only 2 studies.

Conclusions and Relevance

This study does not suggest that corticosteroid delivered intratympanically is more beneficial than systemic treatment in the case of moderate to severe idiopathic sudden sensorineural hearing loss. There were no indications that combined treatment was associated with improved hearing outcomes compared with either systemic or intratympanic treatment.

Postauricular injection glucocorticoid in the treatment of sudden hearing loss: A protocol for systematic review and meta-analysis

BACKGROUND

Sudden hearing loss is an emergency health problem in the Department of Otolaryngology that must be treated in a timely manner, or may cause lifelong regrets. The application of postauricular injection of glucocorticoid is a popular treatment to recover patients hearing level in recent years. However, the effectiveness and safety of postauricular injection of glucocorticoid needs to be assessed systematically.

METHODS AND ANALYSIS

The purpose of the study is to undertake a systematic review and meta-analysis on the effectiveness and safety of postauricular injection of glucocorticoid to treat patient diagnosed with sudden hearing loss. We will search the following databases from the date of publication to July 1, 2020: PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, Wanfang databases, the Chinese Biomedical Literature Database (CBM), the Chinese Science and Technology Periodical Database (VIP) and the Chinese Cochrane Centre's Clinical Trial Registry Platform. Observational studies regarding the association between postauricular injection of glucocorticoid and sudden hearing loss were written in English and Chinese were included. RevManV.5.3 software will be used for meta-analysis. According to the heterogeneity of the research results, fixed effects model, random effects model, subgroup analysis, sensitivity analysis, and others will be used. Ethics approval was not required for this protocol. The findings will be disseminated through journal articles and conference presentations.

RESULTS

Objectively, evaluate the efficacy and safety of postauricular injection of glucocorticoid for sudden hearing loss.

CONCLUSION

To provide evidence-based medicine for glucocorticoid treatment methods in patients with sudden hearing loss.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/N5RV3.

Hyperbaric Oxygenation as Adjunctive Therapy in the Treatment of Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss seems to become a serious social health problem in modern societies. According to the World Health Organization (WHO) reports, adult-onset sensorineural hearing loss is found to be one of the leading diseases at the global level, especially in high-income countries, and is foreseen to move up from the 14th to 7th leading cause of the global burden of diseases by the year 2030. Although the direct mortality rate of this disease is very low, its influence on quality of life is huge; that is the reason why the implementation of the most effective and the safest therapies for the patient is crucial for minimizing the risk of complications and adverse reactions to treatment. The aim of this paper is to present hyperbaric oxygen therapy (HBOT) as a medical procedure useful in the treatment of sudden sensorineural hearing loss as adjunctive therapy of high efficacy. This paper focuses on the molecular mechanisms of action and clinical effectiveness of HBOT in the treatment of idiopathic sudden deafness, taking into consideration both the benefits and potential risks of its implementation.

Quality of smoking cessation advice in guidelines of tobacco-related diseases: An updated systematic review

Tobacco smoking is a major risk factor for a wide range of diseases, and smoking cessation significantly reduces these risks. Clinical guidelines for diseases associated with smoking should therefore include guidance on smoking cessation. This review updated evidence on the proportion of clinical guidelines that do so. We conducted a systematic review investigating clinical guidelines and recommendations developed by UK national or European transnational medical specialty associations and societies between January 2014 and October 2019 on 16 diseases to be at least twice as common among smokers than non-smokers. Outcomes of interest were the reporting of smoking as a risk factor, and the inclusion either of smoking cessation advice or referral to other cessation guidance. We compared our findings with an earlier review of guidelines published between 2000 and 2013. We identified 159 clinical guidelines/recommendations. Over half (51%) made no mention of smoking, while 43% reported smoking as a risk factor for the development of the disease, 31% recommended smoking cessation and 19% provided detailed information on how to deliver smoking cessation support. These proportions were similar to those in our earlier review. Smoking cessation continues to be neglected in clinical management guidance for diseases caused by smoking.

Psychological state of patients with sudden deafness and the effect of psychological intervention on recovery

OBJECTIVE

To determine the effect of personalized psychological interventions on the recovery of patients with sudden deafness.

METHODS

Participants were 438 patients with sudden deafness who were randomly allocated to observation and control groups. Patients in the control group received routine nursing care and drug treatment. Patients in the observation group received personalized psychological interventions, routine nursing care and drug treatment. The Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) were used to measure anxiety and depression. The Simple Coping Style Questionnaire (SCSQ) and the Satisfaction With Life Scale (SWLS) were used to evaluate coping styles, attitude toward life and quality of life.

RESULTS

Patients in both groups had similar SAS and SDS scores at the time of admission. After treatment, there was a significant difference in SAS and SDS scores between the observation and control groups, indicating that the observation group had less anxiety and depression. Both groups had increased SCSQ and SWLS scores following treatment, indicating improvements in positive coping and satisfaction with life.

CONCLUSION

Effective psychological interventions may change negative thoughts, increase response rate and improve quality of life.

Exploratory tympanotomy in sudden sensorineural hearing loss for the identification of a perilymphatic fistula - retrospective analysis and review of the literature

OBJECTIVE

The diagnostic value of exploratory tympanotomy in sudden sensorineural hearing loss remains controversial. This study and review were performed to identify the incidence of perilymphatic fistula in patients with sudden sensorineural hearing loss. The effectiveness of tympanotomy for sealing of the cochlear windows in cases with perilymphatic fistula was evaluated.

METHODS

A search in common databases was performed. Overall, 5034 studies were retrieved. Further, a retrospective analysis on 90 patients was performed.

RESULTS

Eight publications dealing with tympanotomy in patients with sudden sensorineural hearing loss were identified. In 90 patients diagnosed with sudden sensorineural hearing loss and undergoing exploratory tympanotomy, 10 patients (11 per cent) were identified with a perilymphatic fistula, and this corresponds to the results obtained from our review (13.6 per cent).

CONCLUSION

There was no significant improvement after exploratory tympanotomy and sealing of the membranes for patients with a definite perilymphatic fistula.

The use of combined pharmacotherapy and hyperbaric oxygen in the treatment of sudden sensorineural hearing loss

Aim: Sudden sensorineural hearing loss (SSNHL) involves acute unexplained hearing loss, nearly always one-sided of 30dB or greater over at least three contiguous audiometric frequencies. The aetiology of SSNHL is mostly unknown. According to the literature, the causes include vascular, microbial and autoimmune problems. There is still no agreed standard treatment. The aim of the paper was to evaluate the results of combined pharmacotherapy and hyperbaric oxygen therapy in patients with idiopathic sudden deafness. Material/Methods: The study was carried out on 40 patients with SSNHL. The patients were divided into two groups: group I – 24 patients treated with the combined pharmacotherapy and hyperbaric oxygen therapy and group II – 16 patients treated only pharmacologically. The patients from Group 1 were treated in the Centre of Hyperbaric Therapy CREATOR Ltd. in Lodz, Poland. Each patient underwent 15 sessions in a hyperbaric chamber. In all patients, the percentage of hearing loss for the selected frequencies was assessed before and after the therapy according to Sabine and Fowler. Results: The group of 40 patie nts aged from 33 to 77 years (mean 52.4) included 21 females and 19 males. Group I consisted of 24 patients, 11 females and 13 males, group II consisted of 16 patients, 10 females, and 6 males. After therapy, the mean hearing level in all patients improved by 27.14%, in Group I – by 34.34%, in Group II – by 16.3%. Conclusions: Early hyperbaric oxygen therapy combined with steroid therapy improves prognosis and shows good results in sudden hearing loss treatment.

Research progress in refractory sudden hearing loss: steroid therapy

Sudden sensorineural hearing loss (SSNHL) is a common condition with a rapid onset, and its worldwide frequency is increasing each year. Importantly, a significant number of patients with SSNHL do not respond to initial treatment, which is termed refractory sudden hearing loss (RSHL), and further treatment is not standardized in terms of type, duration, administration route, and concentration of topical steroid therapy. Dexamethasone and methylprednisolone are effective in treating RSHL, and salvage treatment typically consists of 2 weeks of steroid therapy followed by 3–6 months of follow-up. Near-continual steroid perfusion appears to be more effective than intermittent steroid injection. Furthermore, several novel therapeutic regimens have shown promising results in small-scale studies. However, the optimum treatment needs to be confirmed in larger randomized controlled trials.

Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss

INTRODUCTION

Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden, unexplained unilateral hearing loss.

OBJECTIVES

To update the Spanish Consensus on the diagnosis, treatment and follow-up of ISSNHL.

MATERIAL AND METHODS

After a systematic review of the literature from 1966 to March 2018, on MESH terms «(acute or sudden) hearing loss or deafness», a third update was performed, including 1508 relevant papers.

RESULTS

Regarding diagnosis, 11ISSNHL is clinically suspected, the following diagnostic tests are mandatory: otoscopy, acumetry, tonal audiometry, speech audiometry, and tympanometry, to discount conductive causes. After clinical diagnosis has been established, and before treatment is started, a full analysis should be performed. An MRI should then be requested, ideally performed during the first 15 days after diagnosis, to discount specific causes and to help to understand the physiopathological mechanisms in each case. Although treatment is very controversial, due to its effect on quality of life after ISSNHL and the few rare adverse effects associated with short-term steroid treatment, this consensus recommends that all patients should be treated with steroids, orally and/or intratympanically, depending on each patient. In the event of failure of systemic steroids, intratympanic rescue is also recommended. Follow-up should be at day 7, and after 12 months.

CONCLUSION

By consensus, results after treatment should be reported as absolute decibels recovered in pure tonal audiometry and as improvement in speech audiometry.

Prognostic factors regarding the hearing outcome in severe to profound sudden sensorineural hearing loss treated by tympanotomy and sealing of labyrinthine windows after ineffective systemic corticosteroid application

PURPOSE

Tympanotomy and sealing of labyrinthine membranes has become in some centers used to treat severe to profound sudden sensorineural hearing loss refractory to conservative treatment. The aim of this retrospective study was to determine which preoperative factors influence the likelihood of postoperative recovery according to different audiological assessment criteria.

METHODS

The mean final hearing threshold, the hearing improvement, the probability of a complete recovery according to two different classifications, and probability of a significant recovery of 136 adult subjects were studied by univariate and multivariate analyses.

RESULTS

The subject's mean postoperative 4-pure-tone-average was 63.9 ± 35.9 dB, the mean improvement was 42.8 ± 32.6 dB. Depending on the classification system used, 18.4-28.0% of subjects experienced a complete recovery. 77.2% of subjects had a significant hearing improvement. History of a pressure change (odds ratio (OR):4.6) was the only positive prognostic factor for hearing improvement. It also enhanced probability of experiencing a complete hearing recovery (OR: 2.8-6.3). Preoperative total deafness (OR: 1.5-1.9) and vertigo (OR: 3.3-4.6) were negative prognostic factors for the mean final hearing threshold and the probability of a complete hearing recovery. Patients with a preceding pressure change event achieved a complete recovery in 45.5-50.0%, those without such an event recovered completely only in 13.2-23.7%.

CONCLUSION

Evaluating prognostic factors and the rate of complete hearing recovery are influenced by the underlying assessment parameters. In addition to the mean postoperative hearing threshold and hearing gain, the probability of regaining a serviceable hearing is clinically important for the individual and should be added to the assessment criteria in future studies.