Sudden sensorineural hearing loss: a review of diagnosis, treatment, and prognosis

Adjuvant Migraine Medications in the Treatment of Sudden Sensorineural Hearing Loss

OBJECTIVES/HYPOTHESIS

To examine the hearing outcomes of patients with sudden sensorineural hearing loss (SSNHL) treated with oral and intratympanic (IT) steroid only or a combination of steroid and migraine treatment. Our hypothesis was that adjuvant migraine medications may improve outcomes in SSNHL.

METHODS

A retrospective chart review at a tertiary otology center was conducted to identify patients with SSNHL who received oral steroid and IT dexamethasone injection(s) with or without migraine medications (a combination of nortriptyline and topiramate).

RESULTS

A total of 47 patients received oral steroid and IT dexamethasone injection(s) only, and 46 patients received oral steroid and IT dexamethasone injection(s) as well as migraine lifestyle changes plus a combination of nortriptyline and topiramate. There were no significant differences in demographics and baseline audiometric data between the two groups. Both groups demonstrated improvements in pure tone average (PTA) and hearing thresholds at 250 Hz and 8000 Hz posttreatment. However, compared to steroid-only group, the adjuvant migraine medications group had significantly greater improvements in hearing thresholds at the lower frequencies (250 Hz, 500 Hz, 1000 Hz). Patients in the latter cohort also had greater improvement in PTA (P = .01) and received fewer IT injections (P = .04) PTA improvement of ≥ 10 dB was observed in 36 patients (78%) in the adjuvant migraine medications group and 22 patients (46%) in the control group (P < .001).

CONCLUSION

In multimodal treatment of SSNHL, supplementing oral and IT steroid with migraine medications may result in greater improvements in lower frequency hearing thresholds and PTA. Furthermore, adjuvant migraine treatment can lead to decrease in number of IT injections, thus reducing procedure-related risks and complications.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:E283-E288, 2021.

Audiological disturbances in patients with primary antiphospholipid syndrome

Background

Antiphospholipid syndrome (APS) is an autoimmune disease of hypercoagulability state in the presence of antibodies against phospholipids. Many neurological deficits related to APS have been described. Sensory neural hearing loss has been described only anecdotally, mostly in case reports. This study investigated a possible association between hearing disorders and APS.

Methods

Seventeen patients (aged 20–80 years) diagnosed with primary APS were evaluated for evidence of hearing disorders. All had otoscopy, full audiometry test, brainstem evoked response audiometry and otoacoustic emissions testing, and completed a questionnaire. Hearing levels were compared to the standard hearing levels of the general population by age group.

Results

Of the 17 APS patients, 10 (age groups 20–29 and 50–59) had significantly reduced hearing levels in all or part of the tested frequencies compared to standard levels. Three patients (age group 60–69) had better hearing levels at low frequencies compared to standard hearing levels.

Conclusion

These findings support the existence of hearing disorders in primary APS.

Investigation of the prognostic role of neutrophil-to-lymphocyte ratio in Idiopathic Sudden Sensorineural Hearing Loss based on propensity score matching: a retrospective observational study

INTRODUCTION

The aetiology, management and prognosis of idiopathic Sdden Sensorineural Hearing Loss (ISSNHL) are still uncertain despite adequate investigation.

OBJECTIVE

We conducted the present study to investigate the possible relationship between the neutrophil-to-lymphocyte ratio (NLR) and the prognosis of ISSNHL based on PSM.

METHODS

This was a retrospective observational study. Data and statistical analyses were performed using the SPSS statistical program (SPSS 19.0). PSM was performed using STATA (15.0).

RESULTS

NLR = 3.42 was the cut-off value. After PSM, 84 pairs of patients were successfully matched. The number of patients in the effective group with the NLR < 3.42 and NLR < 3.42 were significantly different (P < 0.001).

CONCLUSION

The NLR is an inexpensive and reliable index to predict the ISSNHL. We hold the view that the NLR can be a reliable factor for clinical doctors to predict the prognosis in ISSNHL. To further prove that the NLR is a powerful prognostic factor in ISSNHL, larger prospective studies are required in the future.

Effectiveness of Steroid Treatment for Sudden Sensorineural Hearing Loss: A Meta-analysis of Randomized Controlled Trials

Background:

The best way to administer steroids for sudden sensorineural hearing loss (SSHL) is still unclear. The present study was aimed at estimating the efficacy of steroids by intratympanic, systemic, and combined therapy (CT) routes.

Methods:

A systematic literature search was performed from 1950 to October 2019 for randomized controlled trials comparing the use of intratympanic, systemic, and combined steroid therapy for SSHL. The outcomes of recovery rate and pure tone average (PTA) improvement were assessed by random-effects and fixed-effects meta-analysis.

Results:

A total of 20 articles identified from 7 countries were eligible for analysis. Although no significant difference in recovery rate was observed between intratympanic steroid therapy (IST) and systemic steroid therapy (SST), IST did demonstrate better hearing improvement, as evidenced by a higher PTA than SST. Compared with SST, CT comprising IST and SST had significant recovery rate improvement. Patients treated with CT had a significantly higher PTA than those treated with SST. Through subgroup analysis based on the equivalent dose of prednisone, it was shown that CT led to a significantly higher PTA than SST only in the high-dose CT versus high-dose SST groups and moderate-dose CT versus high-dose SST groups.

Conclusion:

Moderate and high dose of CT could accelerate hearing improvement in SSHL.

Vestibular evoked myogenic potentials in the prognosis of sudden hearing loss ‒ a systematic review

INTRODUCTION

Sudden hearing loss is an otorhinolaryngological emergency that often leads to severe damage to the auditory and vestibular function. The vestibular evoked myogenic potential is a test that allows a noninvasive evaluation of the otolithic system function and vestibulospinal and vestibulo-ocular pathways.

OBJECTIVE

To evaluate the importance of vestibular evoked myogenic potential in determining the prognosis of patients with sudden hearing loss.

METHODS

A search for articles published up to December 2018 was performed in the PubMed, Cochrane, VHL and LILACS databases using MeSH descriptors. Retrospective and prospective articles were included containing cervical or ocular vestibular evoked myogenic potential in sudden hearing loss patients and information on associated vertigo and/or dizziness.

RESULTS

Sixteen of 62 initially selected articles met the inclusion criteria and were analyzed. Regarding the methodology of the evaluated studies, 8 studies were prospective, six were retrospective, one contained part of the data from a retrospective analysis and another part from a prospective analysis, and one study was cross-sectional. A total of 872 patients were evaluated (50.22% males and 49.77% females) with a mean age of 51.26 years. Four hundred and twenty-six patients (50.35%) had vertigo and/or dizziness associated with sudden hearing loss. The cervical vestibular evoked myogenic potential was performed in all studies, but only seven assessed the ocular vestibular evoked myogenic potential. The cervical vestibular evoked myogenic potential showed alterations in 38.65% of 846 evaluated ears, whereas ocular vestibular evoked myogenic potential showed alterations in 47.88% of 368 evaluated ears. The hearing recovery rate was analyzed by 8 articles, with 63.4% of 410 evaluated ears showing hearing recovery.

CONCLUSIONS

The studies suggest that the assessment of the vestibular system using vestibular evoked myogenic potential seems to be important in the prognosis of sudden hearing loss. For better follow-up of patients with sudden hearing loss, the emphasis should not be limited to the cochlea, but also include the diagnosis and treatment of vestibular abnormalities, regardless of the presence of vertigo.

Integrating Cupping Therapy in the Management of Sudden Sensorineural Hearing Loss: A Case Report

Sudden sensorineural hearing loss (SSNHL) is most often defined as a rapid hearing loss of ≥ 30 decibels across at least three contiguous audiometric frequencies over a time of ≤ 72 hours. Cupping therapy has been practiced across the world for thousands of years. Cupping therapy is practiced by creating suction inside cups that are placed on predefined skin areas. Our case is a 48-year-old female with a four-year history of Meniere’s disease, recurrent tinnitus, episodes of dizziness attacks, and fullness of the right ear. The patient developed sudden sensorineural hearing loss. She received conventional treatment and wet cupping therapy as a complementary integrative treatment. After the integrative management protocol was completed, pure tone audiometry tests revealed significant hearing improvement across almost all frequencies. To the best of our knowledge, this case presentation is the first reported case of this type. A positive effect of cupping was reported in our case as an integrative complementary treatment. Large, well-designed quality clinical trials to evaluate the efficacy and safety of wet cupping therapy (WCT) as a complementary treatment of SSNHL is highly recommended.

Sphenoid Wing Meningioma Presenting as Sudden Sensorineural Hearing Loss: A Case Report and Literature Review

Sphenoid wing meningiomas are tumors that typically present with vision deterioration and neurological changes due to their proximity to the sella, cavernous sinus, and other vital structures. Some unusual symptoms have also been described in the literature, such as cognitive dysfunction, parkinsonism, and intracerebral hemorrhage. In this report, we detail another unusual case of sphenoid wing meningioma in a 63-year-old female who presented with left sudden sensorineural hearing loss. A brief review of the literature is also included.

5-HT3 Receptor Antagonists in Neurologic and Neuropsychiatric Disorders: The Iceberg Still Lies beneath the Surface

5-HT₃ receptor antagonists, first introduced to the market in the mid-1980s, are proven efficient agents to counteract chemotherapy-induced emesis. Nonetheless, recent investigations have shed light on unappreciated dimensions of this class of compounds in conditions with an immunoinflammatory component as well as in neurologic and psychiatric disorders. The promising findings from multiple studies have unveiled several beneficial effects of these compounds in multiple sclerosis, stroke, Alzheimer disease, and Parkinson disease. Reports continue to uncover important roles for 5-HT₃ receptors in the physiopathology of neuropsychiatric disorders, including depression, anxiety, drug abuse, and schizophrenia. This review addresses the potential of 5-HT₃ receptor antagonists in neurology- and neuropsychiatry-related disorders. The broad therapeutic window and high compliance observed with these agents position them as suitable prototypes for the development of novel pharmacotherapeutics with higher efficacy and fewer adverse effects.

Sudden Sensorineural Hearing Loss in Systemic Lupus Erythematosus and Antiphospholipid Syndrome: A Clinical Review

BACKGROUND

Sudden sensorineural hearing loss (SSNHL) is defined as a sudden loss of hearing, usually unilateral, of more than 30 dB in 3 contiguous frequencies of the tonal audiometry. SSNHL estimates an incidence ranging from 5 to 20 per 100.000 people per year. In approximately 75% of cases, a cause cannot be identified. However, it could be a clinical manifestation of Systemic lupus erythematosus (SLE) and Antiphospholipid Syndrome (APS).

OBJECTIVE

This review will focus on the clinical presentation, diagnosis, and management of the SLE and APS associated SSNHL.

METHODS

We searched in PubMed, Scopus, Lilacs, and Cochrane reviewing reports of Sudden sensorineural hearing loss in SLE and/or APS. Articles written in English and Spanish, and were available in full text, were included.

RESULTS

In patients with SLE, bilateral involvement was frequent. Antiphospholipid antibodies were positive in the majority of the patients. Corticosteroids were the mainstay of the treatment. The auditory prognosis was poor with total hearing loss recovery reached in only 22% of patients. On the other hand, most of the patients with SSNHL and APS were males and presented associated symptoms such as vertigo, tinnitus and/or headache, 75% had bilateral disease. Lupus anticoagulant and aCL were found in equal proportions, all patients were anticoagulated, and aspirin was associated in 25% of the cases. Complete resolution or improvement of symptoms was observed in 25% of the patients.

CONCLUSION

Sudden sensorineural hearing loss, can be a clinical feature of SLE and APS. Treating physicians should be aware of this devastating complication, especially when bilateral involvement occurs.

Outcomes of unilateral idiopathic sudden sensorineural hearing loss: Two decades of experience

OBJECTIVES

(a) Determine the demographic and medical risk factors for patients who presented with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL); (b) identify treatments that patients underwent; (c) evaluate the adequacy of follow-up and compliance with long-term hearing rehabilitation.

METHODS

Retrospective review of patients who presented with unilateral ISSNHL between January 1998 and December 2017 at a tertiary care academic medical center.

RESULTS

Two hundred-four patients met inclusion criteria. Of these, 129 (63.2%) did not undergo treatment at an outside hospital prior to our evaluation. In this subgroup, the average pretreatment pure tone average (PTA) was 61.9 ± 2.5 dB (dB). The most common treatment was oral steroids and was recommended in 76 patients (59.9%). Patients also underwent intratympanic (IT) steroid injections (7.2%) or oral steroids followed by salvage IT injections (19.4%). Mean follow-up duration was 17.9 (±29.2) months, and posttreatment PTA (45.6 ± 2.6 dB) was significantly better than baseline (P < .001). In this cohort, hearing amplification was infrequently recommended. Less than 20% of patients reported active hearing amplification use at their most recent visit. At follow-up, 90 patients (69.8%) reported subjective improvement in hearing after treatment. Only 55 patients (42.6%) showed improvement in PTA compared to their pretreatment audiograms.

CONCLUSION

Many patients with ISSNHL experienced audiometric improvement after treatments, but most had persistent hearing loss. The duration of follow-up was short. Most patients did not use long-term hearing amplification. Future studies are needed to identify factors that contribute to reduced follow-up and low compliance with hearing amplification use in ISSNHL.

LEVEL OF EVIDENCE

2c.

Methadone associated long term hearing loss and nephrotoxicity; a case report and literature review

Background

Methadone is a long-acting opioid receptor agonist. Reported adverse effects of methadone include constipation, respiratory depression, dizziness, nausea, vomiting, itching, sweating, rhabdomyolysis, QT prolongation, and orthostatic hypotension. Hearing loss has been rarely reported following methadone use, and when reported, long term follow-up is rare.

Herein we report a case of methadone poisoning with rhabdomyolysis, acute kidney injury, and persistent hearing loss documented by a 2 year follow up.

Case presentation

The patient was a 34 years old male who presented with a reduced level of consciousness and acute hearing loss after suicidal ingestion of 40 mg of methadone while experiencing family-related stresses. He had no prior history of methadone use, abuse, or addiction.

Initial laboratory testing was significant for a serum creatinine concentration of 4.1 mg/dl, a mixed metabolic and respiratory acidosis, thrombocytopenia, abnormal hepatic transaminases, and coagulation tests. The patient then developed severe rhabdomyolysis. Also, audiometry showed a bilateral sensorineural hearing loss. The patient required hemodialysis for 11 days while his metabolic abnormalities gradually resolved. However, his hearing loss was persistent, as demonstrated by 2 years of follow up.

Conclusion

Our patient simultaneously had kidney failure, rhabdomyolysis, and permanent hearing loss following methadone poisoning. Although rare, ototoxicity and permanent hearing loss may happen in cases of methadone poisoning. While opioid-induced hearing loss is uncommon, methadone toxicity should be taken into account for any previously healthy patient presenting with acute hearing loss with or without rhabdomyolysis.

Increased incidence of age-related macular degeneration in sensorineural hearing loss: A population-based cohort study

Background

To evaluate the incidence of age-related macular degeneration (AMD) in patients diagnosed with sensorineural hearing loss (SNHL) via the application of the National Health Insurance Research Database in Taiwan.

Methodology/Principal findings

A retrospective cohort study was conducted. Patients with a diagnosis of SNHL was enrolled in the study group after exclusion and a propensity score matched group without SNHL was served as the control group with a 1:2 ratio. The main outcome was regarded as the emergence of AMD diagnostic codes. Cox proportional hazard regression was applied to analyze the incidence and adjusted hazard ratio (aHR) of AMD in the multivariate model. A total of 15,686 patients with SNHL were included in the study group while another 31,372 non-SNHL patients served as the control group. After a follow-up interval up to 16 years, there were 484 AMD events occurred in the study group and 660 AMD cases in those non-SNHL patients with a significantly higher aHR compared to the control group after adjusting for multiple potential risk factors (aHR: 1.399, 95% CI: 1.244–1.574). Other prominent risk factors for AMD included older age, ischemic heart disease, hyperlipidemia, Alzheimer's disease, liver disease and kidney disease. Besides, a higher cumulative probability of AMD was observed in the study group (log-rank P <0.0001).

Conclusion

The patients with SNHL demonstrated a higher incidence of developing AMD.

Dissecting basilar artery aneurysm manifesting as sudden sensorineural hearing loss: a case report and literature review

• Dissecting basilar artery aneurysm (DBAA) is relatively rare.

• We report the first case of a DBAA manifesting as sudden sensorineural hearing loss.

• This case report adds to the symptom spectrum of DBAA.

Dissecting aneurysms of the basilar artery are rare and severe entities with high hemorrhage and mortality rates. Common clinical symptoms of this condition include cerebral ischemia, subarachnoid hemorrhage, and neurological deficits induced by space-occupying effects. Vertigo, headache, and cranial nerve paralysis are also frequent symptoms. We report a case of dissecting basilar artery aneurysm manifesting as sudden sensorineural hearing loss. A 53-year-old man presented with vertigo, left-sided tinnitus, and sudden sensorineural hearing loss for 1 hour. A physical examination showed left-sided hearing loss and bilateral horizontal nystagmus, and a radiological examination showed a dissecting aneurysm originating from the basilar artery. A diagnosis of a dissecting aneurysm of the basilar artery with sudden sensorineural hearing loss was made. The aneurysm was treated using stent-assisted coil embolization. Postoperatively, the vertigo and tinnitus, as well as the left hearing loss, greatly improved. Follow-up digital subtraction angiography 10 months after the operation showed complete disappearance of the dissecting aneurysm of the basilar artery. In patients with sudden sensorineural hearing loss, clinicians should be aware of the potential of a dissecting basilar artery aneurysm. An interdisciplinary approach is important in diagnosis and treatment of this rare condition.

A systematic review and network meta-analysis of existing pharmacologic therapies in patients with idiopathic sudden sensorineural hearing loss

BACKGROUND

Hearing loss is one of the leading causes of disability worldwide. Patients with hearing loss experience impaired quality of life, as well as emotional and financial consequences that affect both themselves and their families. Idiopathic sudden sensorineural hearing loss (ISSNHL) is a common but difficult to treat condition that has a sudden onset of ≤ 72 hour associated with various etiologies, with the majority of cases being idiopathic. There exists a wide range of therapeutic options, however, the uncertainty surrounding their comparative efficacy and safety makes selection of treatment difficult. This systematic review and network meta-analysis (NMA) assessed the relative effects of competing treatments for management of ISSNHL.

METHODS

A protocol for this review was registered with PROSPERO (CRD42017073756). A detailed search of MEDLINE, Embase and the Cochrane Library from inception to February 8th, 2018 was carried out by an experienced information specialist. Grey literature was also searched. Screening full-text records, and risk of bias assessment were carried out independently by two reviewers, and disagreements were resolved through consensus or third party adjudication, while data was collected by one reviewer and verified by a second reviewer. Bayesian network meta-analyses (NMA) were performed to inform comparisons between interventions for a priori specified outcomes that included pure tone average (PTA) improvement and hearing recovery.

RESULTS

The search identified a total of 1,138 citations, of which 613 remained for review after removal of duplicates. Of these, 23 publications describing 19 unique studies (total sample size of 1,527) met our a priori eligibility criteria, that were assessed to be at unclear or high risk of bias on several domains. We identified data on several interventions for ISSNHL therapy and were able to construct treatment networks consisting of six intervention groups that included placebo; intratympanic (IT) steroid; IT plus systemic steroid; per oral (PO) steroid; intravenous (IV) steroid; and IV plus PO steroid for our NMAs. IT plus systemic steroids demonstrated the largest difference in PTA improvement compared to placebo (25.85 dB, 95% CrI 7.18-40.58), followed by IV plus PO steroids (22.06 dB, 95% CrI 1.24-39.17), IT steroids (18.24 dB, 95% CrI 3.00-29.81). We observed that the difference of PTA improvement between each intervention and placebo diminished over time, attributed to spontaneous recovery. The binary outcomes of hearing recovery demonstrated similar relative ordering of interventions but were less sensitive than PTA improvement to capture the significant differences between interventions and placebo.

CONCLUSION

Unclear to high risk of bias trials rated IT plus systemic steroid treatment as the best among the six interventions compared, and all active treatments were better than placebo in improving PTA. However, it should be noted that certain comparisons were based on indirect evidence only or few studies of small sample size, and analyses were unable to control for steroid type and dosage. Given these limitations, further data originating from methodologically sound and rigorous trials with adequate reporting are needed to confirm our findings.

Increased Incidence of Glaucoma in Sensorineural Hearing Loss: A Population-Based Cohort Study

The purpose of the current study was to evaluate the incidence of glaucoma in patients diagnosed with sensorineural hearing loss (SNHL) via the application of the National Health Insurance Research Database in Taiwan. A retrospective cohort study was conducted. Patients with a diagnosis of SNHL were enrolled in the study group after an exclusion procedure and a propensity score matched group without SNHL was served as the control group with a 1:2 ratio. The main outcome was regarded as the emergence of glaucoma diagnostic codes. Cox proportional hazard regression was applied to analyze the incidence and adjusted hazard ratio (aHR) of glaucoma in the multivariate model. A total of 15,686 patients diagnosed with SNHL were enrolled in the study group while another 31,372 non-SNHL individuals served as the control group. There were 444 glaucoma events in the study group and 647 glaucoma events in those non-SNHL individuals after the follow-up interval of 16 years. The study group demonstrated a significantly higher aHR compared to the control group after adjusting for multiple possible risk factors. In the subgroup analysis, both the normal tension glaucoma and angle closure glaucoma subgroups revealed a higher aHR in the study group. In conclusion, the patients with SNHL demonstrated a higher incidence of developing glaucoma. Moreover, the incidence was more prominent for patients diagnosed with normal tension glaucoma and angle closure glaucoma.

Inhibition of Brain Area and Functional Connectivity in Idiopathic Sudden Sensorineural Hearing Loss With Tinnitus, Based on Resting-State EEG

This study aimed to identify the mechanism behind idiopathic sudden sensorineural hearing loss (ISSNHL) in patients with tinnitus by investigating aberrant activity in areas of the brain and functional connectivity. High-density electroencephalography (EEG) was used to investigate central nervous changes in 25 ISSNHL subjects and 27 healthy controls. ISSNHL subjects had significantly reduced activity in the left frontal lobe at the alpha 2 frequency band compared with controls. Linear lagged connectivity and lagged coherence analysis showed significantly reduced functional connectivity between the temporal gyrus and supramarginal gyrus at the gamma 2 frequency band in the ISSNHL group. Additionally, a significantly reduced functional connectivity was found between the central cingulate gyrus and frontal lobe under lagged phase synchronization analysis. These results strongly indicate inhibition of brain area activity and change in functional connectivity in ISSNHL with tinnitus patients.

Heparin therapy as adjuvant treatment for profound idiopathic sudden sensorineural hearing loss

OBJECTIVES/HYPOTHESIS

This study aimed to provide evidence of whether unfractionated heparin used as adjuvant therapy in conjunction with systemic corticosteroid therapy improves hearing recovery in patients with profound idiopathic sudden sensorineural hearing loss (ISSNHL), and to compare the effect of this treatment with those of additional intratympanic corticosteroid therapy.

STUDY DESIGN

Retrospective chart review.

METHODS

Eighty-seven patients with profound ISSNHL (≥90 dB) and who had been admitted at a tertiary referral center between 2010 and 2018 were retrospectively reviewed, 67 patients for additional intratympanic corticosteroid injection (ITSI) (ITSI group) and 21 for adjuvant heparin therapy (heparin group). Hearing recovery was evaluated by grade assessment according to the American Academy of Otolaryngology-Head and Neck Surgery criteria.

RESULTS

Of the patients in the heparin group, 42.8% recovered serviceable hearing, which was significantly higher than the recovery rates (19.7%) of those in the ITSI group. Particularly, in patients with pretreatment hearing level of 90 to 100 dB, adjuvant heparin therapy enhanced therapeutic effects with a significant hearing recovery rate of 80%. However, in patients with initial hearing level >100 dB, the rates of significant hearing recovery in the two groups were roughly equal and remained unsatisfactory (8.1% in the ITSI group and 9.1% in the heparin group).

CONCLUSIONS

The results of this study suggest that the treatment of profound ISSNHL with adjuvant heparin therapy, in combination with systemic steroid therapy, results in higher hearing recovery rates when compared to combined local and systemic corticosteroid therapy, without serious complications.

LEVEL OF EVIDENCE

3b Laryngoscope, 130:1310-1315, 2020.

Risk of sudden sensorineural hearing loss in patients with dysrhythmia: A nationwide population-based cohort study

Objective

Whether dysrhythmia is a risk factor of sudden sensorineural hearing loss (SSNHL) remains unclear. In this study, we aimed to investigate the risk of developing SSNHL among patients with dysrhythmia in different age and gender groups by using population-based data in Taiwan.

Methods

We conducted a matched cohort study by analyzing data between January 2000 and December 2013 obtained from the Taiwan National Health Insurance Research Database. 41,842 newly diagnosed dysrhythmia patients and 83,684 comparison subjects without dysrhythmia were selected from claims. The incidence of sudden sensorineural hearing loss at the end of 2013 was determined in both groups. Univariate and multivariate logistic regression analyses were used to investigate the risk of SSNHL among patients with dysrhythmia.

Results

The incidence of SSNHL was 1.30-fold higher in the dysrhythmia group compared with the control group (53.2 versus 40.9 per 100,000 person-years), and using Cox proportional hazard regressions, the adjusted hazard ratio (HR) was 1.40 (95% confidence interval [CI], 1.15–1.70). Gender-stratified analysis revealed a significantly higher risk of SSNHL in patients with dysrhythmia than in those without dysrhythmia for both men and women (HR = 1.34, 95% CI = 1.02–1.76, P = 0.039, HR = 1.35, 95% CI = 1.02–1.78, P = 0.035, respectively). Age-stratified analysis revealed remarkable associations between dysrhythmia and SSNHL among those aged less than 40 years and more than 65 years (HR = 2.18, 95% CI = 1.03–4.64, P = 0.043 and HR = 1.54, 95% CI = 1.14–2.09, P = 0.006, respectively).

Conclusions

Our findings support dysrhythmia as an independent risk factor for SSNHL. Based on the study results, clinicians managing patients with dysrhythmia should be aware of the increased risk of developing SSNHL, especially among patients aged <40 and >65 years, and counsel patients to seek medical advice immediately if they experience any acute change in their hearing ability.

Untreated primary hypothyroidism with simultaneous rhabdomyolysis, pericardial effusion, and sudden sensorineural hearing loss: a case report

BACKGROUND

Hypothyroidism, one of the prevalent endocrine disorders worldwide, has a broad spectrum of clinical manifestations, from an asymptomatic condition to myxedema coma. Although the majority of patients with hypothyroidism have minor clinical symptoms, which are recovered with levothyroxine treatment, some patients occasionally do experience fatal complications. Here we report, for the first time, the case of a patient who had hypothyroidism with simultaneous occurrence of rhabdomyolysis with acute kidney injury, moderate pericardial effusion, and sudden sensorineural hearing loss.

CASE PRESENTATION

A 57-year-old man with a previous history of dyslipidemia and untreated hypothyroidism was admitted to the hospital due to shortness of breath, lethargy, lower extremity discomfort, and unilateral hearing loss. Laboratory results revealed rhabdomyolysis with acute kidney injury and severe hypothyroidism. We detected cardiomegaly without lung parenchymal infiltration on chest radiography and moderate pericardial effusion on transthoracic echocardiography. We performed pure tone audiometry and identified profound unilateral sensorineural hearing loss. Aggressive fluid resuscitation, levothyroxine treatment, and systemic and intratympanic steroid therapy alleviated the patient's severe hypothyroidism, rhabdomyolysis, and pericardial effusion; however, sensorineural hearing loss was not fully recovered.

CONCLUSIONS

Early recognition of life-threatening complications is important in patients with severe hypothyroidism to prevent adverse outcomes. This case suggests that hypothyroidism should be considered in patients who have rhabdomyolysis with acute kidney disease and pericardial effusion. Moreover, sudden sensorineural hearing loss should be kept in mind as a rare complication of hypothyroidism.

Long-term Audiometric Outcomes in Unilateral Sudden Sensorineural Hearing Loss without Recurrence

OBJECTIVES

The recurrence rate of sudden sensorineural hearing loss (SSNHL) varies from 0.8% to 40%. However, to the best of our knowledge, no data on long-term hearing variations are present in the literature. The aim of this observational study was to analyze long-term variations of the hearing threshold in unilateral SSNHL without recurrence.

MATERIALS AND METHODS

A total of 50 patients affected by unilateral SSNHL were evaluated. Patients underwent a treatment consisting of intravenous corticosteroids. Clinical and audiometric features were recorded. Patients underwent pure tone audiometry at a mean follow-up of 5.26±2.28 years. Differences between the affected and unaffected ear were analyzed.

RESULTS

Comparing the post-treatment and follow-up audiograms, there was a worsening of hearing in the unaffected ear. On the contrary, no significant difference over time was found for the affected ear. 54% of patients showed no changes over time, 26% showed worsening, and 20% showed an improvement in hearing. The variation correlated with alcohol consumption and the presence of vasculopathies. An average improvement of hearing over time was observed at low frequencies.

CONCLUSION

The time evolution in SSNHL is not predictable on the basis of the clinical and audiometric data. The majority the patients shows no changes in hearing loss in the affected ear. Patients who consume alcohol or have vasculopathies also have a higher risk of worsening of hearing. Further prospective studies are mandatory to better assess variations over time and their relationship with the effect of aging on hearing.

Altered Resting-State EEG Microstate in Idiopathic Sudden Sensorineural Hearing Loss Patients With Tinnitus

In order to clarify the central reorganization in acute period of hearing loss, this study explored the aberrant dynamics of electroencephalogram (EEG) microstates and the correlations with the features of idiopathic sudden sensorineural hearing loss (ISSNHL) and tinnitus. We used high-density EEG with 128 channels to investigate alterations in microstate parameters between 25 ISSNHL patients with tinnitus and 27 healthy subjects. This study also explored the associations between microstate characteristics and tinnitus features. Microstates were clustered into four categories. There was a reduced presence of microstate A in amplitude, coverage, lifespan, frequency and an increased presence of microstate B in frequency in ISSNHL patients with tinnitus. According to the syntax analysis, a reduced transition from microstate C to microstate A and an increased transition from microstate C to microstate B were found in ISSNHL subjects. In addition, the significant negative correlations were found between Tinnitus Handicap Inventory (THI) scores and frequency of microstate A as well as between THI scores and the probability of transition from microstate D to microstate A. While THI was positively correlated with the transition probability from microstate D to microstate B. To sum up, the significant differences in the characteristics of resting-state EEG microstates were found between ISSNHL subjects with tinnitus and healthy controls. This study suggests that the alterations of central neural networks occur in acute stage of hearing loss and tinnitus. And EEG microstate may be considered as a useful tool to study the whole brain network in ISSNHL patients.

The atherogenic index (ATH index) as a potential predictive marker of idiopathic sudden sensorineural hearing loss: a case control study

BACKGROUND

The importance of blood lipids in the pathogenesis of sudden sensorineural hearing loss (SSNHL) is widely discussed in the literature. However, the published results that hyperlipidaemia causes hearing problems are contradictory. The objective of this study was to establish whether increased lipid levels affect the risk of idiopathic SSNHL.

METHODS

A case-controlled study was conducted of 27 patients with idiopathic SSNHL and 24 healthy control subjects. All of the subjects underwent complete audiological examination. The plasma levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo) A-I, apoB and apoE were measured with commercially available kits (Chronolab Systems, Spain). Several clinical ratios and indices of lipid metabolism were calculated.

RESULTS

Detailed analysis of lipid metabolism in patients with idiopathic SSNHL has shown that disturbances in auditory function are associated with increased atherogenicity of the lipid profile. However, there were no significant differences in the conventional parameters of lipid metabolism (TC, TG and HDL-C) between patients with idiopathic SSNHL and subjects in the control group. Higher values of the apoB/apoA-I ratio, atherogenic index of plasma (AIP) and atherogenic index (ATH index) in patients with SSNHL indicated increased atherogenicity of the lipid profile. Binary logistic regression analysis showed that of these three indices, only higher values of the ATH index were significantly associated with an increased risk of idiopathic SSNHL.

CONCLUSIONS

The ATH index can be used as a marker indicating the risk of idiopathic SSNHL when the conventional lipid indices are still normal.

Traditional oriental medicine for sensorineural hearing loss: Can ethnopharmacology contribute to potential drug discovery?

ETHNOPHARMACOLOGICAL RELEVANCE

In Traditional Oriental Medicine (TOM), the development of hearing pathologies is related to an inadequate nourishment of the ears by the kidney and other organs involved in regulation of bodily fluids and nutrients. Several herbal species have historically been prescribed for promoting the production of bodily fluids or as antiaging agents to treat deficiencies in hearing.

AIM OF REVIEW

The prevalence of hearing loss has been increasing in the last decade and is projected to grow considerably in the coming years. Recently, several herbal-derived products prescribed in TOM have demonstrated a therapeutic potential for acquired sensorineural hearing loss and tinnitus. Therefore, the aims of this review are to provide a comprehensive overview of the current known efficacy of the herbs used in TOM for preventing different forms of acquired sensorineural hearing loss and tinnitus, and associate the traditional principle with the demonstrated pharmacological mechanisms to establish a solid foundation for directing future research.

METHODS

The present review collected the literature related to herbs used in TOM or related compounds on hearing from Chinese, Korean, and Japanese herbal classics; library catalogs; and scientific databases (PubMed, Scopus, Google Scholar; and Science Direct).

RESULTS

This review shows that approximately 25 herbal species and 40 active compounds prescribed in TOM for hearing loss and tinnitus have shown in vitro or in vivo beneficial effects for acquired sensorineural hearing loss produced by noise, aging, ototoxic drugs or diabetes. The inner ear is highly vulnerable to ischemia and oxidative damage, where several TOM agents have revealed a direct effect on the auditory system by normalizing the blood supply to the cochlea and increasing the antioxidant defense in sensory hair cells. These strategies have shown a positive impact on maintaining the inner ear potential, sustaining the production of endolymph, reducing the accumulation of toxic and inflammatory substances, preventing sensory cell death and preserving sensory transmission. There are still several herbal species with demonstrated therapeutic efficacy whose mechanisms have not been deeply studied and others that have been traditionally used in hearing loss but have not been tested experimentally. In clinical studies, Ginkgo biloba, Panax ginseng, and Astragalus propinquus have demonstrated to improve hearing thresholds in patients with sensorineural hearing loss and alleviated the symptoms of tinnitus. However, some of these clinical studies have been limited by small sample sizes, lack of an adequate control group or contradictory results.

CONCLUSIONS

Current therapeutic strategies have proven that the goal of the traditional oriental medicine principle of increasing bodily fluids is a relevant approach for reducing the development of hearing loss by improving microcirculation in the blood-labyrinth barrier and increasing cochlear blood flow. The potential benefits of TOM agents expand to a multi-target approach on different auditory structures of the inner ear related to increased cochlear blood flow, antioxidant, anti-inflammatory, anti-apoptotic and neuroprotective activities. However, more research is required, given the evidence is very limited in terms of the mechanism of action at the preclinical in vivo level and the scarce number of clinical studies published.

The clinical value of 4-hour delayed-enhanced 3D-FLAIR MR images in sudden hearing loss

OBJECTIVE

The aim of this study was to investigate the clinical significance of 4-hour delayed-enhanced 3.0 Tesla (3T) 3D-fluid-attenuated inversion recovery (FLAIR) MR imaging in sudden sensorineural hearing loss (SSNHL).

STUDY DESIGN

Case series with comparisons.

SETTING

Tertiary referral centre.

PARTICIPANTS

Eighty-seven idiopathic SSNHL patients were enrolled between January 2015 and December 2016 and received high dose steroid therapy and intratympanic steroid injections as salvage treatment.

INTERVENTION

Pre-contrast, 10-minute and 4-hour delayed-enhanced 3D-FLAIR MR images were obtained using double-dose IV gadolinium.

MAIN OUTCOME MEASURES

The results of treatment were evaluated according to Siegel's criteria 3 months after the start of treatment. Where possible lesion-side laterality of the inner ear was identified based on the MR images, the associations between MR findings and other clinical parameters were analysed, and the relationships between hearing recovery and MR image findings were assessed.

RESULTS

Lesion-side laterality was identified on MRI in 52 (59.7%), 18 (20.1%) and 8 (9.2%) patients, based on 4-hour delayed, 10-minute delayed, and pre-contrast images, respectively. The hearing recovery rate was significantly lower in the patients with lesion-side laterality on 4-hour delayed images (P < 0.001). In a multivariate analysis, lesion-side laterality on 4-hour delayed images was associated with poor prognosis (OR = 5.6) after adjusting other prognostic factors including initial hearing level, lesion-side laterality on 10-min delayed images and presence of vertigo. In addition, as the extent of enhancement in the inner ear increased the probability of hearing recover decreased (P = 0.001).

CONCLUSIONS

Contrast enhancement of inner ear structures can be seen on 4-hour delayed-enhanced 3T 3D-FLAIR MR images in idiopathic SSNHL. Asymmetric lesion-side enhancement of the inner ear may be associated with a poor prognosis.

Sequential versus Combination Treatment Using Steroids and Diuretics for Acute Low-Frequency Sensorineural Hearing Loss: A Noninferiority Trial

OBJECTIVE

Acute low-frequency hearing loss (ALHL) is typically treated with combination therapy, including steroids and diuretics. To avoid unnecessary use of steroids we proposed a method of sequential administration using these two drugs, and compared the efficacy of our protocol with that of existing combination treatments.

METHODS

A prospective, randomized, open-label, single-blind, noninferiority clinical trial was conducted to investigate whether the effectiveness of sequential treatment is noninferior to that of combination treatment for ALHL. Ninety-two patients with ALHL received either steroids and diuretics simultaneously for 2 weeks (combination group), or diuretics for 2 weeks followed by steroids for another 2 weeks if they did not respond to diuretic treatment (sequential group). The primary outcome measure was a change in mean hearing threshold at three frequencies (125, 250, and 500 Hz) at 4 weeks after treatment.

RESULTS

The mean hearing threshold of the low frequencies improved 20.0 and 17.2 dB in the combination and the sequential group, respectively. The 95% lower confidence interval was -8.0 dB and noninferiority was established at p < 0.05. At 4 weeks after treatment, the complete recovery rate was 80.5 and 82.9% in the combination and sequential groups, respectively.

CONCLUSION

This is the first study on ALHL treatment following the establishment of Consolidated Standards of Reporting Trials (CONSORT). The sequential treatment is not inferior to combination treatment for ALHL, and therefore may be a better treatment guideline for ALHL considering that patients receive less steroid exposure and smaller restrictions in diuretic use compared with steroids.

Relationship between platelet parameters and sudden sensorineural hearing loss: a systematic review and meta-analysis

Recent years, the discussion about whether platelets participant in the development of sudden sensorineural hearing loss (SSHL) continues and many studies on the relationship between them have come to our attention. Some studies believe that platelet parameters have significantly changed in patients with SSHL, while some not, controversially. Therefore, to investigate the association between platelet parameters, including mean platelet volume (MPV), platelet distribution width (PDW) and platelet count (PLT), and SSHL, expecting to resolve controversy and provide clinical evidence for diagnosis and monitoring of SSHL. Basic methods: Literature was retrieved searching electronic databases (PubMed, Embase, Cochrane, and Scopus) and searching references of related articles by hand. A total of 18 case-control studies involving 1837/1734 subjects (SSHL/control) were included. Meta-analysis showed there was no difference between the patients who suffered SSHL and healthy controls in MPV level [standard mean difference (SMD) (95% confidence interval (CI)) = 0.16 (-0.07, 0.40), I2 = 80%, P<0.00001] and PLT [SMD (95% CI) = -0.03(-0.18, 0.12), I2 = 73%, P<0.00001]. While PDW exhibited significant difference [SMD (95% CI) = 0.85 (0.20, 1.49), I2 = 93%, P<0.00001]. Subgroup analysis about geographical area suggested PLT have obvious evidence for SSHL in Eastern country [SMD (95% CI) = 0.23 (0.14, 0.33), I2 = 0%, P=0.81]. Our study did not support a correlation between MPV and SSHL, while PLT may have clinical significance for SSHL in Eastern country. With insufficient data to explore the resource of heterogeneity for PDW, there is no decisive conclusion reached.

Analysis of the audiogram shape in patients with idiopathic sudden sensorineural hearing loss using a cluster analysis

We performed a cluster analysis to classify the audiogram shape in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). We also investigated whether the audiogram shape is a prognostic indicator in the management of ISSNHL. A total of 115 inpatients with ISSNHL treated between 2001 and 2010 were analyzed. The data collected included age, sex, duration of hearing loss at the time of treatment, and the presence or absence of tinnitus, vertigo, diabetes, nystagmus, and canal paresis. A hierarchical cluster analysis was performed using the hearing threshold for each frequency on audiograms as variables. A logistic regression model was used for the prognostic analysis. The audiogram shape was classified into four clusters: (1) crossing horizontally pattern of all tones; (2) up-sloping pattern of low-tone loss; (3) deaf pattern; and (4) down-sloping pattern of high-tone loss. The age of the patient, presence of canal paresis, and audiogram shape showed statistically significant relationships with hearing improvement. The audiogram shape based on the cluster analysis demonstrated a significant relationship with hearing improvement in patients with ISSNHL. Further studies are needed to elucidate the underlying etiology of each audiogram shape.

Plasma levels of endothelial cell-specific molecule-1 and pentraxin-3 in idiopathic sudden sensorineural hearing loss

OBJECTIVES

To evaluate the plasma levels of endothelial cell-specific molecule-1 (ESM-1) and pentraxin-3 (PTX-3) in patients with idiopathic sudden sensorineural hearing loss, and to compare the pre- and post-treatment levels in patients responsive and non-responsive to therapy.

METHODS

The study included 108 subjects: 51 with idiopathic sudden sensorineural hearing loss and 57 controls. For ESM-1 and PTX-3 analyses, blood samples were collected before and three months after treatment initiation in the idiopathic sudden sensorineural hearing loss group and once for the control group. Treatment response was evaluated three months after therapy initiation with pure tone audiometry, and the patients were divided into two groups: responsive and non-responsive to treatment.

RESULTS

Serum ESM-1 levels were significantly higher in the idiopathic sudden sensorineural hearing loss group than the control group, whereas the difference was not significant for PTX-3. In the responsive and non-responsive groups, ESM-1 and PTX-3 levels were not statistically different before and after treatment.

CONCLUSION

To our knowledge, this is the first study investigating plasma ESM-1 and PTX-3 levels in idiopathic sudden sensorineural hearing loss. Increased plasma ESM-1 levels may confirm endothelial dysfunction involvement in idiopathic sudden sensorineural hearing loss pathogenesis, which could be associated with vascular impairment.

Neutrophil-to-lymphocyte ratio predicts diagnosis and prognosis of idiopathic sudden sensorineural hearing loss: A systematic review and meta-analysis

BACKGROUND

Chronic inflammation has been regarded as one of the causes of idiopathic sudden sensorineural hearing loss (ISSHL). Several individual studies have reported the association between neutrophil-to-lymphocyte ratio (NLR) and ISSHL. However, the findings have been inconsistent, and these data have not been systematically evaluated. Thus, we conducted this meta-analysis to further explore the predictive value of NLR on formation and prognosis of ISSHL.

METHODS

A comprehensive literature search was performed to identify eligible studies based on PubMed, Embase, Web of Science, and China National Knowledge Infrastructure. The Standardized mean deviation (SMD) with its 95% confidence interval (CI) was applied to be the effect size estimate.

RESULTS

A total 10 papers with 15 retrospective case-control studies, which included 1029 ISSHL patients (the case group) and 1020 healthy people (the control group), were selected for the meta-analysis of the relationship between NLR and onset of ISSHL. The NLR levels in the case group were observed to be higher than the control group (SMD = 1.65, 95% CI = 1.20-2.09, P < .001). The pooled results did not significantly change by the subgroup analyses based on study region, baseline matching, and laterality. Moreover, 9 publications with 12 retrospective cohort studies, which included 590 recovered ISSHL patients and 438 unrecovered ISSHL patients, explored the association between NLR and ISSHL prognosis, and the combined data showed that the NLR value was much higher in unrecovered patients rather than recovered patients (SMD = 1.27, 95% CI: 0.62-1.92, P < .001). The subgroup analyses based on study region, laterality, type of steroid, medication administration, maintenance treatment, follow-up period, and definition of "recovered" further supported these results.

CONCLUSION

The results of this meta-analysis suggest that NLR might be a useful biomarker to determine the onset and prognosis of ISSHL.

A comparison of single-dose and multiple divided daily-dose oral steroids for sudden sensorineural hearing loss

INTRODUCTION

Glucocorticoids are considered the first-line therapy for sudden sensorineural hearing loss. But there is currently no consensus on administering them as a single dose versus multiple divided daily doses.

OBJECTIVE

We aim to evaluate the treatment outcome of sudden sensorineural hearing loss between a single-dose and multiple divided daily doses of steroid treatment.

METHODS

A total of 94 patients who were diagnosed and treated for sudden sensorineural hearing loss and followed up for more than three months were reviewed retrospectively. Patients were divided into single-dose and multiple divided-dose groups, based on their medication regimens. Hearing thresholds were repeatedly measured: on the initial visit and 1 week, 1 month, and 3 months after the initial treatment. Treatment outcomes were analyzed by comparing hearing recovery rates and post-treatment audiometric changes.

RESULTS

The hearing threshold was significantly reduced at three months post-treatment in both groups. The hearing recovery rate of the single-dose group was significantly higher than that of the multiple divided-dose groups. Audiometric changes showed no statistical difference either in pure tone threshold or speech discrimination.

CONCLUSION

When oral steroids are indicated for sudden sensorineural hearing loss, both a single dose and multiple divided doses can be effective for treatment and have comparable results. However, the single-dose regimen seems to be more efficacious than the divided-dose regimen.

Acupuncture as an early treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) patients with flat or high-frequency drop audiograms: study protocol for a randomized controlled trial

BACKGROUND

Idiopathic sudden sensorineural hearing loss (ISSNHL) is a common form of deafness. Acupuncture has been used as a salvage therapy for ISSNHL in China since 200 BCE. However, the efficacy of acupuncture has not been confirmed in strictly controlled trials. We designed a randomized controlled clinical trial to evaluate the efficacy and long-term effects of acupuncture in patients with early ISSNHL.

METHODS/DESIGN

In this randomized controlled clinical trial, we will enroll 124 participants with ISSNHL diagnosed 2 to 4 weeks prior to enrollment, who have shown little hearing improvement after routine Western medical treatment (i.e., corticosteroids). 62 of these participants will have flat audiogram and the other 62 will have a high-frequency drop audiogram; they will all take Methycobal while half of the flat type and half of the high-frequency drop type will also receive acupuncture treatments for 4 weeks in a four-group design. The primary outcome measure will be the effective rate of hearing improvement (defined as the proportion of patients with at least 15-dB improvement in the hearing loss frequency band). The secondary outcome will measure the improvements in Pure Tone Average, Word Recognition Score, and Tinnitus Handicap Inventory. The assessments of the participants will be made at baseline, after treatment (week 4), and at follow-up (week 28).

DISCUSSION

This study aims to explore the efficacy and long-term effects of acupuncture in patients with ISSNHL. This study will be a randomized controlled trial with strict methodology and few design deficits. If our study yields positive results, acupuncture could be recommended as a salvage therapy for patients with ISSNHL.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-ICR-15006787 . Registered on 12 July 2015.

The Etiological Relationship Between Migraine and Sudden Hearing Loss

OBJECTIVES

To investigate the relationship between sudden sensorineural hearing loss (SSNHL) and migraine, assess the prevalence of migraine in patients with idiopathic SSNHL, and determine a possible common vascular etiopathogenesis for migraine and SSNHL.

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary referral center.

PATIENTS

This study initially assessed 178 SSNHL cases obtained from the Head and Neck Surgery Clinic patient database at a tertiary hospital in Turkey between January 2011 and March 2016. Ultimately, a total of 61 idiopathic SSNHL patients participated in the present study. İNTERVENTIONS:: Diagnostic.

MAIN OUTCOME MEASURES

Cases with inflammation in the middle or inner ear; a retro cochlear tumor; autoimmune, infectious, functional, metabolic, neoplastic, traumatic, toxic, or vascular causes; Meniere's disease; otosclerosis; multiple sclerosis; and/or cerebrovascular diseases were excluded.

RESULTS

Of the 61 idiopathic SSHNL patients, 34 were women (55.74%); and 24 (39.34%) had migraine, according to the criteria of the International Headache Society (IHS). The mean age of the migraine patients (Group 1) was 43.83 ± 13.16 years, and that of those without migraine (Group 2) was 51.05 ± 16.49 years. The groups did not significantly differ in terms of age, sex, or SSNHL recovery rates according to the Siegel criteria (p > 0.05). Ten of the migraine patients experienced visual aura, and the recovery rates of this group were higher. Additionally, the rate of total hearing loss was lower in Group 1 (n = 3, 12.5%) than in Group 2 (n = 10, 27%).

CONCLUSION

SSNHL patients had a higher prevalence of migraine. Although those with migraine had higher recovery rates, the differences were not statistically significant.

A protocol for a network meta-analysis of interventions to treat patients with sudden sensorineural hearing loss

BACKGROUND

Hearing loss is one of the leading causes of disability worldwide, with greater than 20% of Canadian adults having measurable hearing loss in at least one ear. Patients with hearing loss experience impaired quality of life, and emotional and financial consequences that affect themselves and their families. Sudden sensorineural hearing loss (SSNHL) is a common but difficult to treat form of hearing loss that has a sudden onset of ≤ 72 h associated with various etiologies, with the majority of cases being idiopathic. Some patients may partially or completely recover hearing ability, but for 32 to 65% of patients whose hearing does not recover, feelings of social isolation elevate the risk of anxiety and depression. Hearing loss is also associated with poorer functional status, including difficulty with sound localization and hearing in noise. There exists a wide range of therapeutic options; however, treatment of idiopathic SSNHL is controversial because some patients recover spontaneously. The planned systematic review and network meta-analysis (NMA) will assess the relative effects of competing treatments for management of idiopathic SSNHL in adults.

METHODS

Electronic search strategies were developed by an experienced medical information specialist in consultation with the review team. We will search MEDLINE, Embase, and the Cochrane Library with no date or language restrictions. Key clinical trial registries will also be searched for in-progress and completed trials. Two reviewers will independently screen the literature using pre-specified eligibility criteria, and assess the quality of included studies using the Cochrane Risk of Bias tool. Disagreements will be resolved through consensus or third party adjudication. Bayesian NMAs will be pursued to compare interventions in terms of their effects on hearing (including audiometric thresholds and speech recognition scores), extent of hearing recovery, quality of life, and incidence of harms (including vestibular dysfunction, incidence of infections, and withdrawals due to adverse events).

DISCUSSION

This systematic review and NMA will offer new and informative evaluations of current therapies for SSNHL. The results will inform clinicians as to the relative benefits of the currently available interventions for managing this difficult condition, provide optimal clinical treatment strategies, establish evidence gaps, and identify promising treatments for evaluation in future trials.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD 42017073756 .

Bilateral sudden sensorineural hearing loss as a first symptom of infective endocarditis: two case reports

BACKGROUND

Septic emboli are an unusual cause of sudden sensorineural hearing loss, for which few reports exist in the literature.

CASE REPORT

This paper presents two cases of sudden sensorineural hearing loss, initially considered as idiopathic, but which were caused by septic emboli. Hearing loss in these cases was bilateral, sequential and total. The first patient had mild fever one week prior to their presentation with sudden sensorineural hearing loss; the other patient had no additional symptoms at presentation. These patients were later diagnosed with infective endocarditis, at two and seven months following the sudden sensorineural hearing loss respectively, showing that septic emboli had been the cause of sudden sensorineural hearing loss.

CONCLUSION

Septic emboli should be considered as a possible cause of sudden sensorineural hearing loss in cases of total hearing loss. This form of hearing loss should prompt the otolaryngologist to further investigate for infective endocarditis.

Lassa fever-induced sensorineural hearing loss: A neglected public health and social burden

Although an association between Lassa fever (LF) and sudden-onset sensorineural hearing loss (SNHL) was confirmed clinically in 1990, the prevalence of LF-induced SNHL in endemic countries is still underestimated. LF, a viral hemorrhagic fever disease caused by Lassa virus (LASV), is endemic in West Africa, causing an estimated 500,000 cases and 5,000 deaths per year. Sudden-onset SNHL, one complication of LF, occurs in approximately one-third of survivors and constitutes a neglected public health and social burden. In the endemic countries, where access to hearing aids is limited, SNHL results in a decline of the quality of life for those affected. In addition, hearing loss costs Nigeria approximately 43 million dollars per year. The epidemiology of LF-induced SNHL has not been characterized well. The complication of LF induced by SNHL is also an important consideration for vaccine development and treatments. However, research into the mechanism has been hindered by the lack of autopsy samples and relevant small animal models. Recently, the first animal model that mimics the symptoms of SNHL associated with LF was developed. Preliminary data from the new animal model as well as the clinical case studies support the mechanism of immune-mediated injury that causes SNHL in LF patients. This article summarizes clinical findings of hearing loss in LF patients highlighting the association between LASV infection and SNHL as well as the potential mechanism(s) for LF-induced SNHL. Further research is necessary to identify the mechanism and the epidemiology of LF-induced SNHL.

A Trend in Sudden Sensorineural Hearing Loss: Data from a Population-Based Study

This is the first study reporting on the incidence and clinical aspects of sudden sensorineural hearing loss (SSNHL) in South Korea. Using Health Insurance Review and Assessment Service data from 2011 to 2015, the monthly incidence of unilateral SSNHL and incidence according to patients’ sex, age, and month of diagnosis were investigated. The monthly incidence of unilateral SSNHL increased over the 5-year study period, with a mean annual incidence of 17.76 cases/ 100,000 of the population. The incidence increased with age, with most patients presenting in their 60s. There was a slight female preponderance, with a male-to-female ratio of 1: 1.35. Most new patients were diagnosed in October, and the fewest in January. In conclusion, this large-scale study indicates that unilateral SSNHL has a higher incidence among the elderly, women, and in autumn (i.e., along with colder weather).

Idiopathic Sudden Sensorineural Hearing Loss: Average Time Elapsed Before Presentation to the Otolaryngologist and Effectiveness of Oral and/or Intratympanic Steroids in Late Presentations

Objectives

To determine how long after symptom onset that the average patient with an idiopathic sudden sensorineural hearing loss (ISSNHL) presents to the otolaryngology clinic. 

In late presentations, to determine the time to presentation cutoff after which intervention may not be effective. 

To evaluate the effectiveness of oral steroids versus a combination of oral and intratympanic steroid therapy in late presentations of ISSNHL. 

Methods and procedures

Sixty-four patients met inclusion criteria after chart review of 2,037 patients seen at Metro Health Hospital from 2006 to 2016 for sensorineural hearing loss. All sixty-four patients were used to calculate the average time to presentation, but only 40 were included to evaluate treatment efficacy because 24 were lost to follow-up or declined treatment. Audiograms were analyzed for baseline status and response to treatment. Therapy was either oral steroids or intratympanic (IT) steroids. Thirty-nine of the 40 treated patients received oral steroid therapy. Eighteen of these 39 patients received both oral and IT steroids. One patient received IT steroids only. 

Results

For all 64 patients in the study, the average time to presentation was 55 days, ranging from one day to 240 days. Data for 32 of the 40 treated patients were analyzed. These patients were further divided into smaller groups: Group 1 (N = 11) - treatment within seven days of symptom onset, Group 2 (N = 17) - time to treatment greater than seven days but less than 90 days of symptom onset, and Group 3 (N = 4) - greater than 90 days of symptom onset. In Group 2, there was a significant improvement in pure tone average (P-value: 0.005). Forty-seven percent of patients in this group had objective treatment response utilizing Wilson’s criteria. Two patients had a complete recovery and six had a partial recovery. Hearing gains ranged from 10 dB (decibels) to 23 dB. Sixty-three percent of patients with objective improvement also had subjective improvement. In Group 3, none of the patients met Wilson’s criteria for recovery. There was no statistically significant difference in response between patients treated with oral steroids only versus a combination of oral and IT steroids.

Conclusion

Patients with ISSNHL present to an otolaryngologist on average 55 days after symptom onset. There is statistically and clinically significant response to treatment in late presenters. Improvement can be seen up to three months from symptom onset. Oral steroid therapy is effective. IT steroid therapy may have an added benefit.

Psychological stress as a measure for treatment response prediction in idiopathic sudden hearing loss

OBJECTIVE

Early prediction of therapeutic outcomes could reduce exposure to ineffective treatments and optimize clinical outcomes. However, none of the known otologic predictors is amenable to therapeutic intervention for idiopathic sudden sensorineural hearing loss (ISSNHL). The aims of this study were to investigate psychological stress as a potential predictor to discriminate outcomes in ISSNHL.

METHODS

Various psychological measures were conducted including structured interview assessment tools in patients with recently diagnosed ISSNHL before initiating treatment. Using logistic regression analysis, we identified the predictors of treatment response and estimated the probability of treatment response in 50 ISSNHL patients who participated in a clinical trial.

RESULTS

Treatment non-responders were significantly differentiated from responders by various psychological problems. The depression subscore of Modified form of Stress Response Inventory (SRI-MF) (p=0.007) and duration of hearing loss (p=0.045) significantly predicted treatment response after controlling other clinical correlates. The same predictors were identified from different treatment response measured using Siegel's criteria. The most discriminative measure for treatment response was SRI-MF depression score with an overall classification accuracy of 73%.

CONCLUSIONS

We found depressive stress response to be the strong predictor of treatment response in patients with ISSNHL. Our results highlight the potential use of the psychiatric approach as a tool for enhancing therapeutic outcomes. Future stress intervention studies with larger number of ISSNHL patients are needed.

Analysis of caloric test responses in sudden hearing loss

Sudden sensorineural hearing loss is characterized by a rapid-onset hearing loss that develops within 3 days. Vertigo may also be present. We conducted a retrospective study to investigate whether the severity of a loss of caloric function is associated with the initial hearing loss and with hearing recovery. Our study population was made up of 135 patients-67 men and 68 women, aged 25 to 71 years (mean: 50.9)-with sudden sensorineural hearing loss who had undergone bithermal caloric testing. We compared various patient factors according to patients' hearing level and their response to caloric testing. We also analyzed the canal paresis (CP) value in patients with an abnormal caloric response according to three factors: disease severity, vertigo, and hearing recovery, and we evaluated the correlation between the loss of caloric function and hearing outcomes. We found that an abnormal caloric response was significantly associated with a profound hearing loss at presentation, the presence of vertigo, and poor hearing recovery. Among patients with an abnormal caloric response, the CP value was significantly correlated with hearing recovery (r = 0.503, p = 0.001). Poor hearing recovery was seen in 80% of patients with a CP value of ≥40% but in only 25% of patients with a value of <40%; in addition, the degree of hearing recovery was worse in the patients with a CP value of ≥40% (p = 0.002). We conclude that a CP value of ≥40% is a significant prognostic factor for an unfavorable treatment outcome.

Early identification of idiopathic sudden sensorineural hearing loss

This article discusses the physiology of normal hearing, the pathophysiology and differential diagnoses of sudden sensorineural hearing loss, and an approach for definitive diagnosis and treatment. A focus is placed on idiopathic sudden sensorineural hearing loss in the adult population in a primary care setting.

A honey bee can threat ear: Sudden sensorineural hearing loss

Sudden sensorineural hearing loss is an otologic emergency. Many etiological factors can lead to this pathology. Honey bee (Apis mellifera) sting may lead to local and systemic reactions due to sensitization of the patient. In this paper we described a sudden sensorineural hearing loss occurred after honey bee sting.