1
|
Hoch S, Kremper L, Rudhart SA, Stuck BA. [Role of intratympanic glucocorticoid treatment in sudden hearing loss]. HNO 2024; 72:291-302. [PMID: 38351342 DOI: 10.1007/s00106-024-01424-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 03/24/2024]
Abstract
Idiopathic sudden sensorineural hearing loss (ISSNHL) is one of the most common diseases in otolaryngology. Its etiology remains unknown. Furthermore, there is only a low level of evidence for the efficacy of established treatment modalities. In addition to systemic glucocorticoids, intratympanic corticosteroid treatment (ICT) has become increasingly important for treatment of ISSNHL. Different application strategies and treatment regimens have been described; however, uniform standards do not yet exist. ICT may be used for primary treatment as well as salvage therapy. Current data from meta-analyses show no benefit of intratympanic versus systemic primary therapy for sudden hearing loss (moderate evidence) but suggest a benefit of intratympanic secondary treatment over no treatment or placebo (high effect size, low evidence). Regarding combination of systemic and local glucocorticoid therapy in primary treatment of hearing loss, there may be a small benefit over systemic treatment alone (low effect size, low evidence).
Collapse
Affiliation(s)
- Stephan Hoch
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
| | - Luisa Kremper
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Stefan Alexander Rudhart
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Boris Alexander Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| |
Collapse
|
2
|
Lan WL, Chen CH, Chu YC, Cheng YF, Huang CY. Is There an Association between Concurrent Epstein-Barr Virus Infection and Sudden Hearing Loss?-A Case-Control Study in an East Asian Population. J Clin Med 2023; 12:jcm12051946. [PMID: 36902736 PMCID: PMC10004397 DOI: 10.3390/jcm12051946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/12/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Viral infection serves as the crucial etiology for the development of sudden sensorineural hearing loss (SSNHL). We aimed to investigate whether there is an association between concurrent Epstein-Barr virus (EBV) infection and SSNHL in an East Asian population. Patients who were older than 18 years of age and met the criteria of sudden hearing loss without an identifiable etiology were enrolled from July 2021 until June 2022, followed by the serological testing of IgA antibody responses against EBV-specific early antigen (EA) and viral capsid antigen (VCA) with an indirect hemagglutination assay (IHA) and real-time quantitative polymerase chain reaction (qPCR) of EBV DNA in serum before the treatment was initiated. After the treatment for SSNHL, post-treatment audiometry was performed to record the treatment response and degree of recovery. Among the 29 patients included during enrollment, 3 (10.3%) had a positive qPCR result for EBV. In addition, a trend of poor recovery of hearing thresholds was noted for those patients with a higher viral PCR titer. This is the first study to use real-time PCR to detect possible concurrent EBV infection in SSNHL. Our study demonstrated that approximately one-tenth of the enrolled SSNHL patients had evidence of concurrent EBV infection, as reflected by the positive qPCR test results, and a negative trend between hearing gain and the viral DNA PCR level was found within the affected cohort after steroid therapy. These findings indicate a possible role for EBV infection in East Asian patients with SSNHL. Further larger-scale research is needed to better understand the potential role and underlying mechanism of viral infection in the etiology of SSNHL.
Collapse
Affiliation(s)
- Wei-Lun Lan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Chih-Hao Chen
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Yuan-Chia Chu
- Information Management Office, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Medical AI Development Center, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Information Management, National Taipei University of Nursing and Health, Taipei 112, Taiwan
| | - Yen-Fu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chii-Yuan Huang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Information Management Office, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Correspondence:
| |
Collapse
|
3
|
Liu LM, Xia LL. Efficacy and safety of antivirals in treating hearing loss: A systematic review and network meta-analysis. Front Neurol 2022; 13:1027615. [PMID: 36588899 PMCID: PMC9802665 DOI: 10.3389/fneur.2022.1027615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives This study aimed to compare and rank the therapeutic effects of antivirals in treating hearing loss using a network meta-analysis approach. Methods We searched the PubMed, Embase, and Cochrane Library databases to identify eligible randomized controlled trials (RCTs) through April 2022. Placebo-controlled or head-to-head RCTs of three categories of antivirals for hearing loss were included, and pooled relative risks (RRs) with 95% confidence interval (CI) were calculated using pairwise and network meta-analyses. Results Six RCTs with 405 patients were included in the final analysis. The results showed that ganciclovir had relatively better effects on the incidence of hearing recovery (surface under the cumulative ranking: 88.8%) compared with other antivirals. However, pairwise comparison analyses found that the use of antivirals significantly increased the incidence of hearing recovery compared with the use of a placebo (RR: 1.27; 95% CI: 1.04-1.54; P = 0.017), while no significant difference was observed between any two categories of antivirals. Finally, the use of antivirals did not increase the risk of adverse events compared with the use of a placebo (RR: 1.27; 95% CI: 0.82-1.98; P = 0.285). Conclusion Antivirals are more efficacious than placebos for hearing recovery in patients with hearing loss, and ganciclovir is the most likely to increase the incidence of hearing recovery.
Collapse
|
4
|
Miyawaki A, Ikesu R, Tokuda Y, Goto R, Kobayashi Y, Sano K, Tsugawa Y. Prevalence and changes of low-value care at acute care hospitals: a multicentre observational study in Japan. BMJ Open 2022; 12:e063171. [PMID: 36107742 PMCID: PMC9454035 DOI: 10.1136/bmjopen-2022-063171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We aimed to examine the use and factors associated with the provision of low-value care in Japan. DESIGN A multicentre observational study. SETTING Routinely collected claims data that include all inpatient and outpatient visits in 242 large acute care hospitals (accounting for approximately 11% of all acute hospitalisations in Japan). PARTICIPANTS 345 564 patients (median age (IQR): 62 (40-75) years; 182 938 (52.9%) women) seeking care at least once in the hospitals in the fiscal year 2019. PRIMARY AND SECONDARY OUTCOME MEASURES We identified 33 low-value services, as defined by clinical evidence, and developed two versions of claims-based measures of low-value services with different sensitivity and specificity (broader and narrower definitions). We examined the number of low-value services, the proportion of patients receiving these services and the proportion of total healthcare spending incurred by these services in 2019. We also evaluated the 2015-2019 trends in the number of low-value services. RESULTS Services identified by broader low-value care definition occurred in 7.5% of patients and accounted for 0.5% of overall annual healthcare spending. Services identified by narrower low-value care definition occurred in 4.9% of patients and constituted 0.2% of overall annual healthcare spending. Overall, there was no clear trend in the prevalence of low-value services between 2015 and 2019. When focusing on each of the 17 services accounting for more than 99% of all low-value services identified (narrower definition), 6 showed decreasing trends from 2015 to 2019, while 4 showed increasing trends. Hospital size and patients' age, sex and comorbidities were associated with the probability of receiving low-value service. CONCLUSIONS A substantial number of patients received low-value care in Japan. Several low-value services with high frequency, especially with increasing trends, require further investigation and policy interventions for better resource allocation.
Collapse
Affiliation(s)
- Atsushi Miyawaki
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryo Ikesu
- Department of Epidemiology, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
| | - Yasuharu Tokuda
- Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan
- Muribushi Okinawa Center for Teaching Hospitals, Urasoe, Okinawa, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Yokohama, Kanagawa, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuaki Sano
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Department of Health Policy and Management, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
| |
Collapse
|
5
|
Update on the Management of Idiopathic Sudden Sensorineural Hearing Loss. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00414-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
6
|
Jung WW, Hoegerl C. Sudden Sensorineural Hearing Loss and Why It’s an Emergency. Cureus 2022; 14:e21418. [PMID: 35198323 PMCID: PMC8855894 DOI: 10.7759/cureus.21418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/19/2022] [Indexed: 11/21/2022] Open
Abstract
This review shows the importance of sudden sensorineural hearing loss (SSNHL) as a significant cause of hearing loss that often goes under-recognized, especially by primary care physicians. Contrasted with conductive hearing loss, SSNHL involves inner ear damage. This work reviewed the diagnostic methods and treatments of SSNHL in the U.S. and Canada, including treatment options. It is imperative that primary care physicians and providers be able to recognize this condition early so that treatment may be initiated without delay as hearing loss can become permanent if not managed immediately.
Collapse
|
7
|
Amizadeh M, Mozafarnia K, Moslemikia J, Naghibzadeh-Tahami A. Combination of Pulse Steroid with Intratympanic Injections in Sudden Sensorineural Hearing Loss. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2021; 33:9-13. [PMID: 33654685 PMCID: PMC7897433 DOI: 10.22038/ijorl.2020.43887.2452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Oral prednisolone was suggested as the first step to treat idiopathic sudden sensorineural hearing loss (ISSHL). This study aimed to investigate the effect of pulse therapy with methylprednisolone and intratympanic methylprednisolone, compared to traditional oral prednisolone therapy on patients with ISSHL. Material and Methods This randomized control trial included an experimental group receiving 500 mg intravenous methylprednisolone for three sequential days, followed by 1 mg/kg oral prednisolone for 11 days, and intratympanic Depo-Medrol four times twice a week. On the other hand, the control group received 1 mg/kg oral prednisolone for 14 days. Hearing change was assessed through pure tone audiometry. Subsequently, hearing recovery was investigated and analyzed in this study. Result This study was conducted on 51 patients who were divided into two groups of experimental (n=26) and control (n=25). The result revealed no significant difference between the two groups in terms of hearing improvement (P=0.28). Conclusion This revealed no added benefit in pulse steroids combined with intratympanic injections in cases with sudden hearing loss.
Collapse
Affiliation(s)
- Maryam Amizadeh
- Clinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Keramat Mozafarnia
- Clinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Javad Moslemikia
- Clinical Research Unit, Jiroft University of Medical Science, Jiroft, Iran
| | - Ahmad Naghibzadeh-Tahami
- Modeling of Health Research Center, Institute for Futures Studies in Health, Kerman university ofMedical Science, Kerman, Iran
| |
Collapse
|
8
|
Singh A, Kumar Irugu DV. Sudden sensorineural hearing loss - A contemporary review of management issues. J Otol 2020; 15:67-73. [PMID: 32440269 PMCID: PMC7231990 DOI: 10.1016/j.joto.2019.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 01/24/2023] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is an enigmatic entity, with obscure pathophysiology and debatable efficacy of the treatment agents used. An underlying cause is identified in only 10-15% of cases. The management of the remaining patients, classified as 'idiopathic', is empirical, and is conventionally with systemic steroids, vasodilator therapy, rheological agents, and antioxidants, to list a few amongst the host of the agents employed for the treatment. The availability of conflicting outcomes and lack of conclusive evidence has resulted in the propagation of consensus-based treatment protocols. In the present review, we discuss the various controversial issues and newer developments in the management of idiopathic SSNHL. The current review aims to present a narrative outlook of the updated evidence base available from PUBMED, augmented with relevant designated publications.
Collapse
Affiliation(s)
- Anup Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta- the Medicity, Gurugram, Haryana, India
| | - David Victor Kumar Irugu
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
9
|
Si Y, Jiang HL, Chen YB, Chu YG, Chen SJ, Chen XM, He WH, Zheng YQ, Zhang ZG. Round Window Niche Drilling with Intratympanic Steroid Is a Salvage Therapy of Sudden Hearing Loss. Audiol Neurootol 2019; 23:309-315. [PMID: 30630184 DOI: 10.1159/000493086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/20/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the effectiveness and safety of round window niche drilling combined with intratympanic methylprednisolone injection for the salvage treatment of sudden sensorineural hearing loss (SSNHL) and its associated tinnitus after failed primary treatment. METHOD SSNHL patients who showed a less than 10-dB improvement of pure-tone average after receiving standard systemic treatment and intratympanic steroid injection were enrolled. All included patients were randomly divided into two groups (control and study). Patients in the study group received round window niche drilling combined with daily intratympanic methylprednisolone for 7 times; the control group received only daily intratympanic methylprednisolone for 7 times. One month after treatment, the improvements of PTA, speech discrimination score (SDS), tinnitus and the incidence of adverse events were analyzed. RESULTS 20 patients (10 for each group) were included in this study. The baseline between two groups showed no statistical significance. Patients in the study group experienced an average hearing improvement of 20.38 dB, SDS 19.3 compared with 2.1 dB and SDS 2.0 in the control group. None (0%) in the control group and 4 patients (40%) showed marked recovery, 5 patients (50%) showed slight improvement of hearing in the study group after 1 month. All patients in the study group showed significant recovery of tinnitus. Both tinnitus handicap inventory and a symptom visual analogue scale between two groups revealed statistical differences (p < 0.001, p = 0.002, respectively). None in the control and study groups experienced vertigo, infection and facial paralysis. CONCLUSION Round window niche drilling increases the contact area and time of methylprednisolone. It is an effective and safe salvage therapy of idiopathic SSNHL and its induced tinnitus.
Collapse
Affiliation(s)
- Yu Si
- Department of Otolaryngology, Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Huai Li Jiang
- Department of Otolaryngology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu Bin Chen
- Department of Otolaryngology, Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen, Sun Yat-Sen University, Guangzhou, China
| | - Yu Guo Chu
- Institution for Drug Clinical Trial, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Sui Jun Chen
- Department of Otolaryngology, Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Xi Ming Chen
- Department of Otolaryngology, Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Wu Hui He
- Department of Otolaryngology, Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Yi Qing Zheng
- Department of Otolaryngology, Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Zhi Gang Zhang
- Department of Otolaryngology, Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China, .,Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China,
| |
Collapse
|
10
|
Ashtiani MK, Firouzi F, Bastaninejad S, Dabiri S, Nasirmohtaram S, Saeedi N, Ghazavi H, Sahebi L. Efficacy of systemic and intratympanic corticosteroid combination therapy versus intratympanic or systemic therapy in patients with idiopathic sudden sensorineural hearing loss: a randomized controlled trial. Eur Arch Otorhinolaryngol 2017; 275:89-97. [PMID: 29149379 DOI: 10.1007/s00405-017-4808-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The present study was conducted to compare the rates of recovery from idiopathic sudden deafness after the treatment with oral and intratympanic corticosteroids in both mono and combination therapies. STUDY DESIGN Triple-blind randomized clinical trial. SETTINGS Tertiary referral hospital. SUBJECTS AND METHODS A total of 112 patients who were admitted to the ENT emergency department randomly divided into three groups: an oral corticosteroid plus intratympanic placebo (systemic corticosteroid monotherapy group); an intratympanic corticosteroid plus oral placebo group (IT monotherapy group); and a combination therapy group (IT plus systemic combination group). All patients were treated additionally with antiviral and proton pomp inhibitor. An audiometry was performed once before beginning the therapies and again at the end of the therapy. RESULTS Of the total of 112 patients, 32 received intratympanic (IT) corticosteroids, 45 were receiving systemic corticosteroids, and 35 were receiving a combination of the two. A total of 74 patients (66.1%) responded positively [response to treatment was calculated as gain of at least 10 dB in 10 dB in average threshold or with the minimum improvement of 15% in speech discrimination scores (SDS)] to corticosteroid therapy. No significant differences were observed between the three groups (IT, systemic group, and combination therapy group) in their overall response to treatment (p = 0.5). Patients who suffered from concomitant tinnitus and dizziness responded less positively to the treatment (p < 0.002). Positive family history of SSNHL seems to be negative prognostic factors in the response to treatment (p < 0.001). The response to treatment was not related to the pattern (p = 0.04) and initial severity of hearing loss (p = 0.9). CONCLUSION This study did not find any difference in the rate of hearing improvement between systemic, intratympanic, and combined corticosteroid therapy for sudden hearing loss. LEVEL OF EVIDENCE 1b.
Collapse
Affiliation(s)
- Mohammadtaghi Khorsandi Ashtiani
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Otorhinolaryngology and Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Amir'Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Firouzi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Otorhinolaryngology and Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Bastaninejad
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Otorhinolaryngology and Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran. .,Amir'Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran. .,ENT Department, Amir'Alam Hospital, North Sadee Avenue, Tehran, Iran.
| | - Sasan Dabiri
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Otorhinolaryngology and Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Amir'Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sevil Nasirmohtaram
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Otorhinolaryngology and Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Tehran University of Medical Sciences, Tehran, Iran
| | - Niloufar Saeedi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Otorhinolaryngology and Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghazavi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Otorhinolaryngology and Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Tehran University of Medical Sciences, Tehran, Iran
| | - Leyla Sahebi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Conte G, Di Berardino F, Sina C, Zanetti D, Scola E, Gavagna C, Gaini L, Palumbo G, Capaccio P, Triulzi F. MR Imaging in Sudden Sensorineural Hearing Loss. Time to Talk. AJNR Am J Neuroradiol 2017; 38:1475-1479. [PMID: 28546251 DOI: 10.3174/ajnr.a5230] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/20/2017] [Indexed: 11/07/2022]
Abstract
Sudden sensorineural hearing loss is defined as acute hearing loss of the sensorineural type of at least 30 dB over 3 contiguous frequencies that occurs within a 72-hour period. Although many different causative factors have been proposed, sudden sensorineural hearing loss is still considered "idiopathic" in 71%-85% of cases, and treatments are empiric, not based on etiology. MR imaging implemented with a 3D FLAIR sequence has provided new insights into the etiology of sudden sensorineural hearing loss. Herein, we review the current management trends for patients with sudden sensorineural hearing loss, from the initial clinical diagnosis to therapeutic strategies and diagnostic work-up. We focused primarily on MR imaging assessment and discuss the relevance that MR imaging findings might have for patient management, pointing out different perspectives for future clinical research.
Collapse
Affiliation(s)
- G Conte
- From the Postgraduation School of Radiodiagnostics (G.C.)
| | | | - C Sina
- Neuroradiology (C.S., E.S., C.G., F.T.)
| | | | - E Scola
- Neuroradiology (C.S., E.S., C.G., F.T.)
| | - C Gavagna
- Neuroradiology (C.S., E.S., C.G., F.T.)
| | - L Gaini
- Otolaryngology (L.G., P.C.) Units, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico
| | | | - P Capaccio
- Otolaryngology (L.G., P.C.) Units, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico
| | - F Triulzi
- Neuroradiology (C.S., E.S., C.G., F.T.).,Department of Pathophysiology and Transplantation (F.T.), Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
12
|
Profound sensorineural hearing loss after one cycle of intraperitoneal cisplatin in treatment of advanced ovarian cancer. Gynecol Oncol Rep 2017; 20:103-104. [PMID: 28393095 PMCID: PMC5377914 DOI: 10.1016/j.gore.2017.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/10/2017] [Accepted: 03/16/2017] [Indexed: 11/24/2022] Open
Abstract
Few advances in the treatment of advanced epithelial ovarian cancer have improved patient overall survival. However, the incorporation of intraperitoneal administration of platinum based chemotherapy to standard treatment was one such advancement. It is understood that the intraperitoneal regimen is associated with increased toxicity when compared to intravenous administration alone; however, information regarding the specific risk of ototoxicity is lacking in the literature. We report a case of almost complete sensorineural hearing loss after one cycle of intraperitoneal cisplatin. Three days after receiving an intravenous 24 h paclitaxel at 135 mg/m2 and subsequent intraperitoneal infusion of cisplatin at 75 mg/m2, the patient presented with profound bilateral sensorineural hearing loss. The patient experienced no recovery of hearing despite an aggressive systemic steroid taper and change in chemotherapy regimen to alternative agents. She is currently under consideration for cochlear device implantation. Generally, cisplatin related ototoxicity during treatment of epithelial ovarian cancer is gradual, limited to high-frequency ranges and dose-related; however, the toxicity with only one standard dose can be profound and irreversible. This risk should be addressed when counseling patients prior to initiation of treatment. Cisplatin induced ototoxicity can be severe and irreversible after just one dose. The mainstay of treatment remains early recognition and treatment modification. Counseling regarding cisplatin induced ototoxicity should be included in the consent process.
Collapse
|
13
|
Hyperbaric oxygen therapy for sudden sensorineural hearing loss in divers. The Journal of Laryngology & Otology 2016; 130:1039-1047. [PMID: 27748209 DOI: 10.1017/s0022215116009075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Sudden sensorineural hearing loss in divers may be caused by either inner-ear barotrauma or inner-ear decompression sickness. There is no consensus on the best treatment option. This study aimed to evaluate the therapeutic value of hyperbaric oxygen therapy for sudden sensorineural hearing loss in divers. METHOD A literature review and three cases of divers with sudden sensorineural hearing loss treated with hyperbaric oxygen therapy are presented. RESULTS Hyperbaric oxygen therapy resulted in hearing improvement in 80 per cent of patients: 39 per cent had hearing improvement and 41 per cent had full recovery. CONCLUSION Hyperbaric oxygen therapy improved hearing in divers with sudden sensorineural hearing loss.
Collapse
|
14
|
|
15
|
Abstract
Hearing loss is the most common congenital sensory impairment. According to National Health and Nutrition Examination Survey data from 2001 to 2008, 20.3% of subjects aged greater than or equal to 12 had unilateral or bilateral hearing loss. The World Health Organization notes that, worldwide, there are 360 million people with disabling hearing loss, with 50% preventable. Although many hearing losses are acquired, many others are manifestations of preexisting conditions. The purpose of a pediatric hearing evaluation is to identify the degree and type of hearing loss and etiology and to outline a comprehensive strategy that supports language and social development and communication.
Collapse
Affiliation(s)
- Margaret A Kenna
- Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, BCH3129, Boston, MA 02115, USA.
| |
Collapse
|
16
|
Mühlmeier G, Maier S, Maier M, Maier H. [Intratympanic injection therapy for therapy refractory acute hearing loss: A safe option for secondary treatment]. HNO 2015; 63:698-700, 702-6. [PMID: 26395186 DOI: 10.1007/s00106-015-0067-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND High-dose corticosteroids are currently recommended for idiopathic sudden sensorineural hearing loss (ISSNHL) treatment. Intratympanic injections (ITI) are of growing importance, especially in cases of therapy resistance. The selection of patients for this procedure in SSNHL has not been adequately examined so far. STUDY DESIGN A total of 77 patients with ISSNHL after ineffective systemic pretreatment underwent intratympanic administration of dexamethasone and hyaluronic acid. Improvement after treatment was determined by pure tone audiometry for both ears before and of the treated ear after ITI. RESULTS In this study 34 female and 43 male patients with mean age of 57 years showed a pre-ITI hearing loss of 35 dB in the lower frequencies and 69 dB in the higher frequencies. The mean hearing gain was 10 dB and the response rate was 62%. Absolute hearing gain revealed significant improvements at 500 Hz, 1 kHz and 2 kHz. Under inclusion of contralateral thresholds there were hardly any differences up to 4 kHz. In a detailed analysis of responders moderate improvements could be observed even in higher frequencies. Overall, no relevant adverse events occurred. CONCLUSION Treatment of ISSNHL resistant to systemic regimens by ITI of steroids provides an option that offers additional prospects of auditory improvement for affected patients. The presented results indicate that these modalities are also valid for patients with pancochlear ISSNHL.
Collapse
Affiliation(s)
- G Mühlmeier
- Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - S Maier
- Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - M Maier
- Hals-Nasen-Ohren-Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H Maier
- Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| |
Collapse
|
17
|
Choi MS, Lee HY, Cho CS. Optimal dosage of methylprednisolone for the treatment of sudden hearing loss in geriatric patients: a propensity score-matched analysis. PLoS One 2014; 9:e111479. [PMID: 25383617 PMCID: PMC4226486 DOI: 10.1371/journal.pone.0111479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 10/02/2014] [Indexed: 11/30/2022] Open
Abstract
We aimed to compare the treatment outcomes and the occurrence rates of adverse events associated with different steroid regimens in geriatric patients (aged 65 years or older) with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL). After thorough medical chart reviews of 109 patients with ISSNHL between May 2006 and December 2013, we performed a propensity score-matched analysis using previously known prognostic factors, steroid regimens, and other cointerventions. Patients were divided based on their steroid regimens into group I (which initially received 48 mg of methylprednisolone daily with a subsequently tapered dose) and group II (which initially received 24 mg of methylprednisolone daily with a subsequently tapered dose). We compared final hearing and the occurrence of adverse events between the two groups. As a result, 20 pairs of propensity score-matched patients (n = 40) were enrolled. Group I patients showed better final hearing levels compared with group II patients (42.00±22.35 dB and 57.38±26.40 dB, respectively), although this difference was marginally significant (p = 0.058). Based on the comparative analysis of each of the frequencies in the final audiograms, lower hearing thresholds at 2 KHz were observed in group I (p = 0.049). There was no significant difference in the occurrence of adverse effects between the two groups (p>0.05). In conclusion, conventional steroid regimens produced adverse event occurrence rates that were similar to those of low-dose treatment but may also have produced superior hearing recovery. The use of steroid dose reduction in geriatric patients with ISSNHL is not preferable to conventional steroid regimens.
Collapse
Affiliation(s)
- Myoung Su Choi
- Department of Otorhinolaryngology, Department of Otorhinolaryngology, Head & Neck Surgery, School of Medicine, Eulji University Medical Center, Eulji University, Daejeon, Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology, Department of Otorhinolaryngology, Head & Neck Surgery, School of Medicine, Eulji University Medical Center, Eulji University, Daejeon, Korea
- * E-mail:
| | - Chin Saeng Cho
- Department of Otorhinolaryngology, Department of Otorhinolaryngology, Head & Neck Surgery, School of Medicine, Eulji University Medical Center, Eulji University, Daejeon, Korea
| |
Collapse
|
18
|
Partial Recovery of Audiological, Vestibular, and Radiological Findings following Spontaneous Intralabyrinthine Haemorrhage. Case Rep Otolaryngol 2013; 2013:941530. [PMID: 24455375 PMCID: PMC3884635 DOI: 10.1155/2013/941530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/05/2013] [Indexed: 11/30/2022] Open
Abstract
The diagnosis, work-up, and treatment of sudden sensorineural hearing loss and sudden vestibular loss vary widely between units. With the increasing access to both magnetic resonance imaging and objective vestibular testing, our understanding of the various aetiologies at hand is increasing. Despite this, the therapeutic options are limited and without a particularly strong evidence base. We present a rare, yet increasingly diagnosed, case of intralabyrinthine haemorrhage (ILH) together with radiological, audiological, and vestibular test results. Of note, this occurred spontaneously and has shown partial recovery in all the mentioned modalities.
Collapse
|
19
|
Bilateral sudden sensorineural hearing loss: review. The Journal of Laryngology & Otology 2013; 128 Suppl 1:S8-15. [DOI: 10.1017/s002221511300306x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIntroduction:Unilateral and bilateral sudden sensorineural hearing loss represent different disease entities. The unilateral condition is more common and predominantly idiopathic, and up to 65 per cent of patients spontaneously recover hearing. Conversely, the bilateral condition is rare, mostly associated with serious systemic conditions, and has a higher prevalence of morbidity and mortality.Methods:A literature search using the PubMed database was conducted using the MeSH terms ‘sudden’, ‘bilateral’ and ‘sensorineural hearing loss’.Results:One hundred and three reported cases of bilateral sudden sensorineural hearing loss were identified. The condition is most often associated with toxic, autoimmune, neoplastic and vascular conditions. A younger age of onset, with a bimodal age distribution, was seen for bilateral sudden sensorineural hearing loss, compared with the unilateral condition. Patients with the bilateral condition had more profound hearing loss, with poorer recovery and a 35 per cent mortality rate. Vestibular symptoms were also less common than in the unilateral condition.Conclusion:The presentation of bilateral sudden onset sensorineural hearing loss is a medical emergency requiring thorough and urgent investigation to exclude life-threatening and reversible conditions.
Collapse
|
20
|
Muñoz-Proto F, Carnevale C, Bejarano-Panadés N, Ferrán-de la Cierva L, Mas-Mercant S, Sarría-Echegaray P. [Management of sudden neurosensory hearing loss in a Primary Care Centre]. Semergen 2013; 40:149-54. [PMID: 24071487 DOI: 10.1016/j.semerg.2013.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 11/26/2022]
Abstract
Sudden hearing loss is a rapid loss of neurosensory hearing that may occur within hours or days in an apparently healthy patient. Its origins are variable and multifactorial. Most patients do not recover hearing if not treated, and some even develop cophosis (deafness) in the affected ear. It is an otological emergency, as early therapeutic management offers a better hearing prognosis. As there is limited knowledge on this condition, it may be underdiagnosed in Primary Health Care Centers. It should be suspected in patients with abrupt hearing loss or tinnitus. Sophisticated instruments are not required for its diagnosis, just a detailed history, basic otoscopy, and proper interpretation of the hearing test. In this way, an accurate diagnosis is achieved in most cases, which is confirmed by audiometry.
Collapse
Affiliation(s)
- F Muñoz-Proto
- Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Palma de Mallorca, España.
| | - C Carnevale
- Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - N Bejarano-Panadés
- Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - L Ferrán-de la Cierva
- Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - S Mas-Mercant
- Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - P Sarría-Echegaray
- Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Palma de Mallorca, España
| |
Collapse
|