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Seo HW, Kim Y, Kim HJ, Chung WH, Cho YS. Findings of Intravenous Gadolinium Inner Ear Magnetic Resonance Imaging in Patients With Acute Low-Tone Sensorineural Hearing Loss. Clin Exp Otorhinolaryngol 2023; 16:334-341. [PMID: 37641856 DOI: 10.21053/ceo.2023.00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Acute low-tone sensorineural hearing loss (ALHL) is thought to have a different etiology from that of idiopathic sudden sensorineural hearing loss. We hypothesized that endolymphatic hydrops (EH) in the inner ear organ contributes to ALHL, even in patients without vertigo. This study investigated the presence of EH in ALHL and compared the clinical characteristics of patients with or without EH. METHODS We retrospectively reviewed 38 patients diagnosed with ALHL without vertigo from January 2017 to March 2022. EH was measured in all patients using inner ear magnetic resonance imaging (MRI). In addition, we selected patients who showed only mid- or high-frequency hearing loss and had available MRI data as a control group and compared the ALHL and control groups. RESULTS After treatment, the pure-tone average at low frequencies significantly improved compared to the initial hearing (P<0.001). Hearing recovery was observed in 63.1% of patients; however, the recovery rate did not differ based on the treatment method. During the follow-up period, six patients (15.8%) progressed to Meniere's disease, and 18 (47.4%) experienced recurrence. In the ALHL group, the cochlear hydrops ratio on the affected side (0.34±0.09) was significantly higher than on the contralateral side (0.29±0.12) (P=0.005), and most patients showed hydrops in the apex area of the cochlea. Compared with the control group (0.25±0.15), the ALHL group showed a significantly higher cochlear hydrops ratio (P=0.043). The correlation analysis showed a tendency for hearing thresholds at low frequencies to increase as the hydrops ratio increased, albeit without statistical significance. CONCLUSION The cochlear hydrops ratio, especially in the apex area on the affected side, was significantly higher in patients with ALHL, suggesting that EH in the cochlea contributes to the pathogenesis of ALHL.
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Affiliation(s)
- Hee Won Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Yikyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Ho Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Jiang L, Wang Q, Chen L. Impact of Endolymphatic Hydrops and Semicircular Canal Dysfunction on the Incomplete Recovery of Acute Low-Frequency Sensorineural Hearing Loss. EAR, NOSE & THROAT JOURNAL 2023:1455613231196094. [PMID: 37641914 DOI: 10.1177/01455613231196094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE The reasons for short-term, incomplete recovery of some acute low-frequency sensorineural hearing loss (ALFHL) are unclear. We investigated the impact of endolymphatic hydrops and semicircular canal dysfunction on the incomplete recovery of ALFHL. METHODS The impact of electrocochleography (EcochG), caloric test, video head impulse test (vHIT), cervical vestibular-evoked myogenic potential (cVEMP), and ocular vestibular-evoked myogenic potential (oVEMP) results on the incomplete recovery of 86 patients with ALFHL was analyzed. The correlation between a high abnormal rate of vestibular-evoked myogenic potential (VEMP) and aural fullness, dizziness, and level of hearing loss was also examined. RESULTS Abnormal oVEMP with an odds ratio (OR) of 6.071 (P = .002) and EcochG with an OR of 5.919 (P = .005) were independent risk factors for incomplete recovery in ALFHL, but abnormal cVEMP, caloric test, and vHIT were not independent risk factors for ALFHL. There was no correlation between a high abnormal rate of VEMP and aural fullness, dizziness, or level of hearing loss in ALFHL. CONCLUSION Abnormal oVEMP and EcochG values rather than caloric test and vHIT were risk factors for incomplete recovery of ALFHL, which may be related to the difficulty of successfully treating utricular and cochlear hydrops. High abnormal rate of VEMP was not correlated with hearing loss level, aural fullness, or dizziness in ALFHL. Abnormal oVEMP and EcochG values can indicate poor short-term prognosis of ALFHL.
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Affiliation(s)
- Lizhu Jiang
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Qianying Wang
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Lili Chen
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
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3
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Diao T, Chen Y, Jing Y, Ma X. Clinical characteristics and prognosis of acute low-frequency hearing loss and ascending sensorineural sudden sensorineural hearing loss. Front Neurosci 2023; 16:1076109. [PMID: 36703997 PMCID: PMC9871897 DOI: 10.3389/fnins.2022.1076109] [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: 10/21/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Objective The present study aimed to explore the pathogenesis of the ascending sudden sensorineural hearing (SSNHL) loss by comparing the clinical characteristics and prognosis of acute low-frequency hearing loss (ALFHL) and ascending SSNHL. Methods A total of 43 patients with ALFHL and 122 patients with ascending SSNHL were enrolled in this study. First, the prognosis of patients with ALFHL and ascending SSNHL were compared, and the prognostic factors of AFHL and ascending SSNHL were analyzed. Results Acute low-frequency hearing loss and ascending SSNHL have no remarkable difference in complete recovery rate. Compared to ascending SSNHL, ALFHL has younger onset age, female prevalence, lower hearing threshold, shorter time from onset to recovery, and a lower proportion of combined tinnitus. The PTA at admission and delay from onset to therapy were significantly related to the prognosis of patients with ascending SSNHL, while only delay from onset to therapy was significantly related to the prognosis of patients with ALFHL. The majority of patients with ascending SSNHL and ALFHL recovered completely within 10 days from onset. Conclusion Audiogram shape plays a critical role in the prognosis of SSNHL. Ascending SSNHL and ALFHL may share a common pathological mechanism.
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Chen D, Wang Z, Jia G, Mao H, Ni Y. The Role of Anti-Endothelial Cell Autoantibodies and Immune Response in Acute Low-Tone Hearing Loss. EAR, NOSE & THROAT JOURNAL 2020; 100:292S-300S. [PMID: 32865463 DOI: 10.1177/0145561320952501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Immunity is associated with acute low tone hearing loss. However, the exact pathophysiology of immunity-mediated acute low tone hearing loss remains unknown. In this study, we evaluated the presence, therapeutic effectiveness, and immunopathological mechanisms of anti-endothelial cell autoantibodies (AECEs) in patients with acute low-frequency hearing loss. MATERIAL AND METHODS Forty-nine patients who were treated as inpatients having acute low-frequency hearing loss and additional symptoms, such as ear fullness, tinnitus, dizziness, or hyperacusis, were enrolled in this study. Serum samples from these patients were collected for laboratory serum autoimmunity detection, including AECAs, antinuclear antibodies, immunoglobulin, and circular immune complex. Therapeutic responses to combination therapy in short-term outcome and serum cytokine levels were compared between AECA-positive and AECA-negative patients. RESULTS Anti-endothelial cell autoantibodies-positive patients tended to show significantly less response to standard therapy compared with AECAs controls (P < .05). Moreover, some serum cytokine levels elevated in both AECAs- and AECAs+ groups. Positive ratio of interleukin-8 and concentrations of macrophage inflammatory protein-1α were found higher in AECAs+ groups (P < .05). CONCLUSION The results supported that AECAs might wield influence on the short-term outcome of acute low-tone hearing loss (ALHL) treatment. Furthermore, AECA-mediated acute low-frequency hearing loss possibly involved dysregulation of inflammation process and release of cytokines.
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Affiliation(s)
- Diyan Chen
- ENT institute and Otorhinolaryngology Department of Shanghai Medical School, 159395Eye & ENT Hospital of Fudan University, Shanghai, People's Republic of China.,NHC Key Laboratory of Hearing Medicine, 12478Fudan University, Shanghai, People's Republic of China
| | - Zhujian Wang
- 159395Eye & ENT Hospital of Fudan University, Shanghai, People's Republic of China
| | - Gaogan Jia
- ENT institute and Otorhinolaryngology Department of Shanghai Medical School, 159395Eye & ENT Hospital of Fudan University, Shanghai, People's Republic of China.,NHC Key Laboratory of Hearing Medicine, 12478Fudan University, Shanghai, People's Republic of China
| | - Huanyu Mao
- ENT institute and Otorhinolaryngology Department of Shanghai Medical School, 159395Eye & ENT Hospital of Fudan University, Shanghai, People's Republic of China.,NHC Key Laboratory of Hearing Medicine, 12478Fudan University, Shanghai, People's Republic of China
| | - Yusu Ni
- ENT institute and Otorhinolaryngology Department of Shanghai Medical School, 159395Eye & ENT Hospital of Fudan University, Shanghai, People's Republic of China.,NHC Key Laboratory of Hearing Medicine, 12478Fudan University, Shanghai, People's Republic of China.,Otology and Skull Base Surgery Department, ENT Institute of Eye and ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, People's Republic of China
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Young YH. Contemporary review of the causes and differential diagnosis of sudden sensorineural hearing loss. Int J Audiol 2019; 59:243-253. [DOI: 10.1080/14992027.2019.1689432] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yi-Ho Young
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
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Zhu Y, Li G, Zhuang H, Yang Z, Sun J, Xiong G, Wang X. Meta-Analysis Comparing Steroids and Diuretics in the Treatment of Acute Low-Tone Sensorineural Hearing Loss. EAR, NOSE & THROAT JOURNAL 2019; 100:281S-285S. [PMID: 31569978 DOI: 10.1177/0145561319869610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Our objective was to perform a meta-analysis to compare the effectiveness of steroids and diuretics in the treatment of acute low-tone sensorineural hearing loss (ALHL). METHODS PubMed, Google Scholar, and Sci databases were searched for randomized controlled trials (RCTs) examining the treatment of ALHL with steroids and diuretics. The Cochrane Reviewer's Handbook 5.0 evaluation criteria were used to evaluate the quality of the included RCTs. Meta-analysis was performed using Revman 5.3 software to compare the recovery rate of low-tone hearing levels between patients treated with steroids and diuretics. RESULTS A total of 3 RCTs were included. There was no heterogeneity between the 3 studies (χ2 = 2.61, P = .27, I2 = 23%); thus, a fixed-effects model of analysis was used. Meta-analysis showed there was no significant difference in the recovery rate of patients treated with steroids and those treated with diuretics (odds ratio = 1.48, 95% confidence interval: 0.64-3.40, P = .36). CONCLUSION Steroids and diuretics are equally effective for the treatment of ALHL.
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Affiliation(s)
- Yueying Zhu
- Department of Otorhinolaryngology, The First Affiliated Hospital, 26469Sun Yat-sen University, Guangzhou, China.,Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, China
| | - Guangqi Li
- Department of Otorhinolaryngology, The First Affiliated Hospital, 26469Sun Yat-sen University, Guangzhou, China.,Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, China
| | - Huiwen Zhuang
- Department of Otorhinolaryngology, The First Affiliated Hospital, 26469Sun Yat-sen University, Guangzhou, China.,Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, China
| | - Zijun Yang
- Department of Otorhinolaryngology, The First Affiliated Hospital, 26469Sun Yat-sen University, Guangzhou, China.,Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, China
| | - JinCangjian Sun
- Department of Otorhinolaryngology, The First Affiliated Hospital, 26469Sun Yat-sen University, Guangzhou, China.,Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, China
| | - Guangxia Xiong
- Department of Otorhinolaryngology, The First Affiliated Hospital, 26469Sun Yat-sen University, Guangzhou, China.,Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, China
| | - Xianren Wang
- Department of Otorhinolaryngology, The First Affiliated Hospital, 26469Sun Yat-sen University, Guangzhou, China.,Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, China
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Helmstaedter V, Lenarz T, Erfurt P, Kral A, Baumhoff P. The Summating Potential Is a Reliable Marker of Electrode Position in Electrocochleography: Cochlear Implant as a Theragnostic Probe. Ear Hear 2019; 39:687-700. [PMID: 29251689 DOI: 10.1097/aud.0000000000000526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE For the increasing number of cochlear implantations in subjects with residual hearing, hearing preservation, and thus the prevention of implantation trauma, is crucial. A method for monitoring the intracochlear position of a cochlear implant (CI) and early indication of imminent cochlear trauma would help to assist the surgeon to achieve this goal. The aim of this study was to evaluate the reliability of the different electric components recorded by an intracochlear electrocochleography (ECochG) as markers for the cochleotopic position of a CI. The measurements were made directly from the CI, combining intrasurgical diagnostics with the therapeutical use of the CI, thus, turning the CI into a "theragnostic probe." DESIGN Intracochlear ECochGs were measured in 10 Dunkin Hartley guinea pigs of either sex, with normal auditory brainstem response thresholds. All subjects were fully implanted (4 to 5 mm) with a custom six contact CI. The ECochG was recorded simultaneously from all six contacts with monopolar configuration (retroauricular reference electrode). The gross ECochG signal was filtered off-line to separate three of its main components: compound action potential, cochlear microphonic, and summating potential (SP). Additionally, five cochleae were harvested and histologically processed to access the spatial position of the CI contacts. Both ECochG data and histological reconstructions of the electrode position were fitted with the Greenwood function to verify the reliability of the deduced cochleotopic position of the CI. RESULTS SPs could be used as suitable markers for the frequency position of the recording electrode with an accuracy of ±1/4 octave in the functioning cochlea, verified by histology. Cochlear microphonics showed a dependency on electrode position but were less reliable as positional markers. Compound action potentials were not suitable for CI position information but were sensitive to "cochlear health" (e.g., insertion trauma). CONCLUSIONS SPs directly recorded from the contacts of a CI during surgery can be used to access the intracochlear frequency position of the CI. Using SP monitoring, implantation may be stopped before penetrating functioning cochlear regions. If the technique was similarly effective in humans, it could prevent implantation trauma and increase hearing preservation during CI surgery. Diagnostic hardware and software for recording biological signals with a CI without filter limitations might be a valuable add-on to the portfolios of CI manufacturers.
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Affiliation(s)
- Victor Helmstaedter
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence "Hearing 4 All" (DFG EXC 1077), Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence "Hearing 4 All" (DFG EXC 1077), Hannover, Germany
| | - Peter Erfurt
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Andrej Kral
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence "Hearing 4 All" (DFG EXC 1077), Hannover, Germany.,Department of Experimental Otology & Institute of AudioNeuroTechnology (VIANNA), Hannover, Germany
| | - Peter Baumhoff
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Department of Experimental Otology & Institute of AudioNeuroTechnology (VIANNA), Hannover, Germany
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Sequential versus Combination Treatment Using Steroids and Diuretics for Acute Low-Frequency Sensorineural Hearing Loss: A Noninferiority Trial. Otol Neurotol 2019; 40:305-311. [PMID: 30741894 DOI: 10.1097/mao.0000000000002154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Significance of 1 kHz Pure-tone Threshold in Acute Low-frequency Sensorineural Hearing Loss. Otol Neurotol 2018; 39:e950-e955. [PMID: 30444841 DOI: 10.1097/mao.0000000000002023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze risk factors for acute low-frequency hearing loss (ALFHL), and compare treatment outcomes in the presence or absence of such risk factors. STUDY DESIGN A case series featuring retrospective chart review. SETTING An academic university hospital. PATIENTS We included 170 ALFHL patients without vertigo. All of the patients received one of four treatments: low-dose steroid (LD-steroid), high-dose steroid (HD-steroid), LD-steroid and diuretics (LD-combination therapy), and ITDI (intratympanic dexamethasone injection) and diuretics (ITDI-combination therapy). To identify risk factors, we reviewed the clinical features of patients such as age, sex, chief complaint, accompanying symptoms, diabetes, hypertension, time from disease onset, the extent of hearing loss, treatment methods, and 1 kHz involvement. INTERVENTIONS ALFHL was diagnosed based on the average hearing loss >30 dB at 250 and 500 Hz. RESULTS The overall rates of hearing recovery were 70-80% in the four treatment groups. In terms of the prognosis of ALFHL patients, we found that a longer time from disease onset and 1 kHz involvement were independent risk factors for poor prognosis. In addition, we compared treatment outcomes of four treatment methods in the presence or absence of risk factors. In ALFHL patients with risk factors, we found statistically significant differences (p = 0.042) among treatment methods; effectiveness ranged in the order if ITDI-combination therapy, LD-combination therapy, HD-steroid, and LD-steroid. CONCLUSIONS Risk factors for poor hearing recovery in ALFHL included longer symptom duration and 1 kHz involvement. In ALFHL with such risk factors, combination therapy was more effective than oral steroid therapy.
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Yoshida T, Sone M, Kitoh R, Nishio SY, Ogawa K, Kanzaki S, Hato N, Fukuda S, Hara A, Ikezono T, Ishikawa K, Iwasaki S, Kaga K, Kakehata S, Matsubara A, Matsunaga T, Murata T, Naito Y, Nakagawa T, Nishizaki K, Noguchi Y, Sano H, Sato H, Suzuki M, Shojaku H, Takahashi H, Takeda H, Tono T, Yamashita H, Yamasoba T, Usami SI. Idiopathic sudden sensorineural hearing loss and acute low-tone sensorineural hearing loss: a comparison of the results of a nationwide epidemiological survey in Japan. Acta Otolaryngol 2017; 137:S38-S43. [PMID: 28366083 DOI: 10.1080/00016489.2017.1297539] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the differences between idiopathic sudden sensorineural hearing loss (SSNHL), and acute low-tone sensorineural hearing loss (ALHL) using the results of a nationwide survey database in Japan and to analyze the variables associated with their clinical features and the severity of hearing impairment, treatment, and prognosis. METHODS Participants were patients registered between April 2014 and March 2016 in a multicenter epidemiological survey database involving 30 university hospitals and medical centers across Japan. Statistical analysis was performed to clarify the factors associated with their clinical characteristics and the severity of hearing impairment, treatment, and prognosis. RESULTS Idiopathic SSNHL and ALHL differed significantly in terms of male-to-female ratio, age distribution, and time from onset to start of treatment. The treatment methods and hearing prognosis also differed markedly between the two diseases. A majority (92%) of idiopathic SSNHL patients were administered some type of corticosteroid, while half of the ALHL patients received corticosteroids and a diuretic agent. CONCLUSION The results suggested that idiopathic SSNHL and ALHL belonged to different categories of inner ear disease.
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Affiliation(s)
- Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Ryosuke Kitoh
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-ya Nishio
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Sho Kanzaki
- Department of Otorhinolaryngology Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naohito Hato
- Department of Otolaryngology, Ehime University School of Medicine, Toon, Japan
| | - Satoshi Fukuda
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akira Hara
- Department of Otolaryngology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuo Ikezono
- Department of Otorhinolaryngology, Saitama School of Medicine, Moroyama, Japan
| | - Kotaro Ishikawa
- Department of Otolaryngology, Hospital, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
| | - Satoshi Iwasaki
- Department of Otolaryngology, International University of Health and Welfare, Mita Hospital, Minato, Tokyo, Japan
| | - Kimitaka Kaga
- Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Seiji Kakehata
- Department of Otorhinolaryngology, Yamagata University School of Medicine, Yamagata, Japan
| | - Atsushi Matsubara
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tatsuo Matsunaga
- Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takaaki Murata
- Department of Otolaryngology, Gunma University Graduate School of Medicine, Maebashi-City, Japan
| | - Yasushi Naito
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmacy, Okayama, Japan
| | - Yoshihiro Noguchi
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hajime Sano
- Department of Otolaryngology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroaki Sato
- Department of Otorhinolaryngology, Iwate Medical University, Morioka, Japan
| | - Mikio Suzuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Hideo Shojaku
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Toyama, Toyama, Japan
| | - Haruo Takahashi
- Department of Otolaryngology, Nagasaki University Faculty of Medicine, Nagasaki, Japan
| | - Hidehiko Takeda
- Department of Otolaryngology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Testuya Tono
- Department of Otolaryngology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Yamashita
- Department of Otolaryngology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shin-ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
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Choo OS, Yang SM, Park HY, Lee JB, Jang JH, Choi SJ, Choung YH. Differences in clinical characteristics and prognosis of sudden low- and high-frequency hearing loss. Laryngoscope 2016; 127:1878-1884. [DOI: 10.1002/lary.26382] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/23/2016] [Accepted: 09/27/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Oak-Sung Choo
- Department of Otolaryngology; Ajou University School of Medicine; Suwon Republic of Korea
| | - Suk Min Yang
- Department of Otolaryngology; Ajou University School of Medicine; Suwon Republic of Korea
| | - Hun Yi Park
- Department of Otolaryngology; Ajou University School of Medicine; Suwon Republic of Korea
| | - Jong Bin Lee
- Department of Otorhinolaryngology; College of Medicine, Konyang University and Myunggok Medical Research Center; Daejon Republic of Korea
| | - Jeong Hun Jang
- Department of Otolaryngology; Ajou University School of Medicine; Suwon Republic of Korea
| | - Seong Jun Choi
- Department of Otolaryngology-Head and Neck Surgery; Cheonan Hospital, Soonchunhyang University College of Medicine; Cheonan Republic of Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology; Ajou University School of Medicine; Suwon Republic of Korea
- Bk21 PLUS Research Center for Biomedical Sciences; Ajou University Graduate School of Medicine; Suwon Republic of Korea
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Chang J, Yum G, Im HY, Jung JY, Rah YC, Choi J. Short-Term Outcomes of Acute Low-Tone Sensorineural Hearing Loss According to Treatment Modality. J Audiol Otol 2016; 20:47-52. [PMID: 27144234 PMCID: PMC4853891 DOI: 10.7874/jao.2016.20.1.47] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 02/19/2016] [Accepted: 03/10/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We compared improvements in hearing thresholds in acute low-tone sensorineural hearing loss (ALHL) patients after two different treatments: steroid alone and steroid and diuretic combined. We analyzed how the duration between the onset of symptoms and the initiation of treatment affected hearing loss improvement and investigated the relation between presence of vertigo in ALHL patients and ALHL progression to Ménière's disease (MD). SUBJECTS AND METHODS We retrospectively analyzed the medical records of 47 ALHL patients aged 21 to 76 years. Patients received either orally administered steroid alone (n=12) or steroid and diuretic combined (n=35). We compared improvements in the two groups' hearing thresholds at three lower frequencies (125, 250, and 500 Hz) after participants had received one month of each respective treatment. RESULTS Our two treatments did not show any statistical difference in hearing loss improvement after one month. Forty percent of ALHL patients with vertigo developed MD, which was a significantly higher rate than the 12.5% of ALHL patients without vertigo who developed MD. The shorter duration between the onset of symptoms and the initiation of treatment significantly increased improvement in the sum of lower frequency hearing threshold after one month. CONCLUSIONS The current study suggests that steroid and diuretic administered together and steroid alone similarly improve the hearing threshold in ALHL patients after one month. We concluded that patients should initiate ALHL treatment as soon as they experience symptoms. ALHL patients should also be notified of their higher risk of developing MD.
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Affiliation(s)
- Jinkyung Chang
- The Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Gunhwee Yum
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Ha-Young Im
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Jong Yoon Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - June Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan, Korea
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Morita S, Nakamaru Y, Fujiwara K, Iizuka K, Masuya M, Homma A, Fukuda A, Fukuda S. The Short- and Long-Term Outcome of Intratympanic Steroid Therapy as a Salvage Treatment for Acute Low-Tone Sensorineural Hearing Loss without Episodes of Vertigo. Audiol Neurootol 2016; 21:132-40. [PMID: 27077389 DOI: 10.1159/000444577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 02/08/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate the hearing outcomes of intratympanic steroid (ITS) treatment for patients with acute low-tone sensorineural hearing loss (ALHL) after failure of initial therapy and to investigate the recurrence and progression to definite Ménière's disease (MD) during a long-term follow-up. METHODS We retrospectively reviewed the medical records of 90 patients with refractory ALHL who were followed up for at least 1 year between January 2000 and April 2014. Patients who responded poorly to initial medical treatment received intratympanic dexamethasone injections (ITS group) or isosorbide administration for 4 weeks (diuretic group) as salvage treatment options according to their choice of management. The control group did not receive ITS or the diuretic, due to their refusal of both medical treatments. The hearing outcomes were evaluated 1 month, 1 year and 5 years after the completion of the second-line therapy, and the rates of recurrence and progression to MD were measured during a follow-up period of at least 1 year. RESULTS Twenty-seven patients in the ITS group, 39 patients in the diuretic group and 24 patients in the control group were enrolled. Of these, 12 patients in the ITS group, 15 patients in the diuretic group and 12 patients in the control group were followed up for over 5 years. We found that the recovery rates and the audiometric functional values after 1 month and 1 year in the ITS group were significantly higher than those in the diuretic and control groups. However, there were no significant differences in the recovery rates or the audiometric functional values after 5 years, or in the rates of recurrence and progression to MD between the groups. CONCLUSIONS Salvage ITS therapy can provide a relatively good short-term hearing outcome for ALHL patients who have persistent hearing loss despite conventional treatment. However, both recurrence and progression to MD after treatment were observed in some patients during the long-term follow-up.
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Affiliation(s)
- Shinya Morita
- Department of Otolaryngology, Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Abstract
INTRODUCTION Hydrops and abnormalities of inner fluid pressure are involved in some otologic diseases such as Ménière's disease (MD). However, demonstrating abnormal perilymphatic or endolymphatic pressure is challenging. Multifrequency tympanometry studies in MD patients demonstrated an increase of the width of conductance tympanograms (outside an attack) compared with controls. To confirm that the increase in conductance width is caused by hyperpressure and not hypopressure in these patients tested outside an attack, we assessed the effect of changes in inner ear fluid pressure caused by body tilt on the results of multifrequency admittancemetry tympanograms. MATERIALS AND METHODS A multifrequency tympanometry including conductance (G) tympanogram at 2 kHz and resonance frequency measurements were performed in 20 volunteers (40 ears) free of otologic or neurologic disease. The measures were collected in three different positions: vertical, supine, and Trendelenburg positions. RESULTS Changes in inner ear fluid pressure caused by body tilt induced an increase in the width of G tympanograms. In the vertical position, the mean value was 141.7 ± 56.5 daPa; in the supine position, it increased to 158 ± 58.3 daPa; and increased even more in the Trendelenburg position (20 degrees), with a mean of 184 ± 69.6 daPa (p < 0.01). Resonance frequency also increased in the Trendelenburg position.We conclude that the increased width of G tympanograms in MD patients outside an attack may be caused by an increase in inner ear fluid pressure.
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Roh KJ, Lee EJ, Park AY, Choi BI, Son EJ. Long-Term Outcomes of Acute Low-Tone Hearing Loss. J Audiol Otol 2015; 19:74-8. [PMID: 26413572 PMCID: PMC4582450 DOI: 10.7874/jao.2015.19.2.74] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/16/2015] [Accepted: 05/11/2015] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives Although acute low-tone hearing loss has been associated with cochlear hydrops or early stage Meniere's disease, its prognosis in the short-term has been reported to be better than sudden hearing loss. However, recurrence of hearing loss and possible progression to Meniere's disease remain important concerns in the clinical setting. This study aims to investigate the long-term audiological outcomes of acute low-tone hearing loss. Subjects and Methods A retrospective review of patients presenting with a first attack of acute low-tone hearing loss was performed. Of the 77 patients, 33 were followed up for more than 3 months. Progression, recovery of hearing loss and recurrence of hearing loss were examined. Also, correlation between long-term outcomes and associated clinical factors were analyzed. Results Twenty-five patients (75.7%) had complete hearing recovery, five patients (15.1%) had partial recovery, two patients (6.0%) had no recovery, and one patient (3.0%) had progression of hearing loss 1 month after initial treatment. Thirty-three patients were followed up for more than 3 months (mean 22 months, range 3-79 months). Recurrences of acute low-tone hearing loss were observed in five patients (15.2%). All of the recurrences occurred during the first 12 months of follow-up. Long-term prognosis correlated with the initial therapy results (R2=0.693). Conclusions Recurrences of hearing loss were documented in five patients (15.2%), and all of these cases occurred within one year of the first attack. Audiological outcomes after initial therapy may predict the recurrence of acute low-tone hearing loss.
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Affiliation(s)
- Kyung Jin Roh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong Il Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jin Son
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Young YH. Potential application of ocular and cervical vestibular-evoked myogenic potentials in meniere's disease: A review. Laryngoscope 2012; 123:484-91. [DOI: 10.1002/lary.23640] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 06/25/2012] [Accepted: 07/11/2012] [Indexed: 11/10/2022]
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Yasui T, Iwasaki S, Sugasawa K, Sakamoto T, Kashio A, Suzuki M, Kakigi A, Yamasoba T. Admittance tympanometry with 2-kHz probe tones in patients with low-frequency hearing loss. Laryngoscope 2012; 122:2252-5. [PMID: 22777819 DOI: 10.1002/lary.23439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 04/21/2012] [Accepted: 04/25/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the reliability of admittance tympanometry with 2-kHz probe tones in diagnosing ears with endolymphatic hydrops in patients with low-frequency hearing loss. STUDY DESIGN Case-control study. METHODS Thirty-six Japanese patients with low-frequency hearing loss (including 21 with Mènière disease, three with delayed endolymphatic hydrops, and 12 with acute or repetitious low-frequency sensorineural hearing loss), 18 patients with other types of hearing loss, and 16 subjects with normal hearing were enrolled at University of Tokyo Hospital. We measured the width of the splitting peaks in the admittance tymapnometry with 2-kHz probe tones. RESULTS Widths of the probe pressure corresponding to splitting peaks of admittance (Y) tympanometry were significantly greater in the ears with endolymphatic hydrops than in the ears without endolymphatic hydrops in patients with low-frequency hearing loss. Furthermore, the widths in the ears with endolymphatic hydrops were greater than those in ears with other types of hearing loss. Widths of >255 daPa were observed in 38% of ears with endolymphatic hydrops and low-frequency hearing loss and in 21% of ears with other types of hearing loss. CONCLUSIONS The current study demonstrated that wide splitting peaks of Y tympanometry are more frequently observed in ears showing low-frequency hearing loss than in those with other types of hearing loss, indicating that Y tympanometry can be used to diagnose endolymphatic hydrops in daily practice.
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Affiliation(s)
- Takuya Yasui
- Department of Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Retrocochlear mass lesion in mid-frequency sudden deafness. Otolaryngol Head Neck Surg 2008; 138:13-7. [DOI: 10.1016/j.otohns.2007.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 08/20/2007] [Accepted: 10/10/2007] [Indexed: 11/24/2022]
Abstract
Objective This study retrospectively reviewed all cases of mid-frequency sudden deafness to understand the clinical significance of this hallmark finding. Study Design Retrospective study. Subjects and Methods From 1992 to 2006, a total of 556 patients with sudden deafness were experienced. Based on the audiographic configuration, these patients were classified into: flat-type group, 272 cases; high-frequency group, 146 cases; low-frequency group, 70 cases; mid-frequency group, 30 cases; and unclassified group, 38 cases. All patients underwent a battery of audiovestibular function testing. Results Among 556 sudden deafness patients, 17 patients (3%) were proved to have a retrocochlear tumor, including mid-frequency group (10), high-frequency group (4), flat-type group (2), and low-frequency group (1). Thus, the mid-frequency group had significantly higher (33%) association with a retrocochlear tumor than other groups. Conclusion One-third of the patients with mid-frequency sudden deafness harbor a true retrocochlear mass lesion; hence, MR imaging is mandatory in such cases.
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Nakaya M, Morita I, Horiuchi M. Recurrent hearing loss after myelography treated with epidural blood patch. Auris Nasus Larynx 2005; 32:399-401. [PMID: 16183232 DOI: 10.1016/j.anl.2005.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Revised: 05/31/2005] [Accepted: 07/22/2005] [Indexed: 11/22/2022]
Abstract
Transient hearing impairment is a known sequel after various procedures that result in loss of cerebrospinal fluid, such as lumbar puncture, spinal anesthesia and myelography. But persistent or recurrent hearing loss after dural puncture is a rare entity. We present a case with recurrent low-frequency sensorineural hearing loss after myelography. The patient was treated successfully by means of an epidural blood patch, although the conservative treatment was ineffective.
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Affiliation(s)
- Muneo Nakaya
- Department of Otolaryngology, Central Hospital of Self-Defence Agency, Faculty of Medicine, University of Tokyo, Hongo 7-3-1 Bunkyo-ku, Tokyo 113-8655, Japan.
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Noguchi Y, Nishida H, Tokano H, Kawashima Y, Kitamura K. Comparison of acute low-tone sensorineural hearing loss versus Meniere's disease by electrocochleography. Ann Otol Rhinol Laryngol 2004; 113:194-9. [PMID: 15053200 DOI: 10.1177/000348940411300304] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To clarify the pathogenesis of acute low-tone sensorineural hearing loss (ALHL), we retrospectively compared the electrocochleographic findings from 20 patients with ALHL with those from 58 patients with Meniere's disease (MD) classified into 4 groups (MD1 through MD4) according to their pure tone average. The mean summating potential-action potential ratio in the ALHL group was 0.35 +/- 0.13, which was significantly higher than the control ratio but similar to the ratio seen in the MD1 group (pure tone average < 25 dB hearing level). The mean detection threshold of the cochlear microphonics in the ALHL group was 32.0 +/- 9.4 dB normal hearing level, which was again similar to that seen in the MDI group. Moreover, more than 50% of patients with ALHL had normal cochlear microphonics input-output curves. We therefore conclude that the pathogenesis of ALHL arises from an endolymphatic hydrops with little or no impairment of hair cells that resembles early-stage MD.
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Affiliation(s)
- Yoshihiro Noguchi
- Department of Otolaryngology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Nozawa I, Imamura SI, Mizukoshi A, Honda H, Okamoto Y. Clinical study of acute low-tone sensorineural hearing loss: survey and analysis of glycerol test and orthostatic test. Ann Otol Rhinol Laryngol 2002; 111:160-4. [PMID: 11860069 DOI: 10.1177/000348940211100209] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fifty patients (14 men and 36 women ranging in age from 16 to 66 years) with acute low-tone sensorineural hearing loss (ALHL) were retrospectively analyzed in this study. The glycerol test and the orthostatic test were performed. On the glycerol test, 43.8% of 16 ears of the 14 men and 33.3% of 39 ears of the 36 women with ALHL had a positive result. On the orthostatic test, 42.9% of the 14 men and 52.7% of the 36 women with ALHL had a positive result. In addition, 28.6% of the 14 men and 33.3% of the 36 women had hypotension with a systolic blood pressure of 100 mm Hg or less. Our results suggest that endolymphatic hydrops as shown by the glycerol test and an underlying autonomic imbalance and/or insufficient blood circulation as shown by the orthostatic test may be important factors in the causation of ALHL.
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Affiliation(s)
- Izuru Nozawa
- Department of Otolaryngology, Yamanashi Medical University, Japan
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Imamura S, Nozawa I, Imamura M, Murakami Y. Clinical observations on acute low-tone sensorineural hearing loss. Survey and analysis of 137 patients. Ann Otol Rhinol Laryngol 1997; 106:746-50. [PMID: 9302905 DOI: 10.1177/000348949710600906] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We retrospectively analyzed the clinical records of 137 patients who were treated at our clinic for acute low-tone sensorineural hearing loss of unknown cause over a period of 8 years. The analyses of the clinical records indicated the following clinical characteristics: female preponderance; peak incidence during the fourth decade of life; frequent accompanying tinnitus, sensation of ear fullness, and/ or autophony; suspicion of bilateral involvement; and association with autonomic imbalance. The hearing in most of the patients completely recovered, but some selected patients experienced fluctuating hearing loss or progression to Meniere's disease. Our results suggest that a subgroup of patients with severe initial hearing loss should be carefully followed up, although it is difficult to predict the outcome of this disorder.
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Affiliation(s)
- S Imamura
- Department of Otolaryngology, Yamanashi Medical University, Japan
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