Rare Causes of Unilateral Sensorineural Hearing Loss in Adults: Our Experience

Osteopathic Cranial Manipulative Medicine as a Proposed Addition to the Treatment Regimen for Idiopathic Sudden-Onset Unilateral Sensorineural Hearing Loss: A Case Report

Adult sudden-onset unilateral sensorineural hearing loss is primarily idiopathic. There are few treatment options with high success rates, but the literature suggests there is equally moderate success with oral or intratympanic steroids, with some evidence to support the use of acupuncture as a salvage treatment. Here, we present a case of sudden unilateral sensorineural hearing loss with otolaryngology evaluation and audiograms before and after osteopathic manipulative treatment (OMT). Osteopathic cranial manipulative medicine (OCMM) directed at eustachian tube dysfunction elicited findings indicating resolution of symptoms was at least partly due to cranial treatment. This report explains a probable anatomic mechanism contributing to hearing loss and suggests treatment options that should be considered as part of the treatment of idiopathic unilateral hearing loss. Future research opportunities are also proposed.

Predictive factors for recovery in idiopathic sudden sensory neural hearing loss

Background

Idiopathic sudden sensorineural hearing loss (ISSNHL) is considered a clinical symptom of various conditions. Circulatory disorders, viral infection, labyrinthine membrane rupture, and autoimmune reactions are considered as the common causes, but the exact cause remains unestablished. Various drugs and methods have been used empirically for the treatment of ISSHL. The current study aimed at evaluation factors contributing to the success of standardized medical therapy in cases of ISSNHL.

Methods

In period between 2019 and 2021, a total 40 patients with ISSNHL were enrolled. All patients were subjected to history taking, physical and ENT evaluation. Patients were managed according to the recent guidelines for managing ISSNHL included systemic steroid and salvage therapy.

Results

Mean age of studied patients was 42.55 ± 13.14 years with range between 19 and 70 years. Out of the studied patients; 26 (65%) patients were males and 14 (35%) patients were females. Majority (80%) of patients had no comorbidities. Based on the current study, we found that only 12 (30%) patients were improved while 28 (70%) patients were not improved. It was found that majority (58.3%) of improved patients was females. Frequency of vertigo was significantly higher among patients who were not improved. Three (10.7%) patients of not-improved group and 5 (41.7%) patients of improved group had low lymphocyte:monocytes ratio.

Conclusion

Patients with ISSNHL, the presence of vertigo and late onset of presentation may carry a risk for poor prognosis. Multiple centers studies with large number of patients are warranted to confirm such findings.

Spectrum of Handicap in Unilateral Sensorineural Hearing Loss

Unilateral Sensorineural Hearing Loss (USNHL) can present with varying symptoms apart from hearing loss, such as dizziness and tinnitus. Impaired sound localization, inability to identify speech in noise and decreased temporal summation can significantly impair the daily activities of an individual. This along with dizziness and tinnitus affects the physical, mental and social health as well. The purpose of this study is to assess and correlate the spectrum of handicap faced by USNHL patients. Validated questionnaires were used to evaluate handicap in 42 USNHL patients due to hearing loss (Hearing Handicap Inventory for Adults-HHIA), dizziness (Dizziness Handicap Inventory-DHI) and tinnitus (Tinnitus Handicap Inventory-THI). These handicaps were then correlated with each other using Spearman's correlation coefficient. Statistically significant strong positive correlation of HHIA was seen with DHI (rho = 0.60, p ≤ 0.001) and THI (rho = 0.74, p ≤ 0.001). Similarly, strong positive correlation was seen between emotional subscales of HHIA and DHI (rho = 0.73, p ≤ 0.001). USNHL can lead to significant emotional and social handicap which is compounded in the presence of hearing loss, dizziness and tinnitus. These handicaps are strongly correlated to one another. Hence, a holistic approach is needed for USNHL rehabilitation. There exists a need to develop a comprehensive measure to assess and grade the handicap faced by these patients.

Unilateral Sensorineural Hearing Loss (USNHL): A Retrospective Study of Incidence

This retrospective study was carried out to know the incidence of unilateral sensorineural hearing loss (USNHL) (type and degree). (1) To know the incidence of USNHL (other ear being normal) in patients undergoing Pure Tone Audiometry (PTA) for hearing loss (HL). (2) To establish the type and degree of USNHL in patients. Study was conducted over a period of more than 4 years to find out the incidence and pattern of USNHL (other ear being normal) in the patients attending ear, nose, and throat outpatient department (OPD) with a complaint of HL. Pure tone audiometry data of 10,000 cases between August 2014 and December 2018 with HL were analyzed for this study. Demographic characteristics were compared with types and degrees of unilateral sensorineural hearing impairment. A total of 10,000 OPD cases who had a complaint of HL and had undergone pure tone audigram (PTA) in a period of more than 4 years in the Department of Otorhinolaryngology and Head and Neck Surgery were studied. SNHL type was the highest with 3935 cases (39.3%). Out of 3935 cases of SNHL, 1436 (36.50%) were USNHL-out of which, only 872 cases (60.72%) had USNHL with other ear being normal; this constituted the study group, i.e., 872 cases (8.72%) out of 10,000 PTA and 872/3935 (22.16%) of SNHL cases. Hence, incidence of USNHL (with other ear being normal) is 8.72% among all cases of HL and 22.16% among cases of SNHL. Age of cases ranged from 8 to 76 years (mean age - 39.5 years). Male:Female ratio was 1.6:1.0. Both ears were almost equally involved. 35.6% cases had profound (> 90 dB) hearing loss, followed by mild (25-40 dB) in 32.1%.

The Impact of Unilateral Sensorineural Hearing Loss on Quality of Life of Sub-Himalayan Population

Introduction

Unilateral Sensorineural Hearing Loss (USNHL) is an age-old known entity. Patients with USNHL lack the merits of binaural hearing, i.e., temporal summation, sound localization, and speech recognition in a noisy environment. The lack of binaural hearing affects such individuals' quality of life (QOL). The present study is the most extensive Indian series related to QOL in USNHL patients.

Objectives

This study aims to assess the impact of USNHL on the QOL of patients in the state of Uttarakhand.

Methods

A cross-sectional study was carried out at a tertiary care center in Uttarakhand over a period of 18 months, from January 2018 to July 2019. A total of 115 patients with pure USNHL were evaluated using a validated questionnaire—Hearing Handicap Inventory for Adults-Hindi (HHIA-H).

Results

In our study, patients with higher HHIA-H scores were male, young adults (age group 18–30 years), students, and laborers. Most of our patients (64%) had significant handicaps, followed by moderate handicaps in 25%. However, no significant correlation of degree of handicap was seen with age, duration, and degree of hearing loss.

Conclusion

USNHL can lead to a significant handicap that can severely affect the emotional and social aspects of life. Thus, early diagnosis and rehabilitation are essential to prevent handicap and uplift QOL in patients with USNHL. This trial is registered with Clinical Trials Registry of India (CTRI reg. no. CTRI/2018/06/014396).