Effect of steroid, carbogen inhalation, and lipoprostaglandin E1 combination therapy for sudden sensorineural hearing loss

Is Sensorineural Hearing Loss Related to Chronic Rhinosinusitis Caused by Outer Hair Cell Injury?

Background

Sensorineural hearing loss is caused by defects in the inner ear. In the present study, associations between chronic rhinosinusitis, outer hair cell injury, and sensorineural hearing loss were investigated.

Material/Methods

A total of 103 patients who met the inclusion criteria were recruited and allocated into a chronic rhinosinusitis group (n=82) and a simple deviated nasal septum group (n=21). Degree and type of hearing loss, including distortion product otoacoustic emissions, were used to assess the status of cochlear outer hair cells.

Results

The rate of hearing loss in the simple deviated nasal septum group was significantly lower than in the chronic rhinosinusitis group (4.76%, 1/21 vs. 24.39%, 20/82, P<0.05), among which 15 chronic rhinosinusitis patients (75%, 15/20) had hearing loss in the high frequency range. Acoustic stapedial reflexes were elicited in all patients of the 2 groups, while positive Metz was found in 3 chronic rhinosinusitis patients (15%, 3/20). The pass rate of distortion product otoacoustic emissions (DPOAEs) for chronic rhinosinusitis patients was significantly lower than in simple deviated nasal septum patients (88.10% vs. 70.73%, P<0.05). Moreover, the signal-to-noise ratio of DPOAE test results at 704 Hz, 3991 Hz, and 5649 Hz in the chronic rhinosinusitis group were significantly lower than in the simple deviated nasal septum group (P<0.05). Logistic regression analysis revealed a correlation between severity of chronic rhinosinusitis and sensorineural hearing loss (OR=1.39, P<0.05).

Conclusions

Outer hair cell injury and sensorineural hearing loss may have a common cause in chronic rhinosinusitis patients.

Therapeutic effect of combined steroid-lipoprostaglandin E1 for sudden hearing loss: a propensity score-matched analysis

OBJECTIVES

The aim of this study is to analyze the synergistic effect of combined steroid-lipoprostaglandin E1 for the treatment of sudden hearing loss.

METHODS

A prospective observational, non-randomized study with a historical cohort was performed at a university hospital. Between 2005 and 2012, 421 patients with idiopathic sudden sensorineural hearing loss were enrolled in this study and treated with combined steroid-lipoprostaglandin E1 treatment. Additionally, 132 patients were prospectively enrolled and treated with steroid treatment alone between January 2013 and March 2014. After performing a propensity score-matched analysis, final hearing levels and the degree of recovery were compared according to treatment options.

RESULTS

A total of 240 patients were enrolled after propensity score-matching, with 180 patients classified as combined steroid-lipoprostaglandin E1 treatment group (group I) and 60 patients as steroid treatment alone group (group II). The final hearing level (35.56±34.64dB) in group I was not significantly different from that in group II (34.64±24.67dB) (p<0.05). Logistic regression analysis revealed that the combined treatment did not influence recovery, and the probability of recovery was 1.881 times higher in the absence of dizziness (95% confidence interval: 1.022-3.464, p=0.042), and 1.026 times higher in patients with better hearing in healthy ears (95% confidence interval: 1.010-1.041, p=0.001).

CONCLUSION

Compared to steroid treatment alone, combined steroid-lipoprostaglandin E1 treatment failed to improve sudden hearing loss.

Optimal dosage of methylprednisolone for the treatment of sudden hearing loss in geriatric patients: a propensity score-matched analysis

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.

Steroids for idiopathic sudden sensorineural hearing loss

BACKGROUND

This is an update of a Cochrane review first published in The Cochrane Library in Issue 1, 2006 and previously updated in 2009.Idiopathic sudden sensorineural hearing loss (ISSHL) is a clinical diagnosis characterised by a sudden deafness of cochlear or retrocochlear origin in the absence of a clear precipitating cause. Steroids are commonly prescribed to treat this condition. There is no consensus on their effectiveness.

OBJECTIVES

To determine whether steroids in the treatment of ISSHL a) improve hearing (primary) and b) reduce tinnitus (secondary).To determine the incidence of significant side effects from the medication.

SEARCH METHODS

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 22 April 2013.

SELECTION CRITERIA

We identified all randomised controlled trials (with or without blinding) in which steroids were evaluated in comparison with either no treatment or a placebo. We considered trials including the use of steroids in combination with another treatment if the comparison control group also received the same other treatment. The two authors reviewed the full-text articles of all the retrieved trials of possible relevance and applied the inclusion criteria independently.

DATA COLLECTION AND ANALYSIS

We graded trials for risk of bias using the Cochrane approach. The data extraction was performed in a standardised manner by one author and rechecked by the other author. Where necessary we contacted investigators to obtain the missing information. Meta-analysis was neither possible nor considered appropriate because of the heterogeneity of the populations studied and the differences in steroid formulations, dosages and duration of treatment. We analysed and reported the quality of the results of each study individually. A narrative overview of the results is presented.

MAIN RESULTS

Only three trials, involving 267 participants, satisfied the inclusion criteria and all three studies were at high risk of bias. One trial showed a lack of effect of oral steroids in improving hearing compared with the placebo control group. The second trial showed a significant improvement of hearing in 61% of the patients receiving oral steroid and in only 32% of the patients from the control group (combination of placebo-treated group and untreated control group). The third trial also showed a lack of effect of oral steroids in improving hearing compared with the placebo control. However, this trial did not follow strict inclusion criteria for participant selection and analysis of data was limited by significant exclusion of participants from the final analysis and lack of participant compliance to the treatment protocol. No clear evidence was presented in two trials about any harmful side effects of the steroids. Only one study declared that no patients suffered from adverse effects of the steroid treatment.

AUTHORS' CONCLUSIONS

The value of steroids in the treatment of idiopathic sudden sensorineural hearing loss remains unclear since the evidence obtained from randomised controlled trials is contradictory in outcome, in part because the studies are based upon too small a number of patients.

The effect of topically administered latanoprost on the cochlear blood flow and hearing

OBJECTIVE

The application of intratympanic latanoprost (PGF2α analog) has been recently used to alleviate vertigo, disequilibrium and to improve hearing in Meniere's disease patients. However, there is no known report on the effect of topically applied latanoprost on hearing and cochlear hemodynamic parameters including cochlear blood flow (CBF) and vascular conductance. Our goal was to assess the influence of topically applied latanoprost on cochlear blood flow (CBF) and hearing.

MATERIALS AND METHODS

Twenty male Sprague-Dawley rats were randomly divided into the group A, 50 μl of latanoprost (1 ml containing 50 μg, n=10) and group B, 100 μl (1 ml containing 50 μg, n=10). Topical application of latanoprost was performed at the right side, and the left side was applied with phosphate buffered saline (PBS) as a negative control. Five rats at each group were used to measure cochlear blood flow (CBF). And the others at each group were used for hearing test by auditory brainstem response (ABR). After physiological examination, bullas were extracted. The changes of cochlear hair cells were observed by performing the field emission-scanning electron microscopy (FE-SEM).

RESULTS

The CBF of both groups was found to be decreased compared to the PBS applied left side. Significant decrement of CBF was observed in group B compared to the group A. Significant elevation of hearing threshold at high frequencies was observed in both groups compared to the PBS applied group. However, inner and outer hair cells were intact.

CONCLUSION

Topically administered latanoprost decreased the CBF and impaired hearing. Based on our findings, additional studies are required to evaluate the side effects of intratympanic latanoprost before its use in clinical practice.

Effects of carbogen on cochlear blood flow and hearing function following acute acoustic trauma in guinea pigs

BACKGROUND AND AIMS

Disturbances of microcirculation and hemorheological changes in the inner ear are the results of noise-induced hearing loss (NIHL). Both the disturbances of microcirculation and hemorheological changes are the etiologies of NIHL development, but they are also the results. Although previous reports that inhalation of high concentration of CO(2) may increase cochlear blood flow (CoBF), the effects of carbogen on the cochlear microcirculation and NIHL remain unclear.

METHODS

Changes induced by noise, carbogen and pure oxygen within the cochlear lateral wall microvasculature and in hearing thresholds were observed in guinea pigs using intravital microscopy and the auditory brainstem response. At the same time, arterial oxygen saturation and morphologic changes of cochlear hair cells were observed.

RESULTS

Carbogen inhalation increased vessel diameters and blood flow velocities. Hearing thresholds elevation in the carbogen group was smaller than those in the control and oxygen group (p <0.05). Carbogen inhalation produced a trend toward less threshold shift after noise exposure, which reached statistical significance after day 3 (p <0.01). Respiratory acidosis was not found in our study. The segmented basal membranes of Corti in three groups indicated that no losses or discorders of hair cells were found.

CONCLUSIONS

Carbogen inhalation can preserve hearing in animal models after acute acoustic trauma.

Sudden sensorineural hearing loss: an otologic emergency

The study purpose was to determine the efficacy of steroids, volume expanders and antivirals in the management of idiopathic sudden sensory neural hearing loss and to establish importance of early medical intervention. In this prospective study, thirty-four patients presenting with idiopathic sudden hearing loss of 30 db or more were enrolled in study group between 2005 and 2009. Patient variables as they related to recovery were studied and include patient age, time to onset of therapy, status of contralateral ear, presence of diabetes, severity of hearing loss, pattern of hearing loss in audiogram and presence of associated symptoms, (tinnitus, vertigo). Treatment protocol with intravenous hydrocortisone, intravenous dextran and oral anti-viral agent was followed. Pre-treatment and post-treatment pure tone average was analyzed. With combination therapy the overall improvement in pure tone threshold was seen in 27 patients (79.4%). A statistically significant association was found between the time at which medical intervention was started and hearing improvement. Early intervention in patients presenting before 3 days has given 77.8% complete type 1 recovery Idiopathic sudden sensory neural hearing loss is a medical emergency. It should not be misdiagnosed. Early detection and management with volume expanders, steroids and antivirals will improve the chances of complete recovery.