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Sun H, Yang Y, Yang R, Tian X, Zhao Y, Wu H, Gao Z. Paradoxical Embolism in Juveniles and Young Adults With Severe-to-Profound Sudden Sensorineural Hearing Loss. EAR, NOSE & THROAT JOURNAL 2024:1455613241250185. [PMID: 38801178 DOI: 10.1177/01455613241250185] [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: 05/29/2024] Open
Abstract
Objective: Paradoxical embolism from right-to-left shunting is a common cause of cryptogenic stroke in the young. Circulatory ischemia of the cochlea is closely connected with severe-to-profound sudden sensorineural hearing loss. This study aimed to explore the role of paradoxical embolism in severe-to-profound sudden sensorineural hearing loss in juveniles and young adults. Methods: From August 2021 to September 2022, consecutive outpatients under 35 years of age with severe-to-profound sudden hearing loss were included in the study. Routine auditory electrophysiological testing and contrast transcranial Doppler ultrasonography (c-TCD) were conducted, and the results were retrospectively analyzed. Results: Seven patients (age: 19.4 ± 6.5 years) were enrolled, including 5 juveniles and 2 young adults. Three patients had severe deafness, and 4 patients had profound deafness. Right-to-left shunting was detected in all patients through c-TCD. Patent foramen ovale was found in 2 patients while pulmonary arteriovenous fistula was found in 1 patient through contrast transthoracic echocardiography or cardiac catheterization. No patients had precipitating factors for sudden sensorineural hearing loss, and none had abnormalities on head magnetic resonance imaging. Six patients underwent whole-exome sequencing, and no known deafness gene variant was detected. After standard treatment for 1 month, 2, 3, and 2 patients had complete, slight, and no hearing recovery, respectively. Conclusions: Paradoxical embolism is a possible cause of severe-to-profound sudden sensorineural hearing loss in juveniles and young adults. In young patients, c-TCD is an effective screening tool to detect right-to-left shunting, while contrast transthoracic echocardiography is a complementary examination to c-TCD.
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Affiliation(s)
- Huiying Sun
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuchen Yang
- Department of Neurology and Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruizhe Yang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Tian
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyan Wu
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Gao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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von Werdt M, Korda A, Zamaro E, Wagner F, Kompis M, Caversaccio MD, Mantokoudis G. The acute vestibular syndrome: prevalence of new hearing loss and its diagnostic value. Eur Arch Otorhinolaryngol 2024; 281:1781-1787. [PMID: 37943315 PMCID: PMC10942940 DOI: 10.1007/s00405-023-08296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To assess the prevalence of new hearing losses in patients with acute vestibular syndrome (AVS) and to start to evaluate its diagnostic value for the differentiation between peripheral and central causes. DESIGN We performed a cross-sectional prospective study in AVS patients presenting to our Emergency Department (ED) from February 2015 to November 2020. All patients received an MRI, Head-impulse test, Nystagmus test and Test of skew ('HINTS'), caloric testing and a pure-tone audiometry. RESULTS We assessed 71 AVS patients, 17 of whom had a central and 54 a peripheral cause of dizziness. 12.7% had an objective hearing loss. 'HINTS' had an accuracy of 78.9% to diagnose stroke, whereas 'HINTS' plus audiometry 73.2%. 'HINTS' sensitivity was 82.4% and specificity 77.8% compared to 'HINTS' plus audiometry showing a sensitivity of 82.4% and specificity of 70.4%. The four patients with stroke and minor stroke had all central 'HINTS'. 55% of the patients did not perceive their new unilateral hearing loss. CONCLUSIONS We found that almost one-eighth of the AVS patients had a new onset of hearing loss and only half had self-reported it. 'HINTS' plus audiometry proved to be less accurate to diagnose a central cause than 'HINTS' alone. Audiometry offered little diagnostic accuracy to detect strokes in the ED but might be useful to objectify a new hearing loss that was underestimated in the acute phase. Complete hearing loss should be considered a red flag, as three in four patients suffered from a central cause.
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Affiliation(s)
- Moritz von Werdt
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Martin Kompis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland.
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Lee TE, Kim JS, Yeo CD, Yeom SW, Lee MG, Kang MG, Lee HJ, Lee EJ. Bidirectional Association Between Sudden Sensorineural Hearing Loss and Glaucoma: A Cohort Study. Laryngoscope 2023; 133:3169-3177. [PMID: 37036100 DOI: 10.1002/lary.30689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To investigate the bidirectional association between sudden sensorineural hearing loss (SSNHL) and open-angle glaucoma (OAG) over a 12-year follow-up period using nationwide, population-based data. METHODS The study was conducted using the National Health Information Database of the National Health Insurance Service (NHIS-NHID), which covered 3.5 million individuals from 2008 to 2019. In Study 1, we evaluated the effect of OAG on SSNHL, and in Study 2, we evaluated the effect of SSNHL on OAG. Participants of the control group were enrolled through "greedy nearest-neighbor" 1:1 propensity score matching. RESULTS In Study 1, 26,777 people were included in each group. The hazard ratio (HR) for SSNHL of the OAG group was 1.27 (95% confidence interval [CI], 1.15-1.39). In subgroup analysis, there was significant HR value regarding (old age: 1.17, hyperlipidemia: 1.19). In Study 2, 15,433 people were included in each group. The HR for OAG of the SSNHL group was 1.18 (95% CI, 1.07-1.30). In subgroup analysis, the HRs were significant for old age (2.31), hypertension (1.17), diabetes (1.39), and hyperlipidemia (1.26). CONCLUSION Over the 12-year follow-up, we found a bidirectional association between SSNHL and OAG, suggesting a shared pathogenesis. LEVEL OF EVIDENCE N/A. Laryngoscope, 133:3169-3177, 2023.
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Affiliation(s)
- Tae-Eun Lee
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jong Seung Kim
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Cha Dong Yeo
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Sang Woo Yeom
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Min Gyu Lee
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Min Gu Kang
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Eun Jung Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, Republic of Korea
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Shilo S, Gilboa D, Oron Y, Handzel O, Eta RA, Muhanna N, Brenner‐Ullman A, Ungar OJ. Vertebrobasilar System Laterality and Idiopathic Sudden Sensorineural Hearing Loss. Audiol Neurootol 2023; 29:114-123. [PMID: 37866348 PMCID: PMC10994577 DOI: 10.1159/000534153] [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] [Received: 02/17/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION The etiology of idiopathic sudden sensorineural hearing loss (ISSNHL) remains elusive, with vascular compromise as a proposed cause. This study aimed to explore the correlation between the vertebrobasilar vascular system laterality (VBVSL) and ISSNHL laterality. METHODS We conducted a retrospective analysis of consecutive patients diagnosed with ISSNHL from 2015 to 2020. The VBVSL pattern was established via magnetic resonance imaging scans by a neuroradiologist. ISSNHL occurring contralaterally to the basilar artery (BA) curvature or ipsilaterally to the dominant vertebral artery (VA) was designated as a "positive match," with all other scenarios classified as a "negative match." RESULTS Our study included 191 ISSNHL patients (median age 57 years, 89 males, 93 right ears). The majority of patients did not exhibit a positive match between ISSNHL laterality and the sides of BA curvature or dominant VA (28.8% and 36.6% for BA and VA, respectively). Notably, VA-positive match patients were significantly older than VA-negative match patients (59 vs. 53 years, p = 0.043), with a similar trend observed in BA-positive match compared to BA-negative match (59 vs. 54.5 years, p = 0.057). However, there was no significant difference in any other clinical, audiometric, or outcome factors between the positive and negative match groups. CONCLUSION The findings suggest no association between VBVSL and ISSNHL laterality. Furthermore, patients in the positive match group did not exhibit distinct clinical or audiometric features compared to those without a match.
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Affiliation(s)
- Shahaf Shilo
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dor Gilboa
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rani Abu Eta
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adi Brenner‐Ullman
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Omer Jacob Ungar
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Jeong JY, Byun H, Lee SH, Chung JH. Sudden Hearing Loss and Vertigo With Silent Pontine Infarction: A Case Report. J Audiol Otol 2023; 27:240-245. [PMID: 37872758 PMCID: PMC10603286 DOI: 10.7874/jao.2023.00241] [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: 06/21/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 10/25/2023] Open
Abstract
Most cases of sudden sensorineural hearing loss (SSNHL) occur without a specific identifiable cause, although vascular factors may serve as potential etiological contributors. Silent infarction refers to ischemic changes observed on imaging studies without accompanying clinical symptoms; however, this condition is clinically significant owing to the increased risk of future stroke. We report a case of left-sided SSNHL accompanied by dizziness in a 62-year-old male patient who was diagnosed with left pontine infarction without any other neurological symptoms. The cochlea and pons receive blood supply from the anterior inferior cerebellar artery; the cochlea lacks collateral vessels and is therefore susceptible to fluctuations in blood flow. This case report provides evidence to support the vascular hypothesis as the etiology underlying SSNHL.
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Affiliation(s)
- Jae Yeong Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Hayoung Byun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Seung Hwan Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jae Ho Chung
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
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Corazzi V, Migliorelli A, Bianchini C, Pelucchi S, Ciorba A. Hearing Loss and Blood Coagulation Disorders: A Review. Hematol Rep 2023; 15:421-431. [PMID: 37489373 PMCID: PMC10366903 DOI: 10.3390/hematolrep15030043] [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: 02/26/2023] [Revised: 04/21/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023] Open
Abstract
A relationship between microvascular disorders and sensorineural hearing loss (SNHL) has been widely proposed. The vascular hypothesis, theorized for the onset of sudden SNHL (SSNHL), is among the most acknowledged: a localized acute cochlear damage, of ischemic or haemorrhagic nature, could be considered a causative factor of SSNHL. The aim of this review is to assess (i) the effect on hearing in patients affected by blood coagulation disorders (prothrombotic or haemorrhagic) and (ii) the possible etiopathogenetic mechanisms of the related hearing loss. A PRISMA-compliant review was performed. Medline, Embase, and Cinahl databases were searched from inception to 31 January 2023, and a total of 14 studies have been included in the review. The available data suggest that it is possible to consider clotting disorders as a potential condition at risk for sensorineural hearing loss; in particular, coagulation tests and eventually the assessment of genetic and acquired prothrombotic factors should be recommended in patients with SSNHL. Also, an audiological evaluation should be recommended for patients with blood coagulation disorders presenting cochlear symptoms, especially in those suffering from clotting diseases.
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Affiliation(s)
- Virginia Corazzi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Andrea Migliorelli
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Chiara Bianchini
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Stefano Pelucchi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Andrea Ciorba
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, 44124 Ferrara, Italy
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Picciotti PM, Anzivino R, Galli J, Franceschi F, Conti G, Simeoni B, Covino M. Clinical Evolution of Acute Vestibular Syndrome: Longitudinal Retrospective Analysis of Epidemiological Data and Prognostic Factors for Recovery. J Pers Med 2023; 13:jpm13030407. [PMID: 36983588 PMCID: PMC10059062 DOI: 10.3390/jpm13030407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
We evaluated the clinical features of patients admitted to the ED with acute vertigo, verifying symptoms after one month and one year to establish epidemiological factors and predictors of resolution. We reviewed 233 records of patients admitted to ED for acute vertigo (125 F and 85 M, mean age 56.12 years). We analyzed the correlation between time of resolution (at one month and one year) and symptoms duration (subjective and/or objective vertigo, instability, cervical pain, audiological, neurological, and neurovegetative symptoms), comorbidities, and therapies, the result of the clinical and instrumental vestibular examination. Resolution of acute vertigo occurred in 81.1%, while persistence of vertigo one year after ED access was reported in 18.8%. There were 135 patients who recovered in one month. The presence of instability, auditory and neurovegetative symptoms, and neck pain represents a significant factor for recovery within one year. Age over 65 and a history of hypertension are associated with a worst recovery. Patients with spontaneous Nystagmus or positive HIT showed a significant difference in symptoms recovery within one month and one year. Presence of positional Nystagmus represents a positive prognostic factor. Our findings emphasize the importance of clinical evaluation of the acute vertigo, helping the clinicians to define central or peripheral diagnosis and predict the resolution of vertigo.
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Affiliation(s)
- Pasqualina M. Picciotti
- Department of Head and Neck, Otolaryngology Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Roberta Anzivino
- Otolaryngology Unit, Sensorineural Department, Di Venere Hospital, ASL BARI, 70131 Bari, Italy
| | - Jacopo Galli
- Department of Head and Neck, Otolaryngology Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Guido Conti
- Department of Head and Neck, Otolaryngology Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Benedetta Simeoni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Yao K, Zu HB. Isolated transient vertigo due to TIA: challenge for diagnosis and therapy. J Neurol 2023; 270:769-779. [PMID: 36371598 DOI: 10.1007/s00415-022-11443-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022]
Abstract
As a prevalent vertigo disease in the clinic, isolated transient vertigo can present as a vertigo episode without focal signs and always free of symptoms on presentation. Previous studies showed a part of isolated transient vertigo events had a high risk of stroke during follow-up. However, how to discern posterior circulation ischemia become a great challenge for clinicians, especially in emergency, neurology, and ENT departments. Routine besides, hematological, and imaging examinations are often difficult provide a clear etiological diagnosis. Hence, this article reviews current knowledge about the epidemiology, risk factors, offending lesions, and clinical manifestation of transient ischemic attack (TIA) presenting as isolated transient vertigo. In addition, we summarize several advances in besides examinations, serum biomarkers, and imaging technologies to better identify stroke events. Finally, the current situation of therapy was briefly retrospected. Here we present a critical clinical puzzle that needs to be solved in the future. Of note, there is a still lack of high-quality studies in this field. The article reviews the keys to the diagnosis of isolated transient vertigo due to TIA and provides us with more methods to screen for high-risk stroke populations.
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Affiliation(s)
- Kai Yao
- Department of Neurology, Jinshan Hospital Affiliated to Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
| | - Heng-Bing Zu
- Department of Neurology, Jinshan Hospital Affiliated to Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
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Cho JW, Cho SI, Baek W, Kim MS, Nam GS. Significance of Baseline Inferior Vestibular Function on the Prognosis of Patients with Labyrinthitis. Otol Neurotol 2023; 44:e26-e32. [PMID: 36509442 DOI: 10.1097/mao.0000000000003746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Acute spontaneous vertigo with idiopathic sudden sensorineural hearing loss (ISSNHL) can be diagnosed as labyrinthitis, which has a poorer prognosis than ISSNHL without vertigo. Thus, we aimed to identify the effect of the baseline vestibular function on the prognosis of labyrinthitis. METHODS A total of 23 patients with labyrinthitis was retrospectively divided into the recovered group (complete recovery, partial recovery) and the nonrecovered group (slight improvement, no improvement). Differences in caloric weakness and gain in the video head impulse test (vHIT) between the two groups were compared. In addition, the prognostic value of the vHIT on each of the three semicircular canals in predicting hearing recovery was analyzed using a linear regression model. RESULTS In final pure-tone audiometry, 2 patients (8.70%) exhibited complete recovery, 4 patients (17.39%) had partial recovery, and 17 patients (73.91%) had slight or no improvement. The initial ipsilesional posterior canal (iPC) gain and the contralesional anterior canal (cAC) gain were significantly decreased in the nonrecovered group (p < 0.013 for iPC and p < 0.007 for cAC, Mann-Whitney U test). The mean hearing gain was positively correlated with the iPC gain (R2 = 0.36, p = 0.003, Spearman correlation analysis). CONCLUSION An abnormal iPC gain may be a poor prognostic factor for hearing recovery. Additionally, the vHIT on the three semicircular canals can provide prognosis and insights into the pathophysiological mechanisms in patients with labyrinthitis.
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Affiliation(s)
- Ji-Woong Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Chosun University College of Medicine, Gwangju, South Korea
| | - Sung Il Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Chosun University College of Medicine, Gwangju, South Korea
| | - Wonyong Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Chosun University College of Medicine, Gwangju, South Korea
| | - Min Seok Kim
- Chosun University Hospital, Chosun University College of Medicine, Gwangju, South Korea
| | - Gi-Sung Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Chosun University College of Medicine, Gwangju, South Korea
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Castellucci A, Botti C, Delmonte S, Bettini M, Lusetti F, Brizzi P, Ruberto R, Gamberini L, Martellucci S, Malara P, Armato E, Renna L, Ghidini A, Bianchin G. Vestibular assessment in sudden sensorineural hearing loss: Role in the prediction of hearing outcome and in the early detection of vascular and hydropic pathomechanisms. Front Neurol 2023; 14:1127008. [PMID: 36873440 PMCID: PMC9975513 DOI: 10.3389/fneur.2023.1127008] [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: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Predicting hearing outcome in sudden sensorineural hearing loss (SSNHL) is challenging, as well as detecting the underlying pathomechanisms. SSNHL could be associated with vestibular damage since cochleo-vestibular structures share the same vascularization, along with being in close anatomical proximity. Whereas viral inflammations and autoimmune/vascular disorders most likely represent the involved aetiologies, early-stage Menière's disease (MD) can also present with SSNHL. Since an early treatment could beneficially influence hearing outcome, understanding the possible etiology plays a pivotal role in orienting the most appropriate treatment. We aimed to evaluate the extent of vestibular damage in patients presenting with SSNHL with or without vertigo, investigate the prognostic role of vestibular dysfunctions on hearing recovery and detect specific lesion patterns related to the underlying pathomechanisms. Methods We prospectively evaluated 86 patients with SSNHL. Audio-vestibular investigation included pure-tone/speech/impedance audiometry, cervical/ocular-VEMPs, vHIT and video-Frenzel examination. White matter lesions (WML) were evaluated on brain-MRI. Patients were followed-up and divided into "SSNHL-no-vertigo," "SSNHL+vertigo" and "MD" subgroups. Results Hearing was more impaired in "SSNHL+vertigo" patients who exhibited either down-sloping or flat-type audiograms, and was less impaired in "MD" where low frequencies were mostly impaired (p < 0.001). Otolith receptors were more frequently involved than semicircular canals (SCs). Although the "SSNHL-no-vertigo" subgroup exhibited the lowest vestibular impairment (p < 0.001), 52% of patients developed otolith dysfunctions and 72% developed nystagmus. Only "MD" subjects showed anterior SC impairment and upbeating spontaneous/positional nystagmus. They more frequently exhibited cervical-VEMPs frequency tuning (p = 0.036) and ipsilesional spontaneous nystagmus (p < 0.001). "SSNHL+vertigo" subjects presented with more frequently impaired cervical-VEMPs and posterior SC and with higher number of impaired receptors (p < 0.001). They mainly exhibited contralesional spontaneous and vibration-induced nystagmus (p < 0.05) and only they showed the highest WML score and "vascular" lesion patterns (p < 0.001). Concerning the outcomes, hearing was better in "MD" and worse in "SSNHL+vertigo" (p < 0.001). Hearing recovery was mostly affected by cervical-VEMPs impairment and the number of involved receptors (p < 0.05). Patients with "vascular" lesion patterns presented with the highest HL degree and WML score (p ≤ 0.001), while none of them exhibited a complete hearing recovery (p = 0.026). Conclusions Our data suggest that vestibular evaluation in SSNHL can provide useful information on hearing recovery and underlying aetiologies.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Ph.D. Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Delmonte
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Margherita Bettini
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Lusetti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pasquale Brizzi
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosanna Ruberto
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lisa Gamberini
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico Bellinzona, Bellinzona, Switzerland
| | - Enrico Armato
- ENT Unit, SS. Giovanni e Paolo Hospital, Venice, Italy
| | - Luigi Renna
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Bianchin
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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11
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Kim YS, Tehrani ASS, Lee HS. Sudden unilateral hearing loss and vertigo following isolated cerebellar hypoperfusion without infarction due to vertebral artery dissection. BMC Neurol 2022; 22:489. [PMID: 36536304 PMCID: PMC9762102 DOI: 10.1186/s12883-022-03024-2] [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: 06/14/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The definition of sudden sensorineural hearing loss (SSNHL) is broadly accepted as acute sensorineural hearing loss of more than 30 dB over at least three consecutive frequencies in a pure-tone audiogram (PTA). Acute audiovestibular loss is common with ischaemic stroke in the territory of the anterior inferior cerebellar artery (AICA). However, cases in which SSNHL and vertigo occur with hypoperfusion alone are very rare. We describe a patient who developed unilateral SSNHL and vertigo as initial symptoms caused by cerebellar hypoperfusion by vertebral artery (VA) dissection without the occurrence of infarction. CASE PRESENTATION A 51-year-old man suddenly developed acute hearing loss (AHL) in his left ear and vertigo. On neurological examination, he had vibration-induced right-beating nystagmus and left-beating nystagmus after a head-shaking test. Additionally, he had apogeotropic nystagmus during head turns to either side. The head impulse test (HIT) was normal. PTA showed mild unilateral SSNHL in the left ear. Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) showed territorial perfusion deficits in the left posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) without infarction. Two months later, the patient had no vertigo but still had hearing impairment in his left ear. A follow-up PTA documented persistent unilateral SSNHL in the left ear. Additionally, perfusion computed tomography (CT) showed that perfusion deficits remained in the left cerebellum along the PICA and AICA territories. CONCLUSIONS Our case highlights a case of AHL and vertigo presented by isolated cerebellar hypoperfusion without infarction. It is necessary to consider the possibility of a central cause in patients with AHL and vertigo, and it is important to confirm this possibility through brain magnetic resonance imaging (MRI), including PWI, and magnetic resonance angiography (MRA).
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Affiliation(s)
- Young Seo Kim
- Department of Neurology, Institute of Wonkwang Medical Science, Wonkwnag University School of Medicine, Iksan, South Korea ,grid.413112.40000 0004 0647 2826Department of Neurology, Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, 895 Muwang-ro, Iksan, Jeollabuk-do 54538 South Korea
| | - Ali S. Saber Tehrani
- grid.21107.350000 0001 2171 9311Department of Neurology, Division of Neuro-Visual and Vestibular Disorders, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Hak Seung Lee
- Department of Neurology, Institute of Wonkwang Medical Science, Wonkwnag University School of Medicine, Iksan, South Korea ,grid.413112.40000 0004 0647 2826Department of Neurology, Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, 895 Muwang-ro, Iksan, Jeollabuk-do 54538 South Korea
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12
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Cui Y, Liang W, Li M, Zhao Z, Jiang X, Zhao B, Xu Z, Mang J. Better late than never: initial experience of intra-arterial pulsed-urokinase-injection as a salvage therapy for refractory sudden sensorineural hearing loss. Interv Neuroradiol 2022; 28:575-580. [PMID: 34726104 PMCID: PMC9511619 DOI: 10.1177/15910199211056819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Cochlear vascular micro-thrombosis has been hypothesized as one of the pathogenic mechanisms for sudden sensorineural hearing loss (SSNHL) refractory to regular management. This study aimed to evaluate the feasibility and safety of intra-arterial pulsed-injection urokinase (IAPU) as a salvage therapy for SSNHL after the failure of conventional therapy. METHODS We retrospectively reviewed our patient database to identify refractory SSNHL patients between November 2017 and July 2020. Study outcomes before and after the IAPU therapy were compared between IAPU and conventional therapy groups. RESULTS Sixty-seven moderate-profound SSNHL patients (29 in IAUP group, 38 in control group) were included in this study. Compared to the control group, patients in the IAPU group showed more significant improvement in pure tone average (PTA) (34.2 ± 23.5 vs. 10.7 ± 13.1, p < 0.001) and degree of hearing recovery (total: 20.7% vs. 5.3%, partial: 24.1% vs. 10.5%, mild: 27.6% vs. 13.2% and non: 27.6% vs. 71.1%) 2 weeks after admission. In the IAPU group, a significant improvement of PTA (86.6 ± 11.5 vs. 54.6 ± 20.1 dB, p < 0.005) was observed on the first day after IAPU treatment. CONCLUSION In carefully selected SSNHL cases with a highly suspected vascular origin, IAPU is a safe and effective therapy when conventional treatments have failed. Despite the encouraging findings of our work, large studies are needed to better investigate the strengths and limitations of this salvage therapy.
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Affiliation(s)
- Yang Cui
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Wenzhao Liang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Mengxue Li
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Zhongyu Zhao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xinzhao Jiang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Bingyang Zhao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Zhongxin Xu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jing Mang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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13
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Todic J, Guinand N, Lenoir V, Senn P, Becker M. Diagnostic value and prognostic significance of
MRI
findings in sudden sensorineural hearing loss. Laryngoscope Investig Otolaryngol 2022; 7:1575-1583. [PMID: 36258869 PMCID: PMC9575048 DOI: 10.1002/lio2.922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose Materials and Methods Results Conclusion Lay Summary Level of Evidence
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Affiliation(s)
- Jelena Todic
- Department of Clinical Neurosciences, Clinic of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals University of Geneva Geneva Switzerland
| | - Nils Guinand
- Department of Clinical Neurosciences, Clinic of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals University of Geneva Geneva Switzerland
| | - Vincent Lenoir
- Diagnostic Department, Division of Radiology, Geneva University Hospitals University of Geneva Geneva Switzerland
| | - Pascal Senn
- Department of Clinical Neurosciences, Clinic of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals University of Geneva Geneva Switzerland
| | - Minerva Becker
- Diagnostic Department, Division of Radiology, Geneva University Hospitals University of Geneva Geneva Switzerland
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14
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Zhong Z, Wang X, Xu K, Tao J. Clinical Efficacy of Retroauricular Injection of Methylprednisolone Sodium Succinate in the Treatment of Sudden Deafness with Type 2 Diabetes. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3097436. [PMID: 35912152 PMCID: PMC9337928 DOI: 10.1155/2022/3097436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/01/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022]
Abstract
Background The etiology of sudden deafness is still unclear. In recent years, people's life rhythm is getting faster and faster. Fatigue, environment, diet, psychology, and other factors have increased the morbidity rate of sudden deafness and improved the quality of life of patients. And work efficiency is greatly affected. Aims A study to investigate the clinical efficacy of postauricular injection of methylprednisolone sodium succinate in the treatment of sudden deafness with type 2 diabetes. Materials and Methods Sixty patients with sudden deafness who were treated in our hospital from January 2018 to October 2020 were selected as the subjects of this prospective study and divided into 30 cases each in the comparison group and the observation group according to the random number remainder grouping method. The comparison group was treated conventionally, and the observation group was treated with postauricular injection of methylprednisolone sodium succinate on the basis of the comparison group. Patients in the two groups were observed and compared on the 3rd, 6th, and 9th days after treatment with pure-tone hearing threshold checks and regular monitoring of blood glucose, blood rheology, and other indexes. Results On the 7th, 14th, and 30th days after treatment, the pure-tone audiometric thresholds of the two groups were gradually decreased, and the changes in the pure-tone audiometric thresholds in the observation group were greater than those in the control group. After lunch on the 6th day and after lunch on the 9th day, it was lower than that in the control group, and the difference was statistically significant (P < 0.05). 30 days after treatment, the blood viscosity, fibrin, and platelet aggregation rate of the observation group were significantly lower than those of the control group. After treatment, the clinical efficacy rate of the observation group was 96%, which was significantly higher than that of the control group, 80%, and the above differences were statistically significant (P < 0.05). Conclusion Treatment with postauricular injection of methylprednisolone sodium succinate has shown better therapeutic recovery in patients with sudden deafness, improved pure-tone hearing threshold, reduced risk of blood glucose elevation, and improved clinical outcomes for patients with sudden deafness, providing some reference for the treatment of patients with sudden deafness.
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Affiliation(s)
- Zhenbo Zhong
- Department of Otolaryngology, Lishui People's Hospital, Lishui, 323000 Zhejiang Province, China
| | - Xiaofei Wang
- Department of Otolaryngology, Lishui People's Hospital, Lishui, 323000 Zhejiang Province, China
| | - Kairui Xu
- Department of Otolaryngology, Lishui People's Hospital, Lishui, 323000 Zhejiang Province, China
| | - Jing Tao
- Department of Otolaryngology, Lishui People's Hospital, Lishui, 323000 Zhejiang Province, China
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15
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Abstract
PURPOSE OF REVIEW We present here neuro-otological tests using portable video-oculography (VOG) and strategies assisting physicians in the process of decision making beyond the classical 'HINTS' testing battery at the bedside. RECENT FINDINGS Patients with acute vestibular syndrome (AVS) experience dizziness, gait unsteadiness and nausea/vomiting. A variety of causes can lead to this condition, including strokes. These patients cannot be adequately identified with the conventional approach by stratifying based on risk factors and symptom type. In addition to bedside methods such as HINTS and HINTS plus, quantitative methods for recording eye movements using VOG can augment the ability to diagnose and localize the lesion. In particular, the ability to identify and quantify the head impulse test (VOR gain, saccade metrics), nystagmus characteristics (waveform, beating direction and intensity), skew deviation, audiometry and lateropulsion expands our diagnostic capabilities. In addition to telemedicine, algorithms and artificial intelligence can be used to support emergency physicians and nonexperts in the future. SUMMARY VOG, telemedicine and artificial intelligence may assist physicians in the diagnostic process of AVS patients.
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Affiliation(s)
- Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jorge Otero-Millan
- Optometry and Vision Science, University of California, Berkeley, Berkeley, California
- Department of Neurology
| | - Daniel R. Gold
- Departments of Neurology, Ophthalmology, Otolaryngology – Head & Neck Surgery, Neurosurgery, Emergency Medicine, and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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16
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Lee JY, Lee YW, Chang SO, Kim MB. Vestibular function analysis of sudden sensorineural hearing loss with dizziness. J Vestib Res 2021; 30:203-212. [PMID: 32623411 DOI: 10.3233/ves-200703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A considerable number of patients with sudden sensorineural hearing loss (SSNHL) have been reported to have dizziness. OBJECTIVE To analyze vestibular functions and identify the clinical characteristics of SSNHL with dizzinessMETHODS:71 patients with SSNHL who complained of dizziness were investigated retrospectively. The patients underwent vestibular function tests consisting of video-nystagmography, video head impulse test and vestibular evoked myogenic potentials. RESULTS Among 35 patients with spontaneous nystagmus (SN), 21 showed ipsilesional posterior canal gain deficit, 11 showed a gain deficit in the posterior canal only and 9 showed both horizontal and posterior canal gain deficit in video head impulse test. In only one subject with bilateral horizontal canal gain deficit with contralesional SN, AICA infarction was observed.Among 36 patients without SN, 10 were diagnosed as benign paroxysmal positional vertigo and 5 had ipsilesional canal paresis in caloric test. Other 21 patients showed no abnormal signs in vestibular function tests. CONCLUSIONS In VFT analysis of SSNHL with dizziness, diverse patterns were identified. In the absence of SN, no definite vestibular organ involvement was the most frequent. But in the case with SN, posterior canal deficit was most common and cerebellar ischemic stroke was rare.
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Affiliation(s)
- Jung-Yup Lee
- Department of Otolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Woo Lee
- Department of Otolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun O Chang
- Department of Otolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min-Beom Kim
- Department of Otolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Vaughn AS, Rech MA, Lovett S. Silence is deafening: Acute bilateral hearing loss as a rare presentation of acute stroke. Am J Emerg Med 2021; 51:429.e1-429.e2. [PMID: 34312038 DOI: 10.1016/j.ajem.2021.07.028] [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: 06/25/2021] [Accepted: 07/10/2021] [Indexed: 11/26/2022] Open
Abstract
Acute bilateral hearing loss is an uncommon presentation in the Emergency Department (ED), with a variety of potential causes. It is important to consider neurologic vascular etiologies as a cause for acute sensorineural hearing loss. We report a case of acute hemorrhagic stroke presenting as acute bilateral hearing loss. A 60-year-old male with a history of atrial fibrillation presented to the ED with the acute onset of bilateral hearing loss with otherwise intact neurologic testing. He was found to have an acute left temporal hemorrhagic stroke, and magnetic resonance imaging demonstrated multifocal ischemia including an acute right temporal ischemic stroke. In the ED setting, cerebrovascular pathology is an important consideration in the patient presenting with acute hearing loss in the absence of an alternative diagnosis. Missing such a diagnosis can lead to significant morbidity and mortality.
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Affiliation(s)
- Alex S Vaughn
- Stritch School of Medicine, Loyola University Chicago,2160 S 1st Ave, Maywood, IL 60153, United States of America
| | - Megan A Rech
- Department of Emergency Medicine, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, United States of America; Department of Pharmacy, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, United States of America
| | - Shannon Lovett
- Stritch School of Medicine, Loyola University Chicago,2160 S 1st Ave, Maywood, IL 60153, United States of America; Department of Emergency Medicine, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, United States of America.
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18
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Kinouchi T, Ishitani K, Uyama S, Miyamoto T, Fujimoto N, Ueta H. Basilar artery occlusion presenting as sudden bilateral deafness: a case report. J Med Case Rep 2021; 15:111. [PMID: 33653404 PMCID: PMC7927263 DOI: 10.1186/s13256-020-02574-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/03/2020] [Indexed: 12/28/2022] Open
Abstract
Background Most sudden-onset hearing loss is due to otolaryngologic- and very rarely to cerebrovascular disease. We report a woman with sudden bilateral sensorineural hearing loss. This case suggests that even in the absence of brainstem or cerebellar signs, magnetic resonance imaging (MRI) and MR angiography (MRA) should be performed since such studies may reveal signs of life-threatening vertebrobasilar artery occlusion. Case presentation A 73-year-old Japanese woman with a history of hypertension, hyperlipidemia, and atrial fibrillation who suffered bilateral deafness with vertigo and vomiting was transferred from a local hospital to our department. On admission her consciousness was clear and vertigo was absent. Neurological examination revealed only bilateral sensorineural hearing loss. Head computed tomography (CT) returned no significant findings. The next morning she gradually developed severe drowsiness. Diffusion-weighted MRI demonstrated acute cerebral infarction in the brainstem and bilateral cerebellum; MRA showed basilar artery occlusion due to a cardioembolic thrombus. Revascularization was obtained by endovascular treatment. However, her condition worsened progressively during the following hours. CT revealed new brainstem lesions, massive cerebellar swelling, and obstructive hydrocephalus. She died on the second day after her admission. Conclusions When hearing loss is due to vertebrobasilar occlusive disease, the prognosis is very poor. We suggest that vertebrobasilar stroke be suspected in patients with bilateral sensorineural hearing loss who present with risk factors for stroke such as atrial fibrillation and other neurologic signs.
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Affiliation(s)
- Tomoya Kinouchi
- Department of Neurosurgery, Tokushima Municipal Hospital, 2-34, Kitajyosanjima-cho, Tokushima, 770-0812, Japan.
| | - Keisuke Ishitani
- Department of Otolaryngology, Takamatsu Red Cross Hospital, Kagawa, Japan
| | - Shinichi Uyama
- Department of Neurosurgery, Tokushima Municipal Hospital, 2-34, Kitajyosanjima-cho, Tokushima, 770-0812, Japan
| | - Tadashi Miyamoto
- Department of Neurosurgery, Tokushima Municipal Hospital, 2-34, Kitajyosanjima-cho, Tokushima, 770-0812, Japan
| | - Naomi Fujimoto
- Department of Neurosurgery, Tokushima Kensei Hospital, Tokushima, Japan
| | - Hiromi Ueta
- Department of Neurosurgery, Tokushima Municipal Hospital, 2-34, Kitajyosanjima-cho, Tokushima, 770-0812, Japan
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19
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Bilateral sequential sudden sensorineural hearing loss in protein S deficiency. J Neurol 2021; 268:1110-1113. [PMID: 33417006 DOI: 10.1007/s00415-020-10384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
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20
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Ryabtsev B, Slane M. A Case of Bilateral Hearing Loss. Clin Pract Cases Emerg Med 2020; 4:626-627. [PMID: 33217290 PMCID: PMC7676773 DOI: 10.5811/cpcem.2020.9.48949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/09/2020] [Indexed: 11/11/2022] Open
Abstract
Case Presentation A 53-year-old male presented to the emergency department with acute onset of bilateral hearing loss as well as vertigo and severe vomiting. The Head Impulse– Nystagmus–Test of Skew exam was indicative of a central neurologic process. Computed tomography angiogram of the head and neck revealed near-total bilateral vertebral artery occlusions in the second and third segments. The patient was admitted for further evaluation; subsequent magnetic resonance imaging revealed multiple areas of infarction in the cerebellar hemispheres, medulla, and occipital lobes. Discussion This case describes a unique presentation of a posterior stroke. Common symptoms include vertigo, loss of balance, and vomiting. However, bilateral hearing loss as a prominent symptom is uncommon. Imaging revealed a rare finding of bilateral vertebral artery occlusion.
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Affiliation(s)
- Boris Ryabtsev
- Kendall Regional Medical Center, Department of Emergency Medicine, Miami, Florida
| | - Matthew Slane
- Kendall Regional Medical Center, Department of Emergency Medicine, Miami, Florida
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21
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[Diagnostic criteria for Menière's disease according to the Classification Committee of the Bárány Society]. HNO 2019; 65:887-893. [PMID: 28770282 DOI: 10.1007/s00106-017-0387-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper presents diagnostic criteria for Menière's disease jointly formulated by the Classification Committee of the Bárány Society, The Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society. The classification includes two categories: definite Menière's disease and probable Menière's disease. The diagnosis of definite Menière's disease is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing, tinnitus and/or fullness) in the affected ear. Duration of vertigo episodes is limited to a period between 20 min and 12 h. Probable Menière's disease is a broader concept defined by episodic vestibular symptoms (vertigo or dizziness) associated with fluctuating aural symptoms occurring in a period from 20 min to 24 h.
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Byun S, Lee JY, Kim BG, Hong HS. Acute vertigo and sensorineural hearing loss from infarction of the vestibulocochlear nerve: A case report. Medicine (Baltimore) 2018; 97:e12777. [PMID: 30313095 PMCID: PMC6203587 DOI: 10.1097/md.0000000000012777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/17/2018] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Acute unilateral audiovestibulopathy is a common neurotological syndrome. Differential diagnoses of acute unilateral audiovestibulopathy include viral infection, vascular insults, and tumors. Regarding vascular causes, ischemic stroke in the anterior inferior cerebellar artery (AICA) territory is known to be the leading cause of acute audiovestibular loss. Previous reports of AICA infarction with audiovestibulopathy failed to demonstrate magnetic resonance imaging (MRI)-positive vestibulocochlear infarctions. Only 1 report demonstrated acute infarction involving the vestibulocochlear nerve on diffusion weighted imaging (DWI)-MRI. PATIENT CONCERNS A 67 year old man complained of sudden left hearing loss and vertigo. The patient showed left horizontal gaze-evoked nystagmus (GEN) and the head impulse test (HIT) was positive on the left side. Videonystagmography revealed spontaneous rebound nystagmus toward the right side; head-shaking nystagmus toward the right side. The patient presented with left caloric paresis (20.1%). Pure tone audiometry (PTA) revealed severe sensorineural hearing loss on the left side. DIAGNOSIS MRI of temporal bone showed multifocal acute infarctions in the left inferior cerebellum. Moreover, images revealed tiny infarctions along the left vestibulocochlear nerve and the cochlea, implying acute vestibulocochlear nerve and labyrinthine infarction. There was no evidence of steno-occlusion of major cerebral vessels on MR angiography. INTERVENTIONS Immediate stroke management was done. OUTCOMES Neurological symptoms gradually improved after 3 to 5 days. LESSONS We present a case illustrating a rare but significant finding of vestibulocochlear nerve infarction revealed by DWI-MRI. Prompt imaging protocol enabled the detection of significant findings in this patient with acute unilateral audiovestibulopathy. Clinicians should be aware of the vestibulocochlear nerve and labyrinth on MRI in patients with cerebellar stroke.
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Affiliation(s)
| | | | - Bo Gyung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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23
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Kim HA, Yi HA, Lee H. Recent Advances in Cerebellar Ischemic Stroke Syndromes Causing Vertigo and Hearing Loss. THE CEREBELLUM 2017; 15:781-788. [PMID: 26573627 DOI: 10.1007/s12311-015-0745-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cerebellar ischemic stroke is one of the common causes of vascular vertigo. It usually accompanies other neurological symptoms or signs, but a small infarct in the cerebellum can present with vertigo without other localizing symptoms. Approximately 11 % of the patients with isolated cerebellar infarction simulated acute peripheral vestibulopathy, and most patients had an infarct in the territory of the medial branch of the posterior inferior cerebellar artery (PICA). A head impulse test can differentiate acute isolated vertigo associated with PICA territory cerebellar infarction from more benign disorders involving the inner ear. Acute hearing loss (AHL) of a vascular cause is mostly associated with cerebellar infarction in the territory of the anterior inferior cerebellar artery (AICA), but PICA territory cerebellar infarction rarely causes AHL. To date, at least eight subgroups of AICA territory infarction have been identified according to the pattern of neurotological presentations, among which the most common pattern of audiovestibular dysfunction is the combined loss of auditory and vestibular functions. Sometimes acute isolated audiovestibular loss can be the initial symptom of impending posterior circulation ischemic stroke (particularly within the territory of the AICA). Audiovestibular loss from cerebellar infarction has a good long-term outcome than previously thought. Approximately half of patients with superior cerebellar artery territory (SCA) cerebellar infarction experienced true vertigo, suggesting that the vertigo and nystagmus in the SCA territory cerebellar infarctions are more common than previously thought. In this article, recent findings on clinical features of vertigo and hearing loss from cerebellar ischemic stroke syndrome are summarized.
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Affiliation(s)
- Hyun-Ah Kim
- Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea.,Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Hyon-Ah Yi
- Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea.,Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Hyung Lee
- Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea. .,Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea.
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Fasano T, Pertinhez TA, Tribi L, Lasagni D, Pilia A, Vecchia L, Baricchi R, Bianchin G. Laboratory assessment of sudden sensorineural hearing loss: A case-control study. Laryngoscope 2017; 127:2375-2381. [DOI: 10.1002/lary.26514] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/17/2016] [Accepted: 12/02/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Tommaso Fasano
- Clinical Chemistry and Endocrinology Laboratory; Arcispedale Santa Maria Nuova-Scientific Institute for Research, Hospitalization and Health Care; Reggio Emilia Italy
| | - Thelma A. Pertinhez
- Transfusion Medicine Unit; Arcispedale Santa Maria Nuova- Scientific Institute for Research, Hospitalization and Health Care; Reggio Emilia Italy
- Department of Biomedical, Biotechnological, and Translational Sciences; University of Parma; Parma Italy
| | - Lorenzo Tribi
- Department of Otolaryngology and Audiology; Arcispedale Santa Maria Nuova-Scientific Institute for Research, Hospitalization and Health Care; Reggio Emilia Italy
| | - Daniela Lasagni
- Transfusion Medicine Unit; Arcispedale Santa Maria Nuova- Scientific Institute for Research, Hospitalization and Health Care; Reggio Emilia Italy
| | - Annalisa Pilia
- Clinical Chemistry and Endocrinology Laboratory; Arcispedale Santa Maria Nuova-Scientific Institute for Research, Hospitalization and Health Care; Reggio Emilia Italy
| | - Luigi Vecchia
- Clinical Chemistry and Endocrinology Laboratory; Arcispedale Santa Maria Nuova-Scientific Institute for Research, Hospitalization and Health Care; Reggio Emilia Italy
| | - Roberto Baricchi
- Transfusion Medicine Unit; Arcispedale Santa Maria Nuova- Scientific Institute for Research, Hospitalization and Health Care; Reggio Emilia Italy
| | - Giovanni Bianchin
- Department of Otolaryngology and Audiology; Arcispedale Santa Maria Nuova-Scientific Institute for Research, Hospitalization and Health Care; Reggio Emilia Italy
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Wegmann-Vicuña R, Muñoz-Hernández DE, Gallegos-Constantino V, Domínguez-Echavarri P, Irimia-Sieira P, Pérez-Fernández N. Acute vestibular syndrome with down-beat nystagmus as a sole clinical presentation in AICA transient ischemic attack with an uncommon clinical course. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1367255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Diana E. Muñoz-Hernández
- Department of Otorhinolaryngology, Instituto Nacional de Rehabilitación, Distrito Federal, Mexico
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Vertigo with sudden hearing loss: audio-vestibular characteristics. J Neurol 2016; 263:2086-96. [DOI: 10.1007/s00415-016-8214-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
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Bovo R, Ortore R, Ciorba A, Berto A, Martini A. Bilateral Sudden Profound Hearing Loss and Vertigo as a Unique Manifestation of Bilateral Symmetric Inferior Pontine Infarctions. Ann Otol Rhinol Laryngol 2016; 116:407-10. [PMID: 17672241 DOI: 10.1177/000348940711600603] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We present a case of sudden bilateral profound deafness and vertigo, without any accompanying neurologic signs, secondary to bilateral infarctions of the cochlear and vestibular nuclei. Methods: Vertigo, vomiting, tinnitus, and bilateral profound deafness suddenly developed in a 65-year-old woman without any accompanying neurologic signs. In particular, she did not present dysarthria, numbness, cranial nerve palsies, or visual or cerebellar signs. Results: Magnetic resonance imaging of the brain revealed 2 fresh infarctions of 8 to 10 mm symmetrically localized in the posterolateral bulbopontine junction. Angiography revealed a complete occlusion of the basilar artery, with a well-represented backward flow of its distal portion from the carotid artery via posterior communicating arteries. Excluding a transient ischemic attack that occurred 16 days after the acute episode, the patient had had no other neurologic events at 8 months of follow-up. Conclusions: Acute vertigo and sudden deafness in a patient with known cerebrovascular occlusive disease may represent the warning signs of an impending brain stem or cerebellar infarction, even when other neurologic signs are absent. These events are fortunately very rare, but should be considered by clinicians who see patients with vertigo.
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Affiliation(s)
- Roberto Bovo
- Department of Audiology, Ferrara University, Ferrara, Italy
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1519] [Impact Index Per Article: 189.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A. Criterios diagnósticos de enfermedad de Menière. Documento de consenso de la Bárány Society, la Japan Society for Equilibrium Research, la European Academy of Otology and Neurotology (EAONO), la American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) y la Korean Balance Society. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:1-7. [DOI: 10.1016/j.otorri.2015.05.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 05/24/2015] [Indexed: 11/25/2022]
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Acute unilateral sensorineural hearing loss associated with anabolic steroids and polycythaemia: case report. The Journal of Laryngology & Otology 2015; 130:309-13. [DOI: 10.1017/s0022215115003187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractBackground:Unilateral sudden sensorineural hearing loss due to an infarct in the vertebrobasilar system has been widely reported. Most patients have a background of traditional coronary risk factors related to these cerebrovascular episodes.Case report:A 32-year-old male, a regular user of anabolic steroids, presented to the emergency department with unilateral sensorineural hearing loss and symptoms suggestive of an infarct of the anterior inferior cerebellar artery but in the absence of risk factors for ischaemic stroke.Results:Magnetic resonance imaging confirmed the presence of infarction in the region supplied by the anterior inferior cerebellar artery. Polycythaemia was found on haematological analysis, which we believe was secondary to the use of anabolic steroids. The patient was commenced on aspirin as per the stroke management protocol. There was resolution of neurological symptomatology six weeks after the episode, but no improvement in hearing.Conclusion:To our knowledge, this is the first case report of unilateral sensorineural hearing loss secondary to the use of anabolic steroids causing polycythaemia. This cause should be considered in the differential diagnosis of patients presenting with sensorineural hearing loss, especially in young males, when no other risk factors can be identified.
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Chiu CC, Lee KJ, Weng SF, Yang YM, Lin YS. Gallstone is correlated with an increased risk of idiopathic sudden sensorineural hearing loss: a retrospective cohort study. BMJ Open 2015; 5:e009018. [PMID: 26419682 PMCID: PMC4593166 DOI: 10.1136/bmjopen-2015-009018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES This study aims to test the hypothesis that gallstone disease (GSD) is a risk factor for the development of idiopathic sudden sensorineural hearing loss (ISSNHL). Research has shown risks of cardiovascular and cerebrovascular events in patients with GSD; however, well-conducted English studies on the association between GSD and the development of ISSNHL are lacking. DESIGN AND SETTING Retrospective cohort study using the Taiwan Longitudinal Health Insurance Database. PARTICIPANTS We compared 26,449 patients diagnosed with GSD between 1 January 2001 and 31 December 2007, with 52,898 age-matched, gender-matched and comorbidities propensity scores-matched controls. OUTCOME MEASURED We followed each patient until the end of 2011 and evaluated the incidence of ISSNHL for at least 4 years after the initial GSD diagnosis. RESULTS The incidence of ISSNHL was 1.42 times higher in the GS cohort than in the non-GS cohort (9.27 vs 6.52/10,000 person-years). Using Cox proportional hazard regressions, the adjusted HR was 1.44 (95% CI 1.19 to 1.74). In the cohort of patients with GSD who needed a cholecystectomy, 37 patients suffered from ISSNHL. Among those patients, 31 (83.7%) patients sustained ISSNHL before cholecystectomy and 6 (16.2%) patients sustained ISSNHL after cholecystectomy. CONCLUSIONS A diagnosis of GSD may be an independent risk for ISSNHL. This finding suggests that an underlying vascular and inflammatory mechanism may contribute to the development of ISSNHL. Physicians may want to counsel patients with GSD to seek medical attention if they have hearing impairments, because patients may be at an increased risk of developing ISSNHL.
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Affiliation(s)
- Chong-Chi Chiu
- Department of General Surgery, Chi Mei Medical Center, Tainan and Liouying, Taiwan
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Kuan-Ji Lee
- Department of Otolaryngology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Yuan-Ming Yang
- Department of Otolaryngology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yung-Song Lin
- Department of Otolaryngology, Chi Mei Medical Center, Tainan City, Taiwan
- Center of General education, Southern Taiwan University of Technology, Tainan City, Taiwan
- Department of Otolaryngology, School of Medicine, Taipei Medical University, Taipei, Taiwan
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Kim C, Sohn JH, Jang MU, Hong SK, Lee JS, Kim HJ, Choi HC, Lee JH. Ischemia as a potential etiologic factor in idiopathic unilateral sudden sensorineural hearing loss: Analysis of posterior circulation arteries. Hear Res 2015; 331:144-51. [PMID: 26368028 DOI: 10.1016/j.heares.2015.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 08/04/2015] [Accepted: 09/02/2015] [Indexed: 02/08/2023]
Abstract
The association between idiopathic sudden sensorineural hearing loss (ISSNHL) and the radiologic characteristics of the vertebrobasilar artery is unclear. We hypothesized that the degree and direction of vertebrobasilar artery curvature in the posterior circulation contribute to the occurrence of ISSNHL. We consecutively enrolled patients diagnosed with unilateral ISSNHL in two tertiary hospitals. Magnetic resonance images were performed in all patients to exclude specific causes of ISSNHL, such as vestibular schwannoma, chronic mastoiditis, and anterior inferior cerebellar artery infarct. We measured the following parameters of posterior circulation: vertebral and basilar artery diameter, the degree of basilar artery curvature (modified smoker criteria), and vertebral artery dominance. Pure tone audiometries were performed at admission and again 1 week and 3 months later. A total of 121 ISSNHL patients (mean age, 46.0 ± 17.3 years; 48.8% male) were included in these analyses. The proportion of patients with the left side hearing loss was larger than the proportion with the right side hearing loss (left, 57.9%; right, 42.1%). The majority of patients were characterized by a left dominant vertebral artery and right-sided basilar artery curvature. The direction of the basilar artery curvature was significantly associated with hearing loss lateralization (p = 0.036). Age and sex matched multivariable analyses revealed the absence of diabetes and right-sided basilar artery curvature as significant predictors for left sided hearing loss. There was no statistical difference between atherosclerotic cardiovascular risk score (high versus low) and hearing outcomes at 3 months. In ISSNHL, the laterality of hearing loss was inversely associated with the direction of basilar artery curvature. Our results, therefore, indicate the importance of vascular assessment when evaluating ISSNHL.
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Affiliation(s)
- Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Min Uk Jang
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Sung-Kwang Hong
- Department of Otorhinolaryngology and Head and Neck Surgery, Hallym University Medical Center, Chuncheon, South Korea
| | - Joong-Seob Lee
- Department of Otorhinolaryngology and Head and Neck Surgery, Hallym University Medical Center, Chuncheon, South Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology and Head and Neck Surgery, Hallym University Medical Center, Chuncheon, South Korea
| | - Hui-Chul Choi
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology and Head and Neck Surgery, Hallym University Medical Center, Chuncheon, South Korea.
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Kim JH, Roh KJ, Suh SH, Lee KY. Improvement of sudden bilateral hearing loss after vertebral artery stenting. J Neurointerv Surg 2015; 8:e12. [PMID: 25712982 DOI: 10.1136/neurintsurg-2014-011595.rep] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/28/2015] [Indexed: 12/18/2022]
Abstract
Bilateral deafness is a rare but possible symptom of vertebrobasilar ischemia. We report a case of sudden bilateral sensorineural hearing loss caused by bilateral vertebral artery (VA) occlusion which dramatically improved after stenting. A 54-year-old man was admitted with sudden onset of bilateral deafness, vertigo, and drowsy mental status. Brain diffusion-weighted MRI showed acute infarction involving both the posterior inferior cerebellar artery and left posterior cerebral artery territory. Cerebral angiography showed bilateral distal VA occlusion, and emergency intracranial stenting was performed in the left VA. After reperfusion therapy his symptoms gradually improved, including hearing impairment. Endovascular stenting may be helpful in a patient with sudden deafness caused by bilateral VA occlusion.
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Affiliation(s)
- Ji Hwa Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Jin Roh
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Sooul, Republic of Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Severance Institute for Vascular and Metabolic Research, Yonsei University, Seoul, Republic of Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Severance Institute for Vascular and Metabolic Research, Yonsei University, Seoul, Republic of Korea
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Kim JH, Roh KJ, Suh SH, Lee KY. Improvement of sudden bilateral hearing loss after vertebral artery stenting. BMJ Case Rep 2015; 2015:bcr-2014-011595. [PMID: 25697296 DOI: 10.1136/bcr-2014-011595] [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: 11/03/2022] Open
Abstract
Bilateral deafness is a rare but possible symptom of vertebrobasilar ischemia. We report a case of sudden bilateral sensorineural hearing loss caused by bilateral vertebral artery (VA) occlusion which dramatically improved after stenting. A 54-year-old man was admitted with sudden onset of bilateral deafness, vertigo, and drowsy mental status. Brain diffusion-weighted MRI showed acute infarction involving both the posterior inferior cerebellar artery and left posterior cerebral artery territory. Cerebral angiography showed bilateral distal VA occlusion, and emergency intracranial stenting was performed in the left VA. After reperfusion therapy his symptoms gradually improved, including hearing impairment. Endovascular stenting may be helpful in a patient with sudden deafness caused by bilateral VA occlusion.
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Affiliation(s)
- Ji Hwa Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Jin Roh
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Sooul, Republic of Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Severance Institute for Vascular and Metabolic Research, Yonsei University, Seoul, Republic of Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Severance Institute for Vascular and Metabolic Research, Yonsei University, Seoul, Republic of Korea
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Gomza YY, Mösges R. The Treatment of Peripheral Vestibular Dysfunction Using Caloric Vestibular Stimulation in Patients with Cerebral Hypertensive Crisis. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ijohns.2015.43039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sudden deafness as an initial presenting symptom of posterior inferior cerebellar artery infarction: two case reports. The Journal of Laryngology & Otology 2014; 128:1011-4. [DOI: 10.1017/s0022215114002229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:This paper reports on two patients with posterior inferior cerebellar artery infarction whose only presenting complaint was acute unilateral hearing loss.Case reports:In the two cases reported, sudden hearing loss was an initial symptom, with no other neurological signs. Infarction in the territory of the posterior inferior cerebellar artery was diagnosed using brain magnetic resolution imaging. The patients had some degree of hearing improvement 3 or 4 days after initial treatment.Conclusion:In this article, new cases of posterior inferior cerebellar artery infarction presenting as sudden deafness, without prominent neurological signs, are described. Otologists should be aware that hearing loss can sometimes appear as a warning sign of impending posterior inferior cerebellar artery infarction.
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Abstract
Strokes in the distribution of the posterior circulation may present with vertigo, imbalance, and nystagmus. Although the vertigo due to a posterior circulation stroke is usually associated with other neurologic symptoms or signs, small infarcts involving the cerebellum or brainstem can develop vertigo without other localizing symptoms. Approximately 11% of the patients with an isolated cerebellar infarction present with isolated vertigo, nystagmus, and postural unsteadiness mimicking acute peripheral vestibular disorders. The head impulse test can differentiate acute isolated vertigo associated with cerebellar strokes (particularly within the territory of the posterior inferior cerebellar artery) from more benign disorders involving the inner ear. Acute audiovestibular loss may herald impending infarction in the territory of anterior inferior cerebellar artery. Appropriate bedside evaluation is superior to MRIs for detecting central vascular vertigo syndromes. This article reviews the keys to diagnosis of acute isolated vertigo syndrome due to posterior circulation strokes involving the brainstem and cerebellum.
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Affiliation(s)
- Hyung Lee
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
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Muttikkal TJE, Kesser BW, Mukherjee S. Isolated contralateral sudden sensorineural hearing loss: an unusual manifestation of pontine infarct. Neuroradiol J 2014; 27:483-6. [PMID: 25196624 DOI: 10.15274/nrj-2014-10076] [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: 11/21/2013] [Accepted: 07/05/2014] [Indexed: 11/12/2022] Open
Abstract
Unilateral, acute onset sensorineural hearing loss ("sudden sensorineural hearing loss" [SSNHL]) as an isolated event without other associated neurological deficits usually results from a lesion of the cochlea. Lesions in the ascending central auditory pathways cranial to the cochlear nucleus seldom result in unilateral hearing loss due to decussation of the central auditory pathways at multiple levels. We describe a patient with a tiny acute infarct in the right pons resulting in isolated acute onset left-sided SSHNL, without any other associated acute neurological deficits.
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Weng YC, Young YH. Mapping affected territory of anterior/posterior inferior cerebellar artery infarction using a vestibular test battery. Acta Otolaryngol 2014; 134:268-74. [PMID: 24460135 DOI: 10.3109/00016489.2013.851797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Although the affected territory in the posterior/anterior inferior cerebellar artery (PICA/AICA) infarction could not be meticulously demonstrated by magnetic resonance imaging (MRI), it could be picked up by the results of a vestibular test battery comprising caloric, ocular vestibular evoked myogenic potential (oVEMP), and cervical VEMP (cVEMP) tests. OBJECTIVES This study applied audiometry and caloric, oVEMP, and cVEMP tests to map affected territory in patients with PICA/AICA infarction. METHODS Fourteen patients, including 11 with PICA infarction and 3 with AICA infarction, were enrolled in this study during the last 8 years. Each patient underwent audiometry, caloric test, oVEMP test, and cVEMP test. RESULTS In the PICA group, 8 (36%) of 22 ears had a mean hearing level >25 dB. All six ears (100%) in the AICA group had abnormal hearing, and thus both groups revealed a significant difference. Conversely, significant differences were not observed in the vestibular test battery between the PICA and AICA groups. MRI demonstrated infarction at the brainstem for six patients, while one patient also had cerebellar involvement, indicated by loss of visual suppression on caloric nystagmus. Six patients showed infarction at the cerebellum, and four of them had brainstem affliction based on abnormal oVEMP/cVEMP test results.
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Affiliation(s)
- Yu-Cheng Weng
- Department of Otolaryngology, En Chu Kong Hospital , New Taipei City
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40
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Recent advances in acute hearing loss due to posterior circulation ischemic stroke. J Neurol Sci 2014; 338:23-9. [DOI: 10.1016/j.jns.2013.12.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 12/28/2013] [Accepted: 12/31/2013] [Indexed: 02/06/2023]
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Kim HA, Lee BC, Hong JH, Yeo CK, Yi HA, Lee H. Long-term prognosis for hearing recovery in stroke patients presenting vertigo and acute hearing loss. J Neurol Sci 2014; 339:176-82. [PMID: 24581671 DOI: 10.1016/j.jns.2014.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/15/2014] [Accepted: 02/12/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Vertebrobasilar ischemic stroke (VBIS) can cause acute hearing loss (AHL) because the vertebrobasilar system supplies most of the auditory system including the inner ear. The aim of this study was to assess the long-term prognosis of AHL associated with VBIS. METHODS Over 12.5 years, 62 patients with AHL of a vascular cause who were followed for at least 1 year (mean, 49.2 months; SD, 24.4 months) were enrolled in this study. Quantitative audiovestibular function testing was performed during the acute (mostly within 10 days after symptom onset) and last follow-up periods in all patients. RESULTS On the last follow-up, approximately 65% (39/62) of the patients showed a partial (n=24) or complete (n=15) hearing recovery. All but 2 (97%) patients had acute vertigo and 56 (56/62, 90%) had a unilateral canal paresis to caloric stimulation on the side of the AHL. The most commonly infarcted territory on brain MRI was in the distribution of the anterior inferior cerebellar artery (55/62, 89%). Multivariable analysis showed that multiple risk factors for stroke [odds ratio (OR) 10.46, 95% confidence interval (CI) 1.72 to 13.7, p=0.011] and profound hearing loss [OR 3.92, 95% CI 1.03 to 14.97, p<0.046] predicted a poor outcome for recovery of hearing loss. CONCLUSIONS Acute hearing loss associated with posterior circulation ischemic stroke exhibits a relatively good long-term outcome. Two or more risk factors for stroke and profound hearing loss are adverse prognostic factors for recovery of hearing loss of a vascular cause.
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Affiliation(s)
- Hyun-Ah Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea; Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Byung-Chan Lee
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea; Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Chang-Ki Yeo
- Department of Otorhinolaryngology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyon-Ah Yi
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea; Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea; Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea.
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Kim E, Son MK, Kang CK, Lee YB. Vertebrobasilar occlusion presenting as sudden isolated bilateral sensorineural hearing loss: case report. J Cerebrovasc Endovasc Neurosurg 2013; 15:225-8. [PMID: 24167804 PMCID: PMC3804662 DOI: 10.7461/jcen.2013.15.3.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 04/09/2013] [Accepted: 06/27/2013] [Indexed: 11/26/2022] Open
Abstract
Isolated bilateral deafness is a rare but possible symptom of vertebrobasilar ischemia, primarily due to occlusion of the anterior inferior cerebellar arteries or their branch, the internal auditory artery. We reported on uncommon case of sudden bilateral sensorineural hearing loss without typical neurological symptoms resulting from vertebrobasilar ischemia. We performed the available examinations, including otoscopy, laboratory tests, and pure tone audiogram, however we were not able to identify the cause of bilateral sensorineural hearing loss. Brain magnetic resonance image showed the cerebellar infarction of the posterior inferior cerebellar artery territory. Brain magnetic resonance angiography showed bilateral vertebral and basilar artery occlusion. We suggest vertebrobasilar ischemia as a cause of sudden isolated deafness.
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Affiliation(s)
- Eunja Kim
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
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Bilateral sequential audiovestibular loss as an initial manifestation of chronic myelogenous leukemia. Neurol Sci 2013; 35:463-7. [PMID: 24068484 DOI: 10.1007/s10072-013-1556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
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Shibata K, Matsui K, Ito H, Ito E, Nishimura Y, Kondo H, Sunose H, Otuka K. Bilateral intracranial vertebral artery dissection presenting as sudden bilateral hearing loss. Clin Neurol Neurosurg 2012; 114:1266-9. [DOI: 10.1016/j.clineuro.2012.02.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 01/11/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
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Kim HA, Lee H. Recent advances in central acute vestibular syndrome of a vascular cause. J Neurol Sci 2012; 321:17-22. [DOI: 10.1016/j.jns.2012.07.055] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 11/29/2022]
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46
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Isolated sudden hearing loss as a warning sign of vertebrobasilar insufficiency. Otol Neurotol 2012; 33:e55-6. [PMID: 22892808 DOI: 10.1097/mao.0b013e3182544fc5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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An Isolated Vestibulocochlear Symptom Preceding Brainstem Infarction Due to Basilar Artery Occlusion. Otol Neurotol 2012; 33:730-2. [DOI: 10.1097/mao.0b013e3182565b62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim C, Sohn JH, Choi HC. Vertebrobasilar angulation and its association with sudden sensorineural hearing loss. Med Hypotheses 2012; 79:202-3. [PMID: 22688399 DOI: 10.1016/j.mehy.2012.04.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/19/2012] [Accepted: 04/22/2012] [Indexed: 12/18/2022]
Abstract
The pathogenesis of sudden sensorineural hearing loss (SSNHL) is unclear, though some researchers postulate the major mechanism of onset to be via circulatory disturbance or cochlear inflammation. SSNHL can represent the sole manifestation of anterior inferior cerebellar artery infarction, and patients with a SSNHL may have higher than normal risk of future stoke. According to a vascular remodeling theory, vertebral arteries (VAs) are typically asymmetric with the basilar artery (BA) gradually curving in the opposite direction of the larger VA. Decreased wall shear stress on the inner surface of the curvature (weaker side of the vertebral artery) gives rise to an atherothrombogenic environment. It is hypothesized that angulation of the BA could contribute to the decline of anterior inferior cerebellar artery (AICA) flow or to the development of atheroma formation in the AICA orifice. Vertebrobasilar junction angulation could represent a simple and useful marker of SSNHL caused by a vascular compromise of the cochlea.
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Affiliation(s)
- Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Republic of Korea
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Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, Brown SR, Fife TD, Ford P, Ganiats TG, Hollingsworth DB, Lewandowski CA, Montano JJ, Saunders JE, Tucci DL, Valente M, Warren BE, Yaremchuk KL, Robertson PJ. Clinical Practice Guideline. Otolaryngol Head Neck Surg 2012; 146:S1-35. [DOI: 10.1177/0194599812436449] [Citation(s) in RCA: 659] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective. Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL. Purpose. The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. Results. The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.
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Affiliation(s)
- Robert J. Stachler
- Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Sanford M. Archer
- Division of Otolaryngology–Head & Neck Surgery, University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, New York, USA
| | - Seth R. Schwartz
- Department of Otolaryngology, Virginia Mason Hospital and Medical Center, Seattle, Washington, USA
| | - David M. Barrs
- Department of Otolaryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Steven R. Brown
- Department of Family and Community Medicine, University of Arizona School of Medicine, Phoenix, Arizona, USA
| | - Terry D. Fife
- Department of Neurology, University of Arizona, Phoenix, Arizona, USA
| | | | - Theodore G. Ganiats
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California, USA
| | | | | | | | | | - Debara L. Tucci
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Valente
- Department of Otolaryngology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Barbara E. Warren
- Center for LGBT Social Science & Public Policy, Hunter College, City University of New York, New York, New York, USA
| | | | - Peter J. Robertson
- American Academy of Otolaryngology–Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Lee H. Audiovestibular loss in anterior inferior cerebellar artery territory infarction: a window to early detection? J Neurol Sci 2012; 313:153-9. [PMID: 21996273 DOI: 10.1016/j.jns.2011.08.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/27/2011] [Accepted: 08/29/2011] [Indexed: 01/29/2023]
Abstract
Acute audiovestibular loss is a common neurotological condition that is characterized by sudden onset of severe prolonged (lasting days) vertigo and hearing loss and is diagnosed by the presence of canal paresis to caloric stimulation and sensorineural hearing loss on pure tone audiogram. Before 2000, papers on anterior inferior cerebellar artery (AICA) territory infarction focused mostly on associated brainstem and cerebellar findings, without a detailed description of neurotological findings. Since 2000, several reports have demonstrated that acute audiovestibular loss is an important sign for the diagnosis of AICA territory infarction. To date, at least eight subgroups of AICA infarction have been identified according to the pattern of neurotological presentations, among which the most common pattern of audiovestibular dysfunction is the combined loss of auditory and vestibular functions. Because audiovestibular loss may occur in isolation before ponto-cerebellar infarction involving AICA distribution, audiovestibular loss may serve as a window to prevent the progression of acute audiovestibular loss into more widespread areas of infarction in posterior circulation (mainly in the AICA territory). Clinician should keep in mind that acute audiovestibular loss may herald impending AICA territory infarction, especially when patients had basilar artery occlusive disease presumably close to the origin of the AICA on brain MRA, even if other central signs are absent and MRI does not demonstrate acute infarction.
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Affiliation(s)
- Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea.
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